Persistent ER Users

People who use the emergency room for non-emergency health needs are often villainized as a source of our excessive spending.  They really don’t have much to do with it, but who are these people?  A study in health affairs attempts to find out.   (HA Article)   Frequent ER users are only 4% to 8% of ER patients, but make 21% to 28% of visits.  The researchers used data from 2005 to 2015 from the state of California.  They started with a group of people aged 18 to 55 who had four or more visits in 2005 and tracked their usage in following years.  Frequent use was defined as four or more visits a year and superusers were defined as those with 18 or more visits in a year.  Persistent users had four or more visits in consecutive years.  There are a lot of people using the ER a lot in California; as there were 173,273 people categorized as frequent users, although California apparently has lower ED use than do most other states.  Non-persistent frequent ER users in 2005 were more likely to be female, non-Hispanic white or African-American, to live in a high-poverty area and to have public insurance; they were also more likely to have been hospitalized and to suffer from mental or substance abuse disorders.

Compared to these non-persistent frequent ED users, the persistent ones, were more female and more non-hispanic white or African-American and more mental health issues.  In 2005 6.7% of patients had four or more ER visits and accounted for 27% of all ED use.  8.4% of all visits represented just .7% of patients.  30.5% of frequent users in 2005 were frequent users in 2006.  About 5.7% were still frequent users after six years and 2% were during the entire study.  But half the patients were had been persistent frequent users in the early years of the analysis, had no ER use in later years.  The approximately 3300 patients who had persistent frequent ER use throughout the study averaged 20 visits a year.  This is obviously a real problem, not least for the Medicaid program likely paying for these people.  A large proportion of this group has serious mental health illness, raising a question about whether they would be better off in a residential setting of some type; they simply may not be able to cope well in the community.  Those who aren’t mentally ill are abusing the system and their excessive use should be financially and otherwise disincented.