Research Adds to Information on Exactly Who ED Super-Utilizers Are

March 8th, 2017

ROCKVILLE, MD – This almost certainly won’t come as any surprise to emergency department staff, but “super-utilizers” accounted for a large share of all ED visits, anywhere from 10.5% to 26.2%, in 2014.

For the purposes of the recent healthcare costs and utilization (HCUP) brief, super-utilizers, often called “frequent flyers” by emergency clinicians, were defined as those patients with the highest number of ED visits in 2014, by payer, i.e., four or more visits for privately insured patients aged 1-64 years or Medicare patients aged 65 years and older, and six or more visits for Medicaid or Medicare patients aged 1-64 years.

Super-utilizers visited the ED an average of five to 10 times in one year, depending on the payer:

• Medicare aged 65+ years: 5.4 visits per year;
• Medicare aged 1-64 years: 10.2 visits per year;
• Private insurance: 6.1 visits per year;
• Medicaid: 9.5 visits per year.

“Over the last several years, health care stakeholders have paid increasing attention to issues specific to high-need, high-cost patients who constitute a very small percentage of the population but account for a disproportionally high amount of health care utilization,” note the authors from the federal Agency for Healthcare Research and Quality (AHRQ).

Pointing out that “Programs designed to improve care for super-utilizers need to be tailored to the specific needs of the different subgroups of these patients,” the researchers took a closer look at exactly who they are.

The study team found that for ED visits covered by Medicaid, super-utilizers were older than other patients, on average 32.3 vs. 24.2 years. For patients younger than age 65 years, meanwhile, a greater share of ED visits among super-utilizers were discharged against medical advice compared with ED visits among other patients. That percentage was 3.5 vs. 2.6 for Medicare, 2.2 vs. 1.5 for private insurance, and 3.2 vs. 1.9 for Medicaid.

In terms of conditions, the researchers reported the following:

• Leading diagnoses for ED visits among super-utilizers across all payers were abdominal pain and back pain. In fact, abdominal pain was the most common first-listed diagnosis for patients younger than age 65 years regardless of payer.
• Among Medicare super-utilizers aged 65 years and older, nonspecific chest pain was the most common first-listed diagnosis for ED visits.
• For those younger than age 65 years, headache was a common first-listed diagnosis for ED visits. Super-utilizers accounted for a larger share of ED visits for headaches than for any of the other five most common diagnoses, ranging from 19% (private insurance) to 40% (Medicare aged 1-64 years).
• Superficial injury and sprains/strains also were in the top five first-listed diagnoses for ED visits among Medicare super-utilizers.
• Urinary tract infection was the fourth most common first-listed diagnosis for ED visits among Medicare super-utilizers aged 65 years and older, making up 19% of all ED visits for this condition among older Medicare patients.