Do you know the top reasons why people visit the ER? Analyze your ED’s historical coding data, and you’ll find the path to higher profitability and efficiency.
How much can your Emergency Medicine practice learn from analyzing the most common reasons for emergency room visits?
Each time a patient visits your emergency department (ED), your team must select a primary reason for care from the ICD-10 emergency diagnosis codes list. This includes everything from reports of chest pain to headaches and constipation.
This data isn’t just a record of the interaction and service provided for reimbursement, it’s a wealth of information about the types of cases and patients you serve most often.
The bad news? Most emergency medicine administrators don’t know how to leverage this data for a higher level of efficiency.
So in this quick guide, we’ll highlight recent ED-use statistics, break down the most common reasons for emergency room visits, and explain why understanding this data matters so much as it relates to your group’s efficiency.
Trends in Emergency Room Visits Statistics and Patient Wait Times
Emergency department national benchmarks indicate that ER visits and patient wait times are both increasing exponentially.
Your ED statistics may differ due to the number of other nearby hospitals/freestanding EDs, your local payer mix, and other heavy factors. So let’s take a look at how the data is trending, on average, to assess the future of ED use and your plan to meet these demands.
Emergency Room Visits Statistics
- ED visits grew twice as quickly as the overall population (1.7% vs. 0.7%) between 2010 through 2014.
- Total ED use increased by 2.5 visits more in Medicaid expansion states than in non-expansion states after 2014.
- The number of ED visits increased from 128.97 million to 144.82 million between 2010 and 2016.
Rural and urban ED use trends highlight how administrators are struggling with above-average utilization rates and suffering lower profitability as safety-net hospitals.
Between June 2017 and November 2018[*]:
- Rural ED visit estimates increased by more than 50% from 16.7 million to 28.4 million. That’s a leap from 36.5 to 64.5 visits per 100 persons.
- Urban ED visits increased from 98.6 million to 117.2 million.
With all this extra foot traffic in the ED, it’s no wonder patient waiting times have also ballooned.
Emergency Room Wait Times Statistics
Overcrowding in high-traffic emergency departments leads to longer wait times and increases the chances of patients leaving without being seen.
EDs in Nebraska admit patients in under two hours, on average. Conversely, the average time (in hours) for patients to spend in the ED before being admitted is highest in these states[*]:
- Maryland: 6:22
- New York: 6:10
- New Jersey 5:49
- Delaware: 5:48
- California: 5:45
What about how long patients must wait in the ER before being sent home (if not admitted)? North Dakota EDs take the title here, sending patients home within 1.5 hours. But these states have the highest average discharge times (in hours)[*]:
- Maryland: 3:14
- Delaware: 3:06
- New York/Arizona: 2:49
- Massachusetts: 2:44
- New Jersey: 2:41
So how do emergency medicine administrators, physicians, and staff deal with extra cases, lower patient wait times, and still deliver more reimbursable care? By analyzing why everyone’s there in the first place.
15 Most Common Reasons for Emergency Room Visits
Hypertension may be the most common diagnosis in ER medicine in the US, but there’s much more intel you can glean from your patient coding data and healthcare trends in 2020.
According to historical ICD codes, the 15 most common reasons why people visit the ER include[*]:
- High blood pressure / chest pain / cardiovascular issues
- Acute upper respiratory infection
- Urinary tract infection
- Abdominal pain
- Syncope and collapse
- Noninfective gastroenteritis and colitis
- Dizziness and giddiness
- Low back pain
- Nausea with vomiting
- Unspecified asthma
- Acute bronchitis
- Strain of muscle, fascia, and tendon at neck level
Again, your historical coding data may differ from these averages, so it’s crucial to analyze your specific numbers to get ahead of the trends.
New research also reveals an expanding number of cases related to[*]:
- Generalized anxiety, especially in patients younger than 18
- Major depressive disorder
- Vaping illnesses
- Recreational/medical marijuana
- Undiagnosed hypothyroidism
- Coronavirus (COVID-19)
Another point to remember is that ED visits also wax and wane by the seasons.
Seasonal Reasons for Visiting the ED
Issues like bug bites, allergies, plant rashes, and activity-related injuries are prevalent during summertime in the ED.
Holiday emergency room statistics during the winter months often expose higher incidents of:
- Burns from cooking
- Alcohol-related accidents
- Head, lower back, and hip injuries (from slips-and-falls)
- Food poisoning
So why is it so vital to become aware of these trends?
Why Your ED Coding Data Matters
Partner with the right revenue cycle management team, and you’ll have access to data about your ED’s usage statistics, the types of diagnoses you treat most often, where you’re spending the bulk of money on resources/staff, and more.
Understanding this intel is crucial for your emergency medicine team to:
1. Prepare for Staffing, Equipment, and Supply Needs
Research shows that visits for the five most common clinical coding categories comprise about 30% of all ED visits[*], so you may want to focus on these specific areas to increase the value of your ED care.
An exceptionally high number of cases in any particular category may justify hiring more team members, buying a new diagnostic machine, or renegotiating supply quantities/prices with vendors.
Take a deep dive into your data, and you’ll be better able to predict and prepare for whatever’s in the waiting room — ASAP. You may also take financial safeguards to protect your ED from losses due to unpredictable events or situations, such as a national disaster (i.e., hurricane, tornado, flooding, etc.) or the next coronavirus.
2. Help Staff Understand Common ICD Diagnosis Codes
New emergency physicians are always taught the phrase, “When you hear hooves, think horse; not zebra.” This old adage means that your staff should be familiar with the more common reasons for ER visits rather than expecting an exotic case with a code they’ve never used before. Once they get these down, they can further refine their coding abilities to accurately reflect each case’s nuances using secondary codes.
As your physicians, nurses, and coders understand the most common ICD diagnosis codes, they’ll make fewer mistakes. This is good news for you since inaccurate medical coding and billing can lead to higher denials or medical billing fraud (which doesn’t require intent).
3. Reduce Non-Urgent ED Visits
What percent of ER visits are emergencies? Unfortunately, a meta-analysis of 26 studies reveals that 37% of all ED visits are for non-urgent conditions[*].
Rural and urban EDs have the highest utilization rates because patients either don’t have access to a primary care physician, can’t make appointments with specialists, or don’t have insurance coverage. EM groups must then treat non-urgent cases, leading to higher healthcare spending and unnecessary testing and treatment costs.
You may be able to redirect non-urgent patients using options for telehealth and non-emergent fast tracks (which don’t require an ER doctor). These will save your group time and money, and better help patients in the long-term.
4. Explain Billing Concerns to Patients Early On
EDs should have a system in place to help staff and patients understand billing concerns early in the visit before they’re seen by a physician.
When your team becomes familiar with the most common reasons for visiting the ED, they’ll have a better idea of how much different testing/procedures will cost patients. This should make explaining the difference between higher out-of-network ER charges and lower in-network choices easier for patients to grasp.
This step should raise your reimbursement rates and improve self-pay collections.
5. Lower Wait Times and Boost Patient Satisfaction Scores
Perceived wait times in the ED, more so than actual ED wait times, serve as a predictor of a very favorable ED rating and patient experience[*].
As your team becomes more familiar with assessing common complaints, they’ll know exactly how to speed your patients through triage, diagnosis, and discharge.
Plus, once you have a solid understanding of your ED’s most commonly diagnosed codes, you could try forecasting models and simulation tools to estimate demand and reduce patient waiting times. These may help you balance your allocation of doctors to specific types of patients, or match the availability of doctors to forecasted demand patterns. You can even generate and test solutions to decrease overcrowding.
Coding Stats from Your Emergency Medicine Revenue Cycle Management Provider Will Help Your ED Thrive
Around the country, EDs are closing despite an influx of patients. Why? Because it’s hard to remain profitable when your operating costs exceed your total reimbursements.
Analyzing and understanding your data for the most common reasons for emergency room visits will help administrators better allocate, prepare, and predict your ED’s staff and patient needs.
An experienced RCM partner will provide this vital insight and show you the daily inefficiencies affecting your emergency medicine practice. To learn where you may be losing valuable revenue, check out the free DuvaSawko Medical Billing Calculator now.
Ready to touch base, ask questions, or learn more about our proprietary technology? Contact the DuvaSawko team today!
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start an emergency department medical practice - 6 easy steps
start an emergency department medical practice – 6 easy steps