Sicker, More Complex Patients Are Driving Up Intensity of ED Care

Summary

Policymakers have noted an upward shift in the intensity of services provided to fee-for-service (FFS) Medicare beneficiaries in hospital emergency departments (EDs), as reflected in the level of evaluation and management (E/M) visits coded. This report examines a number of factors contributing to this trend including:

• Rising severity of illness among Medicare FFS patients receiving ED services;
• An increase in the number and frequency of ED visits by Medicare FFS beneficiaries;
• Increasing numbers of ED visits that include outpatient observation services due to mounting pressure to shift care from the inpatient to the outpatient setting;
• Greater use of the ED by people dually eligible for Medicare and Medicaid (dual-eligibles), who tend to be sicker and have more chronic conditions; and
• Increasing use of the ED by Medicare FFS beneficiaries with behavioral health diagnoses who require a higher intensity of services.