Nearly $2 billion in ER visits and hospital care preventable

More than 1 million emergency room visits and more than 70,000 hospital admissions in Minnesota possibly could have been prevented, according to a new Minnesota Department of Health Study.

In the state's first look at how the health care system is being overused, department economists found $1.9 billion potentially preventable ER visits and hospital admissions in 2012. They said about two-thirds of ER visits likely could have been avoided if patients had better access to preventative care or better-coordinated health care.

The cost of the potentially preventable care amounted to nearly 5 percent of the about $40 billion in total health care spending in Minnesota that year. The findings will lead to a more detailed analysis of health costs, State Health Economist Stefan Gildemeister said.

"This creates a framework to ask, of some of these health care events, which should have taken place in more primary care setting?" Gildemeister said. "Under what circumstances could have patients received care at the right time and in the right settings, perhaps even saving health care costs in the process?"

Potentially preventable care can include a hospital readmission for a recurrence of the problem doctors treated when a patient was first admitted to a hospital. It also could include a trip to the emergency room for an asthma patient who is short of breath and who could be treated at much lower cost in a primary care clinic.

The study marks the first time state health officials have analyzed ER and hospital admissions in the Minnesota All Payer Claims Database.

Among its findings were concentrations of health system overuse.

For example, patients covered under Medicaid accounted for 40 percent of avoidable ER visits, even though the Medicaid recipients comprise less than 20 percent of state residents.

Gildemeister said as many as 50,000 Minnesotans had four or more ER visits that might have been avoidable.

"What we're learning from this study is that there are opportunities to reduce this volume of potentially preventable events," he said.

To reduce ER visits and hospital admissions, Department of Health officials are calling for more access to high-quality preventive care, better coordination of services and improved medication management. To reduce hospital readmissions, they are recommending more thorough discharge planning to avoid future problems.

Jonathan Watson, director of public policy for the Minnesota Association of Community Health Centers, said the department's recommendations can cut costs. He said efforts to better coordinate care for 25,000 community clinic Medicaid patients have reduced ER visits by 15 to 18 percent over the past two years and saved more than $5 million.

Watson said clinics could save more money if they had data on other locations from which their patients seek care and how often.

"We need to have line of site into where our patients go once they're past the four walls of our community health centers," he said. "That is a piece that we need further investment in in Minnesota."

Watson hopes the new Department of Health study will help him lobby for state funding on more comprehensive health care usage data.

The study's findings do not surprise Jim Schowalter, president and CEO of the Minnesota Council of Health Plans. But he suspects preventable ER visits are on the decline, even if there is still a ways to go.

"Some of it is just continuing to educate, give people information and help them know that it's not taking away the option of going to the emergency room but giving them better services and more convenient services that they're familiar with," Schowalter said.

About 30 percent of health care spending nationally could be prevented, according to an Institute of Medicine estimate. In Minnesota, that would translate to as much as $12 billion in spending on avoidable care. That means the $1.9 billion in preventable care state health officials found would be a relatively small portion of Minnesota's avoidable spending.

Health department officials are now analyzing 2014 data to see what, if any, impact the federal Affordable Care Act's health insurance mandate has had on ER visits and hospitalizations deemed "potentially preventable."