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Emergency care episodes: an economic profile.
S A Optenberg1, P Jacobs, K Bay
1Army Medical Department Center and School, Fort Sam Houston, TX.
The Journal of Ambulatory Care Management
|December 9, 1994
Summary
A new definition for emergency care episodes, including follow-up within 48 hours, was created. Analyzing 1.6 million cases shows episodic data improves economic analysis and reimbursement for emergency services.
Area of Science:
- Health Economics
- Emergency Medicine
- Health Services Research
Background:
- Traditional analyses of emergency care often overlook post-encounter services.
- Understanding the full scope of emergency care costs requires a comprehensive approach.
- Defining 'episodes of care' is crucial for accurate economic evaluation.
Purpose of the Study:
- To develop and validate a novel definition of an
Main Methods:
- A new definition of emergency care was established, encompassing the emergency department visit and related care within 48 hours.
- Data from 1.6 million episodes of care for 809,145 patients were analyzed using a national claims database.
- Analysis stratified by ICD-9-CM Major Diagnostic Category (MDC) and surgical intervention.
Main Results:
- Secondary and adjunct services constituted a significant portion of total episode charges.
- Hospitalization and surgical procedures were key cost drivers for several MDCs.
- Episodic data revealed substantial costs beyond the initial emergency department encounter.
Conclusions:
- The developed "episode of care" definition provides a more holistic view of emergency care utilization and costs.
- Economic analysis and reimbursement strategies for emergency services are enhanced by adopting an episodic data perspective.
- This approach supports better resource allocation and financial planning in emergency healthcare.