The Centers for Disease Control and Prevention (CDC) recently released its ongoing statistical survey of emergency department visits for 2013 and 2014, finding that ongoing volume increases took place on the long-term trendlines. The calendar year 2014 ED summary tables are available here.
Explore This IssueACEP Now: Vol 36 – No 11 – November 2017
The 2014 report is an extension of the survey process that began in 1992. It is used to identify trends in ED visits that are important for emergency department, hospital, and public health practitioners to understand. The 2014 data report is based on a sampling of 23,844 ED patient care reports from 283 emergency departments. National population census data were used to estimate utilization of ED services by populations.
The year 2014 saw the highest estimated volume of ED visits ever, an increase to 141.4 million compared to 130.4 million in 2013. The 20-year volume trend remains upward, at about 1.9 percent per year. ED utilization averages approximately 451 visits per 1,000 persons.
Reflecting the demographics of the American population, 15.4 percent of ED visits are from seniors older than age 65, and 19.6 percent are from pediatric patients (defined by the National Hospital Ambulatory Medical Care Survey [NHAMCS] as younger than age 15). An estimated 4.3 percent of ED visits were nonurgent, with the highest rates of these visits from pediatric patients.
High-utilizers continue to be nursing home residents, who accounted for about 2.5 million visits, with a utilization of 1,787 visits per 1,000 residents. About 30 percent of nursing home patient ED visits resulted in hospital admission (756,000), with an average length of stay in the hospital of 7.4 days.
The year 2014 was also the year that the Affordable Care Act placed insurance expansion into effect. It marks the first year in the CDC survey years that Medicaid and the Children’s Health Insurance Program (CHIP) accounted for the largest expected source of payment, at 34.9 percent. Next, was private insurance at about 34.6 percent of ED visits, with Medicare at 17.5 percent, and no insurance equaling 11.8 percent. Figure 1 reflects the trend in the payer mix over the years of CDC data collection. The trend continues for decreased use of emergency departments by patients who identified workers’ compensation as the source of payment, which is down to 0.8 percent. The most frequent payer type for admission to the hospital through the emergency department was Medicare (48 percent), followed by private insurance (42 percent), Medicaid or CHIP or other state-based program (22 percent), and no insurance (5.2 percent).