Minnesota is the first state in the nation to analyze potentially preventable emergency department visits and hospital admissions and readmissions.
Although Minnesota is one of the most efficient and cost-effective health care systems in the nation, experts said the study shows there’s still room for improvement.
The one-year study, conducted by the Minnesota Department of Health (MDH), revealed nearly 1.3 million patient visits to emergency departments and hospital admissions and readmissions were potentially preventable and cost nearly $2 billion.
The study used 2012 claims data from the Minnesota All Payer Claims Database, which includes data from both public and private insurance payers.
The potentially preventable health care events are defined as hospital and emergency department visits that patients could have avoided under the right circumstances such as timely access to primary care, improved medication management, greater health and health system literacy and better coordination of care among clinicians, social service providers, patients and families.
Here are two examples:
• A patient visiting an emergency department for a urinary tract infection that could have been treated in primary care.
• A patient is readmitted to a hospital because of poor follow-up care after a discharge.
Two-thirds of the emergency department visits in 2012 were potentially preventable and cost $1.3 billion, according to MDH.
Many patients were seen more than once for a potentially preventable condition – things like upper respiratory infections and back pain, the study noted.
Medicaid members made up a disproportionately high percentage – about 40 percent – of overall emergency department visits. Medicaid patients make up about 14 percent of the population.
“Douglas County Hospital has a vested interest in ensuring health care is delivered in the most efficient and cost effective manner for both patients and insurers,” said Carl Vaagenes, CEO of DCH and current chairman of the Minnesota Hospital Association Board of Directors.
“We strive to inform, educate and promote the benefits of having a close primary clinical care provider who understands their patients’ health and manages their care to avoid any unnecessary hospitalizations or emergency room visits,” he said.
However, Vaagenes added, “Health care providers alone can’t prevent avoidable emergency room use or hospitalizations. Social determinants of health – housing conditions, transportation availability, income, social services, health literacy – play a crucial role in the underlying causality of individuals’ health outcomes.”
Vaagenes also noted that the Minnesota Hospital Association co-led a statewide effort called the Reducing Avoidable Readmissions Effectively (RARE) Campaign that resulted in cutting potentially avoidable readmissions by 19 percent over three years.
From 2011 to 2013, Minnesota hospitals reportedly prevented 8,773 readmissions, saved more than $70 million and helped patients sleep 35,000 nights at home instead of in the hospital, according to Vaagenes.
The study also includes strategies for reducing potentially preventable events that Minnesota providers, state agencies and other stakeholders are already pursuing, including:
• Ensuring patient access to timely, preventive care in outpatient settings
• Ensuring consistent and strong engagement by patients and families
• Improve coordination of care, in particular between long-term care settings and hospitals
• Improving comprehensive discharge planning, medication management and transition care communications
“Equipped with these findings, we will work with providers and community leaders to ensure patients more consistently receive the right care, in the right place at the right time,” said Dr. Ed Ehlinger, Minnesota Commissioner of Health.
TO SUM IT UP
• During 2012, 1.3 million of Minnesota’s emergency department visits, hospital admissions and hospital readmissions were potentially preventable.
• The cost of those visits and admissions totaled nearly $2 billion, which accounted for about 4.8 percent of total health care spending in the state that year. However, the volume of spending does not represent real potential savings because not all identified events were actually clinically preventable and preventing them may require new investments elsewhere in the system.
WHAT’S A POTENTIALLY PREVENTABLE HEALTH CARE EVENT?
Hospital and emergency department visits that patients possibly could have avoided under the right circumstances such as:
• Timely access to primary care
• Improved medication management
• Greater health and health system literacy
• Better coordination of care among clinicians, social service providers, patients and families
Source: MN Dept. of Health