HJAR Jul/Aug 2019

Healthcare Journal of ARKANSAS I  JUL / AUG 2019 51 of emergency services. In 2018, around 200,000 Medicaid beneficiaries generated 350,000 paid visits in an Arkansas ER. Of those visits, 165,000 (45 percent) were for children under the age of 15. About 83 percent of patients went to the ER two or fewer times. Another 13 percent went to the ER three to five times, and around 900 patients went to the ER eleven or more times. About 4 percent of patients seen in the ER were admitted or received observation care. Most patients sought care for a medical or surgical problem, while 5 percent of patients were seen for a behavioral health issue. About 25 percent of ER patients had an underlying behavioral health diagnosis in addition to their physical complaints. There were about 14,000 visits for a behavioral health issue, and over 25 percent of these mental health visits were attempted suicides. Substance abuse issues, including alcohol-related prob- lems, comprised another 20 percent of be- havioral health ER visits. Most patients were seen for mild disorders. Upper respiratory tract infections, earaches, urinary tract infections, and viral infections comprised nearly 20 percent of all ER vis- its. Four percent of patients were seen for a pregnancy related problem. Even though most patients were seen for mild disorders that didn’t require admittance, nearly 20 percent of adult patients seen in the ER received a CT scan. This compares to a 4 percent rate in Canadian ERs. There is considerable variation in CT scanning by different hospital ERs. This substantial use of CT scanning in the ER raised issues about ra- diation exposure and program expenditures. The new data analytics also examined rates of patients who visited an ERmultiple times within 72 hours of their first visit. In general, a little over 7 percent of patients in the ER had a second ER visit within the next three days. Half of the repeat visits were in a different ER. Variation was considerable—a few hospitals had over a 10 percent rate of repeat visits, while others were closer to 5 percent. There may well be opportunities to get patients into ambulatory settings for follow up care in lieu of repeat ER events. Alternatives to emergency room care have grown in the community. Urgent care centers and telemedicine services are available as al- ternatives to ERs, but they too often provide episodic, fragmented care. Several studies document overuse of antibiotics by these new acute care sites. Ultimately, good established relationships with outpatient health profes- sionals can save patients time and money while avoiding unnecessary care. Data analytics like Arkansas Medicaid’s semi-annual ER usage report can help shape future care trends by identifying opportuni- ties to redirect services to more appropriate venues. n Reference Bissell, MB., Hartery, A., Seidel, J., & Vatturi, S. (2019) Retrospective analysis of emergency CT imaging at an academic center. Canadian Associa- tion of Radiologists Journal, 70 (1), 13-22. WilliamGolden, MD Medical Director Arkansas Medicaid