Sep 7, 2017

Study: Unnecessary ER visits aren't that common

David Goldman / AP

A new study from researchers at the University of California at San Francisco has found that only a tiny fraction (3.3%) of emergency room visits are considered "avoidable" — meaning people went home and didn't need any procedures, tests or medications. The results were based on seven years of federal ER visit data.

Why it matters: Some states and health insurers are charging people higher out-of-pocket costs or refusing to pay claims if they determine after the fact that an ER visit was unnecessary. The goal is to save money and route people to lower-cost settings like urgent care centers. But the study suggests that most ER visits are valid, and that retrospectively penalizing patients could complicate the issue.

The details: ER doctors conducted this study and others. But they focused on objective insurance claims and federal data, giving credence to the methodology. Toothaches, back pain and headaches were the most common forms of preventable ER visits. But there's more to the study:

  • The definition of "avoidable" is what splits most parties. And determining a visit is avoidable after it happens may ignore symptoms that appear to be urgent at the time.
  • It's difficult for an average person to know what an emergency is. And if it's after hours, most things seem like an emergency.
  • Investing more in preventive measures like dental or mental health (or dealing with exorbitant provider prices) could alleviate many concerns.

Outside voice: "Sore throats and runny noses are not bogging down our system," said Laura Burke, an emergency room physician and researcher at Beth Israel Deaconess Medical Center in Boston, who was not involved in the latest study. She works at several emergency sites and believes few visits are truly preventable. But she said she also tries to understand why someone would come to the ER if the problem doesn't seem urgent.

"Usually it's a reason that makes sense," Burke said. "Maybe they work two jobs, and 2 a.m. was the only time they could come."

Go deeper