Massachusetts emergency room use drops for fourth year in a row

Health

BOSTON (SHNS) – The frequency of Massachusetts residents using hospital emergency rooms dropped in 2019, continuing a years-long trend that could be driven in part by the emergence of alternatives like urgent care centers.

While Bay Staters continued to be hospitalized more than the national average, the statewide rate of emergency department visits dipped slightly to 351 per 1,000 residents in 2019, according to data presented at a Wednesday meeting of the Health Policy Commission’s Market Oversight and Transparency Committee.

That marked the fourth straight year of decline for the state’s emergency department use rate, which stood at 367 visits per 1,000 residents in 2016, 358 in 2017, and 357 in 2018.

Asked during Wednesday’s meeting if the rapid growth of urgent care centers contributed to the ER decline, HPC Research Director David Auerbach said the trends could be linked and that officials will continue to explore their overlap.

“The answer seems to be: a little bit,” Auerbach said. “That seems to be the conclusion from a number of studies. Probably not enough to really move the needle on ED visits, but some, yes. And that’s not the only way to measure the utility of urgent care centers.”

Over the past decade, retail clinics typically located inside pharmacy chains and urgent care centers that offer a larger range of services have exploded in popularity in Massachusetts.

In 2010, the state was home to 20 retail clinics and 18 urgent care centers. By 2017, the count stood at 58 retail clinics and 145 urgent care centers, according to an HPC report from 2018, and Auerbach said Tuesday the numbers have most likely increased since then.

The Commission’s 2018 analysis found that patients most often turned to those non-emergency options when experiencing common illnesses such as sore throats and respiratory infections, though other problems such as pains, wounds and ankle sprains were among the 20 most common reasons for visits at urgent care centers. Many locations have also offered COVID-19 testing or vaccines during the pandemic.

Past studies — including some referenced in a 2016 analysis analysis from Auerbach and others at the HPC — have projected that a sizable chunk of emergency room visits could be diverted to retail or urgent care facilities.

Experts at the Commission are working to update their 2018 Datapoints issue on urgent care facilities, and Auerbach said an ongoing study could offer more insight into how they fit into the state’s health care landscape.

Like the overall rate of emergency department visits, the statewide rate of avoidable and behavioral health emergency department visits also continued to drop in 2019, Auerbach said Wednesday. The margin of change was smaller: from 143 visits per 1,000 residents in 2018 to 142 per 1,000 in 2019 for avoidable visits, and from 28 visits per 1,000 residents in 2018 to 27 per 1,000 in 2019 for behavioral health reasons.

David Cutler, a Harvard University economics professor who chairs the committee, said the decline in emergency visits is “very impressive” amid an opioid epidemic that continues to rage “quite strongly in Massachusetts.”

“That suggests either some terrible things, that people are not making it to the ED, or that folks are doing some very, very good things to keep people out of the ED and getting people in treatment,” Cutler said.

Figures in Auerbach’s report only ran through 2018 or 2019, depending on the dataset, meaning none of the trends highlighted Wednesday factor in the COVID-19 pandemic’s impacts, which will likely drive down emergency room use even further.

An interim report the HPC released in April found that emergency department visits dropped considerably during the pandemic. The number from January to September 2020 was 23 percent lower than the same span in 2019, the commission said.

Auerbach presented more than two dozen charts depicting trends in hospital stays, spending across health systems, and price variations at Wednesday’s meeting.

The per-capita hospitalization rate in Massachusetts continued to hover about 8 percent above the U.S. average in 2018, the data show. The Bay State has had a higher rate than the nation since 2003.

Analysts found sizable variations in prices for many common health care services depending on where they were performed. In 2018, for example, the average mammography price at the highest-cost hospital was $152 more than at the lowest-cost hospital.

HPC Executive Director David Seltz said officials are discussing ways to deploy those datapoints to address gaps and inefficiencies more quickly than reviewing them at an annual cost trends hearing.

“Where we see these massive variations in either pricing or total medical spending, depending on where you go, there are opportunities here,” Seltz said.

The HPC typically releases an annual Cost Trends Report in January or February, but the final report will now come out in the summer after officials implemented a new schedule for providers to report data.

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