Insurance Status and Emergency Department Visits Associated With Hemodialysis in Texas

West, J.R.; Chan, Hei Kit; Molony, Donald A.; Robinson, David J.; Foringer, John R.; Wang, Henry E.

doi:10.1001/jamanetworkopen.2019.21447

Cited by 6 publications

(11 citation statements)

References 2 publications

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“…Undocumented persons receiving HD have higher rates of hospitalization, increased hospitalization days, and higher mortality. 32,33,64 In a Texas cohort, individuals receiving emergency-only dialysis had a 5-fold higher mortality rate than those receiving scheduled dialysis. 33 Undocumented persons receiving HD do not qualify for Medicare insurance, so many rely on the ED for dialysis, which contributes to their higher rate of ED utilization.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review

et al. 2022

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“…This is one of the largest and most comprehensive descriptions of the national burden of uninsured ESKD requiring ED HD. 1,[9][10][11][12][13][14][15][16] The enormous burden of ED HD falls most heavily on the southern census region of the United States. Most of the states in this region failed to adopt the Medicaid expansion under the Affordable Care Act, 23 and the resulting coverage gap could explain the greater amount of uninsured ED HD in southern states.…”

Section: Discussionmentioning

confidence: 99%

“…These ED visits resulted in charges over $374 million. This is one of the largest and most comprehensive descriptions of the national burden of uninsured ESKD requiring ED HD 1,9–16 …”

Section: Discussionmentioning

confidence: 99%

“…Prior studies characterizing the size and use of ED HD for ESKD patients have been limited to single regions or states. 1,[9][10][11][12][13][14][15][16] These small studies estimate that there are ≈ 7000 uninsured patients with ESKD in the United States and describe this population as mostly undocumented…”

Section: Importancementioning

confidence: 99%

“…A paucity of literature describes the impact of HD on the ED. Prior studies characterizing the size and use of ED HD for ESKD patients have been limited to single regions or states 1,9–16 . These small studies estimate that there are ≈ 7000 uninsured patients with ESKD in the United States and describe this population as mostly undocumented Latino immigrants who must rely on the ED for HD 16,17 .…”

Section: Introductionmentioning

confidence: 99%

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Emergency department visits for hemodialysis by insurance status in the United States

et al. 2022

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Objective Many uninsured patients with end‐stage kidney disease (ESKD) depend upon the emergency department (ED) for hemodialysis (HD). We sought to characterize ED visits for emergent HD by insurance status. Methods We performed a cross‐sectional analysis of the 2017 Nationwide Emergency Department Sample, including ED visits by patients ≥18 years old with a length of stay ≤1 day and performance of HD. Insurance status determined by “insured” as Medicare, Medicaid, or commercial and “uninsured” as self‐pay or charity. Results Of 118,034,396 adult ED visits, 235,988 were associated with HD: uninsured 62,503 (incidence 5.30 per 10,000, 95% confidence interval [CI]: 5.26–5.34) and insured 172,889 (incidence 14.65 per 10,000, 95% CI: 14.60–14.74). The south census region accounted for 89% of uninsured ED HD (odds ratio [OR] 31.55, 95% CI: 8.97–110.97). Compared to insured patients, uninsured ED HD patients were more likely to be younger (age 18–44, 37.6% vs 19.9%). The most common primary diagnosis for uninsured and insured ED HD patients was hypertensive chronic kidney disease (34.6% and 26.2%, respectively). Uninsured ED HD patients were less likely to be admitted (3.4% vs 36.0%, OR 0.06, 95% CI: 0.02–0.20). Most ED HD patients were discharged home (95.2% uninsured vs 57.6% insured). ED charges per visit were $5,992.32 for uninsured and $10,985.87 for insured ED HD patients. Conclusions Our findings highlight the health care burden of ED HD. Novel system approaches are needed for the management of uninsured and insured patients with ESKD.

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Emergency care for undocumented immigrants

Wampler

Wang

2021

JACEP Open

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Insurance Status and Emergency Department Visits Associated With Hemodialysis in Texas

Cited by 6 publications

References 2 publications

Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review

Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review

Emergency department visits for hemodialysis by insurance status in the United States

Emergency care for undocumented immigrants

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