Insurance Status Contributes Most to ED Frequent Flyer Status

A new study reveals that contrary to popular belief, minorities and the poor do not make up the majority of emergency department (ED) regular visitors.

Researchers at the Medical University of South Carolina (Charleston, USA) constructed a database of 127,672 patients in a regional health information exchange (HIE), representing every adult ED encounter in all hospital systems in the region for a one year period, beginning in April 2012. Patients were defined as a frequent ED user (FEDU) if they had four or more visits to the ED during the study period. Predictor variables included age, race, sex, payer class, county, and International Classification of Diseases (ICD-9) codes.


The results showed that 9.6% of the patients in the HIE database were FEDUs. Patient characteristics that were significantly associated with being a FEDU included age of 35-44 years; African American race; Medicaid, Medicare, and dual-pay payer class; and ICD codes 630-679 (complications of pregnancy, childbirth, and puerperium), 780-799 (ill-defined conditions), 280-289 (diseases of the blood), 290-319 (mental disorders), 680-709 (diseases of the skin and subcutaneous tissue), 710-739 (musculoskeletal and connective tissue disease), 460-519 (respiratory disease), and 520-579 (digestive disease). The study was published in the July 2016 issue of Southern Medical Journal.

“Although it is commonly suspected that uninsured minorities make up the bulk of the patients who frequently use the ED, analysis of our data showed that this was not the case,” concluded lead author Steven Saef, MD, of the division of emergency medicine, and colleagues. “In fact, the greatest predictor, outside of specific medical complaints, of a patient being a frequent ED user was having a dual Medicare and Medicaid payer classification.”

While FEDUs account for less than a tenth of all ED patients, they contribute to between a fifth and a third of all visits. Many of these patients take advantage of the ED as an access point to healthcare, often with problems that are not emergencies, and for which care could be better provided by primary care providers or outpatient clinics. However, mental, social, economic, and logistical barriers prevent many of these patients from pursuing the normal avenues to healthcare, and the ED is typically the easiest option.

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Medical University of South Carolina