Minnesota employers, health plans and individuals spent $1.9 billion in 2012 for health care that potentially could have been prevented.
So says the state's Department of Health in a first-in-the-nation analysis released today on visits to emergency rooms and hospital admissions and readmissions. Nearly 1.3 million patient visits that year potentially could have prevented, according to the analysis.
Using data collected for about 4.3 million Minnesotans covered by private and public health insurance, the health department used a system by 3M Health Information Systems to analyze care that might have been prevented by timely access to quality outpatient care, improved medication management, greater public knowledge about health and health services, and better coordination of care among health care providers.
The amount spent on preventable care amounted to 4.8 percent of Minnesota's total health care spending that year, said Dr. Ed Ehlinger, the state's health commissioner, in a news conference on Wednesday.
"No one likes to pay unnecessary medical bills or wants to take a trip to the hospital that could have been avoided," Ehlinger said.
By far the biggest overuse came in the emergency room, the analysts reported, with 1.2 million visits that shouldn't have been necessary at a cost of about $1.3 billion.
That's no surprise to Scott Wolff of St. Luke's hospital, an emergency room doctor for 27 years. Nor is he optimistic about change.
"I've been doing this for almost three decades, and always this has been an issue and it is getting worse," Wolff said.
The emergency department at St. Luke's is invariably "redlined," meaning it is at or beyond capacity, he said. He was able to speak with a reporter on Wednesday only because he had been assigned to urgent care that day.
Much of the problem, Wolff said, is a lack of doctors in primary care.
"I see plenty of people who say: I called my primary care doctor and they said go to the ER," Wolff related.
Authors of the analysis were quick to point out that it's not realistic to expect to save all of the $1.9 billion. Some individual cases should be treated in a hospital or ER even if, in general, that kind of case shouldn't require that level of care, they wrote. Moreover, money likely will have to be spent in other areas to prevent unnecessary care from happening in the hospital, they wrote.
"Eliminating all potentially preventable events is likely not a realistic goal," the analysts wrote.
It may not even be desirable, Wolff said, when primary care isn't quickly available. For instance, the report included urinary tract infection as an example of an ER visit that could have been treated in primary care. But such an infection, if not treated promptly, can lead to complications. So if the patient has to wait three weeks to see a family doctor, it might be better to go to the ER, he said.
Ehlinger said the analysis is intended as a "baseline," to measure future progress in reducing unnecessary visits. Data were not available for groups such as those served by the Veterans Administration and for the uninsured, he said. There's also no way to compare Minnesota with other states because no similar study has been done in any other state. In fact, only a handful of states collect data that's comprehensive enough to make such an analysis possible, according to the report.
The report wasn't broken down by geographic region or to analyze the differences between urban and rural areas. Looking for variation among geographic areas and provider types is part of the work that lies ahead, said Stefan Gildemeister, the state's health economist.