ED admissions for heart failure outpace non-ED admissions - Data Trends - emergency department

Healthcare Financial Management, Oct, 2003

Admissions to U.S. hospitals for heart failure increased by 1.2 percent from 2000 to 200l, and they remained essentially unchanged from 2001 to 2002. At face value, these statistics may seem inconsequential, yet a closer look discloses a possibly significant trend regarding the source of these admissions--whether the patients ate admitted through the emergency department (ED) or from some other source.

Historically, almost one third of heart-failure-related admissions have come from a source other than the ED, with the physician's office accounting for more than 80 percent of these non-ED admissions. Over the past three years, however, the percentage of such admissions coming from non-ED sources has declined. In 2002, non-ED admissions accounted for 31 percent of inpatient stays under DRG 127 (heart failure and shock), compared with 34 percent in 2000.

The increasing percentage of DRG 127 admissions coming from the ED may pose a challenge for hospitals. As a result of this trend, already-crowded EDs may see an increase in patients with potentially life-threatening illnesses, because the average severity for ED admissions is slightly higher than non-ED admissions. Analysis of the 2000-2002 MEDPAR data for DRG 127 shows that patients with heart failure who are admitted through the ED have higher average charges, although they also have shorter lengths-of-stay.

The slight upward trend in ED utilization is somewhat surprising, given the prevalence of improved diagnostic technologies, the increased focus on medical management, and the pursuit of strategies designed to improve physician access. The financial implications of this trend may be significant.

Hospital financial managers should consider monitoring the types of admissions coming through their ED. If a rising percentage of patients with high-risk conditions such as heart failure are being admitted through the ED, steps may be required to reverse this trend.

DRG 127 ADMISSIONS

Admits       Average    Average     Average    ALOS    Year
              Charge        Age    Severity

686,459      $11,308         77        1.04    5.35    2000
694,907      $12,510         77        1.07    5.35    2001
694,607      $14,472         77        1.09    5.33    2002

DRG 127 ED ADMISSIONS

Admits       Average    Average     Average    ALOS    Year
              Charge        Age    Severity

455,553      $11,524         77        1.05    5.23    2000
471,326      $12,779         77        1.07    5.21    2001
479,059      $14,836         77        1.10    5.17    2002

DRG 127 NON-ED ADMISSIONS

Admits       Average    Average     Average    ALOS    Year
              Charge        Age    Severity

230,906      $10,884         77        1.02    5.59    2000
223,581      $11,941         77        1.06    5.64    2001
215,548      $13,665         77        1.07    5.68    2002