Emergency Departments across the State under Strain

Emergency department visits in South Carolina are growing faster than our population. South Carolina’s rate of ED visits outpaces the national average and this rate is increasing.  Contrary to the myth, the uninsured are not overwhelming South Carolina’s emergency departments.

The South Carolina Public Health Institute released a comprehensive report on the frequent users of emergency departments.  The report was developed to address concern about emergency rooms being used as safety net primary care providers and to understand the patient population that frequents emergency rooms and the reasons for their visits.  The report examines ED activity before job losses and declining household incomes resulting from the current recession, which increased the number of South Carolinians without private health insurance and increased the number of Medicaid enrollees.

The report provides a comprehensive baseline picture of what ED use looked like in ‘normal’ times.  Now, as our state’s Medicaid program moves to reduce payment to physicians and hospitals, decision makers will have a starting point for comparison of how these changes affect safety net utilization.

“This report underscores the burden that emergency rooms across the state are experiencing and the fragile health conditions of people who are repeat users of emergency department services,” said Lee Pearson, Director of SCPHI.  “Behavioral health and unmanaged chronic illnesses have a major impact on South Carolina EDs in terms of visits and costs.”

EDs are not designed or staffed to meet the needs of these patients but often, they have no where else to receive care.  The emerging medical home model is one recognized approach to managing these patients.  Hospitals across the state have approached inappropriate utilization and frequent users in different ways with varying degrees of success.

Lynn Bailey, Columbia health care economist and SCPHI Advisory Board member, contributed to the report.  She summarized frequent users as follows:  “They are one fifth of total ED visits and account for 10% of costs, yet they are only 5% of the patients.  Those few patients are using the ED a lot. But overall most of us use the ED responsibly.”

SCPHI works to bring together governmental and community-based stakeholders around issues important to the health and well-being of South Carolinians and to provide evidence-based information to inform public health policy.

Click to access the full report.

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© 2015 South Carolina Institute of Medicine and Public Health