Sicker, More Complex Patients Are Driving Up Intensity of ED Care

Summary

Policymakers have noted an upward shift in the intensity of services provided to fee-for-service (FFS) Medicare beneficiaries in hospital emergency departments (EDs), as reflected in the level of evaluation and management (E/M) visits coded. This report examines a number of factors contributing to this trend including:

  • Rising severity of illness among Medicare FFS patients receiving ED services;
  • An increase in the number and frequency of ED visits by Medicare FFS beneficiaries;
  • Increasing numbers of ED visits that include outpatient observation services due to mounting pressure to shift care from the inpatient to the outpatient setting;
  • Greater use of the ED by people dually eligible for Medicare and Medicaid (dual-eligibles), who tend to be sicker and have more chronic conditions; and
  • Increasing use of the ED by Medicare FFS beneficiaries with behavioral health diagnoses who require a higher intensity of services.

Related Resources

Advisory
Member
In the Centers for Medicare…
Advisory
Member
The AHA released new tools to help the field prepare for appropriate use criteria reporting requirements that will start to go into effect on a voluntary basis…
Infographics
Public
The Protecting Access to Medicare Act (PAMA) requires the Centers for Medicare & Medicaid Services (CMS) to establish a program that promotes A
Infographics
Public
The Protecting Access to Medicare Act (PAMA) requires the Centers for Medicare…
Special Bulletin
Member
President Trump today submitted to Congress his budget request for fiscal year (FY) 2020. The budget request, which is not binding, proposes hundreds of…
Guides/Reports
Public
The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) released a new report that details the impact that a Medicare public…