Emergency Department Visits Between Inpatient Visits: An Overlooked Quality Measure?

Abstract

Healthcare costs are rapidly accelerating in the United States and payers are looking for a solution to contain out-of-control expenditures. Readmissions can be easily measured thus making them an attractive metric of quality care. The Centers for Medicare and Medicaid Services (CMS) wants to minimize its financial outlay while pushing for increased quality. By this theory, if a patient remains out of the hospital, then the care delivered is considered to be high quality. Currently, emergency department (ED) visits between inpatient visits are not calculated into readmission rates. This review examined the sparse literature on this issue and proposed ideas to better examine readmissions as a quality measure overall. CMS has targeted patient readmissions to hospitals as a quality-based means of adjusting financial reimbursement. In 2013, the national patient readmission rate reduced from 19.5% to 17.5%. This review determined that (a) the overlooked ED visits could be a metric for delivery of quality care; (b) decision analysis methods should be employed to determine whether or not these ED visits are actually a cost-effective means of keeping readmissions down and quality up; and (c) numerous process-based obstacles must be overcome before any reimbursement system would be impacted by ED visits. It is critical that changes to reimbursement or quality measures be fair and meaningful for providers and quality care for patients must remain the top priority to address ED visits between inpatient visits.