Costs Associated with Ambulatory Care Sensitive Conditions Across Hospital‐based Settings

Abstract

Objectives: Ambulatory care sensitive conditions (ACSCs) are acute care diagnoses that could potentially be prevented through improved primary care. This study investigated how payments and charges for these ACSC visits differ by three hospital-based settings (outpatient, emergency department [ED], and inpatient) and examined differences in payments and charges by their physician and facility components.Methods: This was a secondary analysis of data (2005 through 2010) from the Medical Expenditure Panel Survey. Multiple linear regression models were used to assess differences in the mean-adjusted payments and charges for ACSC visits by clinical setting and further divided payments and charges into physician and facility components.Results: Of all ACSC visits from 2005 through 2010, 41% were outpatient visits, 36% were ED visits, and 23% were hospital admissions. After adjusting for patient demographics and comorbid conditions, charges for an inpatient ACSC visit were four times higher ($11,414 vs. $2,563) and payments were five times higher ($4,325 vs. $859) when compared to an ED visit. By comparison, charges for an ACSC ED visit were two times higher ($2,563 vs. $1,084) and payments 2.5 times higher ($859 vs. $341) relative to an ACSC visit managed in an outpatient hospital-based clinic. Across all clinical settings, hospital facility fees account for 77% to 94% of the charge differences and 81% to 93% of the payment differences.Conclusions: For hospital-based ACSC visits, inpatient hospitalizations are by far the most expensive. Finding ways to expand outpatient resources and improve the health management of the chronically ill may avoid conditions that lead to more expensive hospital-based encounters. Across all hospital-based settings, facility fees are the major contributor of expense.ACADEMIC EMERGENCY MEDICINE 2015;22:172-181

Ambulatory Care Sensitive Admissions in Individuals With Autism Spectrum Disorder, Intellectual Disability, and Population Controls

“…ED visits and inpatient hospital admissions for ACS conditions, collectively termed ACS admissions, are often used as indicators of access to quality primary care management and outpatient services [Harrison et al, 2014]. It is welldocumented that costs associated with ACS admissions exceed costs for non-ACS admissions [Mkanta, Chumbler, Yang, Saigal, & Abdollahi, 2016] and costs for treating ACS conditions in an outpatient setting [Galarraga et al, 2015]. ACS admissions account for approximately 12% of all hospital charges for adults and 20% for children [Shi, Samuels, Pease, Bailey, & Corley, 1999].…”

Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions

“…The ED PQIs are measures that build on the concept of ambulatory care sensitive conditions (ACSC), or conditions for which hospitalization may have been avoidable through access to highquality community-based care. Recently the concept has been expanded to potentially preventable ED visits ( Johnson et al 2012;Brownell et al 2014;Galarraga, Mutter, and Pines 2015).…”

Analysis of factors that determine hospitalization of emergency department patients

“…undoubtedly, inpatient care is more expensive than outpatient treatment because of the high fixed costs incurred in maintaining operational capability for 24 hours a day, seven days a week [21]. thus, in the discussion on the possibility of reducing healthcare expenditure, we should focus on improving primary care as a means of decreasing disease burden [22]. In practice, this should be done in two ways: first, by providing comprehensive care for chronically ill patients (especially for those with multiple morbidities) with multidisciplinary teams of professionals with regard to patients' biopsychosocial needs (e.g., the Chronic Care Model) [23][24][25][26]; and secondly, by extending the competence and range of primary care services through surgical procedures (so-called 'small surgery') [27].…”