Study: Discharge Diagnosis No Help in Reducing Patient Emergency Room Abuse

Those hoping that employing discharge diagnoses data to patients visiting the emergency department to weed out primary care patients from those needing emergency triage will be disheartened to learn that a recent study found that as a metric, it won’t work.

The most recent issue of the Journal of the American Medical Association published a study (available free online here) that reviewed nearly 35,000 patient records and found a large majority of emergency department patients who received a discharge diagnosis of “primary care-treatable” required emergency department triage. “The limited concordance between presenting complaints and ED discharge diagnoses suggests that these discharge diagnoses are unable to accurately identify nonemergency ED visits,” wrote the study’s authors, Maria C. Raven, Robert A. Lowe, Judith Maselli, and Renee Y. Hsia.

The study pulled its data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS).

The main reason for the study was to investigate whether a hospital could “deny or limit payment” under Medicaid or similar program if an emergency room patient is diagnosed as not having an emergency condition. “Legislatures or regulators in Tennessee, Iowa, New Hampshire, and Illinois have considered or enacted legislation or regulations that would limit payment for nonemergency ED visits by Medicaid enrollees, based on discharge diagnosis,” the authors write. “Other states, including Arizona, Oregon, Illinois, Iowa, Nebraska, North Carolina, and New Mexico, have recently implemented or considered implementing some level of copayment requirement for nonemergency use of the ED.” In the state of Washington, the authors report, there was a proposal to use emergency department discharge diagnosis in making a payment determination.