New reports find potential overuse of health care services across Washington state
Analyses of hospital readmissions, potentially avoidable emergency room use and geographic distribution of common medical tests and procedures finds widespread variation by counties, age groups and gender.
SEATTLE (January 29, 2015) – The Washington Health Alliance announced today the release of three new reports that detail potential overuse of health care services in Washington state. Overuse means people are receiving more medical care than necessary and is a significant problem in the health care system. Variation in how commonly people receive certain services can sometimes signal overuse. All three reports draw upon the Alliance’s robust claims database of more than 3.3 million lives in Washington state.
“In making these reports available, the Alliance hopes to highlight the role that everyone—hospitals, primary care providers, employers, health plans and patients―have to play in addressing the problem of overuse,” said Nancy A. Giunto, executive director of the Alliance.
9,578 emergency room visits in one year were for six non-urgent reasons
The report Right Care, Right Setting: A Report on Potentially Avoidable Emergency Room Visits in Washington State offers a unique look at the problem of potentially avoidable ER visits in Washington state by examining visits both by hospital and by the patient’s medical group. The Alliance relied upon diagnoses that providers widely accept as appropriate for treatment in a primary care office. The rate of avoidable ER visits for commercially-insured patients was 8.9 percent and 11.3 percent for Medicaid patients. Eliminating these visits could have saved $24 million in one year in the Puget Sound region alone.
Outpatient visits linked to fewer hospital readmissions
This report Hospital Readmissions and Outpatient Care: A Report on Hospital Readmissions and Post-Discharge Care for Commercially Insured Patients in Washington State is a first look at hospital readmissions for the commercially insured in Washington state. While there are other publicly available reports on hospital readmissions, this report shares, for the first time in Washington state, a local view of hospital readmissions within 30 days for all causes among commercially-insured patients and when possible, comparison to national benchmarks.
In addition, the report examines whether outpatient visits occurred between hospitalizations. Less than one-half of readmitted patients had an outpatient provider visit within 30 days of being initially discharged from the hospital, and only about one-third of patients had a follow-up outpatient visit within the recommended seven days following discharge. For the first time in our state, we have data supporting the medical view that an outpatient visit soon after leaving the hospital reduces the likelihood of readmission.
Where you live can affect the care you receive
The report Different Regions, Different Health Care: Where You Live Matters found that where someone lives often influences the health care services they receive. By looking at health care service delivery patterns for 11 common tests and procedures, the Alliance found significant geographic variation in how often these tests and procedures, which can be expensive and pose potential medical risk, are delivered. Some key findings include:
- Women ages 45–54 living in Olympia were 192 percent more likely to have a spine fusion than their counterparts in Seattle.
- Residents of Monroe were almost twice as likely to receive an MRI scan of an extremity as people living in other Puget Sound communities.
- Women ages 35–44 in Puyallup were 193 percent more likely to have a hysterectomy than their counterparts living in Seattle.
“These reports have practical applications for employers and consumers who would like to reduce the risk and cost of medically unnecessary services; and for hospitals and medical groups, who want to be more competitive and efficient,” said Ms. Giunto. “The ultimate goal is to contribute to a healthier Washington.”
You can find all three reports and accompanying infographics at: https://wahealthalliance.org/alliance-reports-websites/alliance-reports/.