D547 Task 1 ED Data Analysis Presentation Example

Who Comes to the Emergency Department, and Why: Visits by Expected Source of Payment and What They Mean for a Composite Regional Hospital

Student Name

Leavitt School of Health, Western Governors University

D547: Evidence-Based Healthcare Administration, Task 1

Course Instructor

Month Day, Year

Slide 1: Purpose

Analyst briefing for Ridgeline Regional Hospital leadership

National emergency department visit data, analyzed by expected source of payment

Goal: understand visit patterns and prepare for regional benchmarking

Speaker notes: Good morning. As the quality improvement analyst, I was asked to use national emergency department visit data to help leadership understand who uses emergency departments and why, and to prepare for comparing our own department with regional benchmarks. Ridgeline Regional, a composite hospital, sees about 48,000 emergency visits a year. The data come from a national survey of emergency department visits of the kind the National Center for Health Statistics publishes, which records each visit's patient characteristics, reason for visit and diagnosis (National Center for Health Statistics, n.d.). The figures in this presentation are illustrative, and I built them with pivot tables in the accompanying workbook.

Slide 2: Why Expected Source of Payment

Four categories: private insurance, Medicare, Medicaid or CHIP, no insurance

Payment source shapes access to other care, and our finances

Our payer mix is shifting toward Medicaid and Medicare

Speaker notes: The data could be grouped by sex, age, race and ethnicity, region, metropolitan status or expected source of payment. I chose expected source of payment for three reasons. It reflects access to care outside the emergency department: people with different coverage have different options for primary and urgent care. It affects our revenue directly. And our own payer mix has been shifting toward Medicaid and Medicare over the past three years, so understanding these groups helps us plan. I used four categories: private insurance, Medicare, Medicaid or the Children's Health Insurance Program, and no insurance.

Slide 3: Private Insurance

Top primary diagnoses: abdominal and pelvic pain; chest pain

Most common reason for visit: stomach and abdominal pain

Mostly working-age adults; many visits end in discharge

Speaker notes: For privately insured patients, the pivot table filtered to private insurance and sorted by count shows that the two most common primary diagnoses were abdominal and pelvic pain and chest pain, and the most common reason patients gave for coming was stomach and abdominal pain. These are mostly working-age adults, and most of these visits end with the patient going home after tests rule out a serious cause. That pattern means much of the workload for this group is diagnostic: imaging and laboratory testing to exclude conditions such as appendicitis or a heart attack.

Slide 4: Medicare

Top primary diagnoses: chest pain; urinary tract infection

Most common reason for visit: shortness of breath

Oldest group; highest share admitted or placed in observation

Speaker notes: Medicare patients are mostly adults aged 65 and older. Their two most common primary diagnoses were chest pain and urinary tract infection, and the most common reason for visit was shortness of breath. This group had the highest share of visits ending in hospital admission or observation, which matters for us because these patients occupy emergency beds while they wait for inpatient or observation space.

Slide 5: Medicaid or CHIP

Top primary diagnoses: acute upper respiratory infection; abdominal pain

Most common reason for visit: fever

Youngest group; many visits are children, many in the evening

Speaker notes: Visits paid by Medicaid or the Children's Health Insurance Program include many children. The top primary diagnoses were acute upper respiratory infection and abdominal pain, and the most common reason for visit was fever. Many of these visits happen in the evening and on weekends, when pediatric offices are closed. Coverage itself tends to increase emergency department use: when Oregon enrolled adults in Medicaid by lottery, those who gained coverage used the emergency department about 40% more than those who did not over the following 18 months (Taubman et al., 2014). Coverage opens a door, but it does not create a primary care appointment at 9 p.m.

Slide 6: No Insurance

Top primary diagnoses: abdominal pain; sprains and strains

Most common reason for visit: stomach and abdominal pain

Higher share of injuries; fewer admissions; more leave before completion

Speaker notes: Uninsured patients showed the two most common primary diagnoses of abdominal pain and sprains and strains, with stomach and abdominal pain the most common reason for visit. Compared with the insured groups, a higher share of visits were for injuries, fewer led to admission and more patients left before their care was completed. For many uninsured patients, the emergency department is their only reliable source of care.

Slide 7: Three Notable Variations

1. Medicare visits: highest admission share, driven by chest pain and breathing problems

2. Medicaid or CHIP visits: youngest, respiratory and fever, concentrated after hours

3. Uninsured visits: more injuries and more left before completion

Speaker notes: Three variations stand out in the pivot chart comparing the four groups. First, Medicare visits lead to admission or observation far more often than the others, and they are driven by chest pain and breathing problems, which require monitoring and testing. Second, Medicaid and CHIP visits are the youngest and most often for respiratory infections and fever, and they cluster after regular office hours, which suggests a gap in pediatric access rather than a need for emergency-level care. Third, uninsured visits include more injuries and a higher share of patients who leave before completing care, which may reflect worry about cost. These variations matter because each points to a different operational response.

Slide 8: What This Means for Decisions

Medicare: expand observation capacity and chest pain pathway

Medicaid or CHIP: evening pediatric fast track; partnership with pediatric practices

Uninsured: financial counseling in the department; community clinic referral

Speaker notes: Each variation suggests a decision leadership could evaluate. For Medicare patients, an observation unit with a standardized chest pain pathway could shorten time in emergency beds. For Medicaid and CHIP patients, a fast track staffed for pediatric minor illness in the evening, or an after-hours partnership with local pediatric practices, could shorten waits. National estimates suggest that between 13.7% and 27.1% of emergency visits could be managed in urgent care centers or retail clinics, mostly for minor illness and injuries (Weinick et al., 2010). For uninsured patients, financial counselors in the department could screen for Medicaid eligibility and hospital charity care, and staff could refer patients to the federally qualified health center for follow-up.

Slide 9: Regional Benchmarking and Limits

Next step: compare our own visits with regional peers on the same measures

Sources: state hospital association data, the state discharge database

Limits: national data describe the country, not our community

Speaker notes: National data describe patterns across the country, not our community. To judge our own performance, we need regional benchmarks. I recommend two steps: first, request emergency department data by payer from the state hospital association or the state's hospital discharge database, which allows comparison with peer hospitals in our region; second, rebuild these same pivot tables from our own records, so we can see where we differ. The limits of this analysis should be kept in mind. The survey is a sample, so small categories are imprecise; diagnoses are recorded as the emergency physician understood them at the time; and the payer recorded is the expected source, which can change. Used with those limits, the data give us a clear starting point for decisions.

References

National Center for Health Statistics. (n.d.). Ambulatory health care data: Web tables. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/ahcd/web_tables.htm

Taubman, S. L., Allen, H. L., Wright, B. J., Baicker, K., & Finkelstein, A. N. (2014). Medicaid increases emergency-department use: Evidence from Oregon's Health Insurance Experiment. Science, 343(6168), 263-268. https://doi.org/10.1126/science.1246183

Weinick, R. M., Burns, R. M., & Mehrotra, A. (2010). Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs, 29(9), 1630-1636. https://doi.org/10.1377/hlthaff.2009.0748