Study: 'Life circumstances' blamed for frequent ER use by vets

Results cast doubt that ACOs can reduce frequent ER use by socially challenged population
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Veterans use emergency rooms frequently not because of poor access to healthcare but because of "severely compromised life circumstances," according to a study published online by the Annals of Emergency Medicine. Nearly 8 percent of Veterans Health Administration patients visit the emergency room at least twice a year.

The American College of Emergency Physicians said the study casts doubt that any "simplistic solution" to frequent ER use exists.

"Just as we see in the civilian population, frequent users of the ER in the VHA generally have severely compromised life circumstances and high levels of psychosocial dysfunction in addition to medical needs," lead study author Kelly Doran, M.D., of the Yale University School of Medicine, said in a statement.

"Our findings defy the common assumption that once patients have ongoing medical care and health insurance their ER use will drop off. Instead, it appears that improved health outcomes may be realized through increased spending on social services, such as housing subsidies and income supplements," she added.

Analyzing 4 million records from 2010 for patients enrolled in the VHA, researchers found that 8.9 percent had one ER visit per year. Patients who visited two to four times a year made up 6.4 percent of the patient population, those who went five to 10 times accounted for 1.3 percent, and those who went 11 to 25 times made up 0.2 percent.

A sliver of the patient population, 0.01 percent, had more than 25 visits per year. The primary reasons for ER visits included schizophrenia, homelessness, opiate prescriptions and heart failure.

The VHA "is an integrated delivery system that operates in many ways like an accountable care organization," wrote Jesse Pines, M.D., of the George Washington University in Washington, D.C., and a FierceHealthcare Editorial Advisory Board member, in an accompanying editorial.

"Even accountable care organizations will have frequent ER users. Therefore efforts should focus on enhancing the quality of emergency care, rather than policies intended to undermine emergency departments," Pines said.

The study findings show non-payment programs for ER care are "just not good public policy," he  noted.

To learn more:
- read the study
- read the announcement

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