The efforts to reduce emergency department usage have worked. Hospital data show that from 2012-14
compared to 2009-2011, emergency department visits dropped by more than 10 percent. And visits for
conditions, known as Ambulatory Care Sensitive Conditions, which might have been prevented by appropriate
outpatient care, dropped by 61 percent. The rate of other potentially avoidable ED visits has decreased by 12
percent. Emergency department visits from frequent users (those with four or more visits in a calendar year)
have decreased by 15 percent.
While the health system is providing more appropriate care to its patients, it comes at a cost. Each ED visit
replaced by an office visit saves the healthcare system $450, but that’s $450 Franklin loses.
“All of this highly skilled care coordination negatively impacts the overall financial stability of the
organization,” Dubord said. “Insurance reimburses hospitals a lot more for patients seen in the ED than those
seen by a primary care provider.
“Nurses’ follow-up phone calls to patients are also not reimbursed by insurance, nor is time spent in
coordination meetings where providers discuss care strategies for high ED utilization patients. Until payers
develop new reimbursement methods for keeping patients well, providers like Franklin will be caught between
doing the right thing for patient care and maintaining the overall financial sustainability of their organization,”
Dubord said. “The old fee-for-service reimbursement system has to change more quickly if forward-thinking,
wellness-focused organizations like Franklin are going to be able to continue the population health and
wellness work that needs to be the backbone of our healthcare system."
Franklin Memorial Hospital
Data from the hospital show that emergency department
visits dropped by more than 10 percent.
