“Frequent users” are not abusing ER services, multi-state studies say

People who visit an emergency room (ER) multiple times per year—nicknamed “frequent flyers”—have been accused of taking advantage of an ER’s convenience by using it as a substitute primary care physician. But new studies show that frequent flyers comprise a very low percentage of total ER patients, and that most visits were justified by an urgent medical need.

The American College of Emergency Physicians (ACEP), the nation’s leading emergency medicine association, examined the habits and medical urgency of repeat emergency room visitors in several state studies. In the Virginia study, patients who visited the ER more than nine times in a six-month period made up only two percent of all ER visits. The study also found that these super-users were more likely than other patients to be Medicare beneficiaries and to have behavioral health issues.

The Massachusetts study found that only 11 percent of ER visits were frequent flyers who came to the ER more than five times per year. They, too, were more likely to be on Medicare or Medicaid and to have mental health factors—sending up a red flag about the availability of behavioral health services.

“Frequent users are equally justified in seeking emergency care as non-frequent users because they have serious medical problems that demand emergency care,” said Andy Sama, MD, ACEP’s president in a release.  “If one certainty emerges here, it is that patients with mental illnesses and psychiatric emergencies are coming to the ER because other resources are simply not available to them. Frequent users are also more likely to be insured by Medicare or Medicaid and to be chronically ill.”

The studies also reveal the complications that arise when the ER is used as a catch-all replacement for ongoing care. In several of the state studies, including Virginia, frequent ER users who were admitted to the hospital had a significantly higher chance of being readmitted after 30 days.

“Federal programs designed to penalize providers for 30-day readmissions may be dangerous for high-risk patient populations,” explained Robert E. O’Connor, MD, MPH, a member of the Virginia study team. “Our data show that patients who were frequent users of emergency department services following hospital discharge were more likely to require readmission for unstable health conditions that could not be managed in an ambulatory setting.”

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