AHRQ Stats: Medicare “Super-Utilizer” Patients

“Super-utilizers" -- patients who visit an emergency department (ED) four times or more in a year -- accounted for 19 percent of ED visits by people on Medicare for urinary tract infections in 2014. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #221: Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014.)

Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014

H. Joanna Jiang, Ph.D., Audrey J. Weiss, Ph.D., and Marguerite L. Barrett, M.S.

Introduction

Over the last several years, health care stakeholders have paid increasing attention to issues specific to high-need, high-cost patients who constitute a very small percentage of the population but account for a disproportionally high amount of health care utilization. These patients, dubbed super-utilizers, represent a broad spectrum of demographic and clinical characteristics and socioeconomic conditions. Programs designed to improve care for super-utilizers need to be tailored to the specific needs of the different subgroups of these patients. As part of this effort, it is important to examine differences in utilization patterns among different types of super-utilizers, in comparison to national benchmarks.

Highlights

Emergency department (ED) super-utilizers were defined as those patients with the highest number of ED visits in 2014, by payer: four or more visits for privately insured patients aged 1-64 years or Medicare patients aged 65 years and older; six or more visits for Medicaid or Medicare patients aged 1-64 years.

In 2014, although super-utilizers constituted a relatively small proportion of all patients seen in the ED (2.6 to 6.1 percent, depending on the payer-age group), they accounted for a large share of all ED visits (10.5 to 26.2 percent).

Among Medicare patients aged 65 years and older, those with three or more chronic conditions constituted 33.3 percent of all ED visits among super-utilizers compared with 26.7 percent of ED visits among other patients.

ED super-utilizers accounted for 15 to 34 percent of all ED visits for abdominal pain and 13 to 29 percent of all ED visits for back pain.

ED super-utilizers aged 65 years and older accounted for 19 percent of all ED visits for urinary tract infections, 16 percent of ED visits for nonspecific chest pain, and 14 percent of ED visits for superficial injury.