title: The prehospital and hospital costs of emergency care for frequent ED patients.
abstract: BACKGROUND
  Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care.
  
  
  METHODS
  Data on 2012 ED visits to a rural Level I Trauma Center and public safety net hospital were collected through a deidentified patient database. Transport data and 2012 Medicare Reimbursement Schedules were used to estimate the cost of EMS transport. Health information, outcomes, and costs were compared to find differences between the FP and non-FP group.
  
  
  RESULTS
  This study identified 1242 FPs who visited the ED 5 or more times in 2012. Frequent patients comprised 3.25% of ED patients but accounted for 17% of ED visits and 13.7% of hospital costs. Frequent patients had higher rates of chronic disease, severity scores, and mortality. Frequent patients arrived more often via ambulance and accounted for 32% of total transports at an estimated cost of $2.5-$3.2 million. Hospital costs attributable to FPs were $29.1 million, bringing the total cost of emergency care to $31.6-$32.3 million, approximately $25,000 per patient.
  
  
  CONCLUSIONS
  This study demonstrates that the inclusion of a prehospital cost estimate adds approximately 10% to the cost of care for the FP population. In addition to improving care for a sick population of patients, programs that reduce frequent EMS and ED use have the potential to produce a favorable cost benefit to communities and health systems.
authors.affiliation: University of Virginia School of Medicine. Electronic address: rgs5jz@virginia.edu.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Solberg
authors.affiliation: University of Virginia Health System. Electronic address: ble4n@hscmail.mcc.virginia.edu.
authors.forename: Brandy L
authors.initials: BL
authors.lastname: Edwards
authors.affiliation: University of Virginia School of Medicine. Electronic address: jpc5hr@virginia.edu.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Chidester
authors.affiliation: University of Virginia Health System. Electronic address: dgp3a@hscmail.mcc.virginia.edu.
authors.forename: Debra G
authors.initials: DG
authors.lastname: Perina
authors.affiliation: University of Virginia Health System. Electronic address: wb4z@hscmail.mcc.virginia.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Brady
authors.affiliation: University of Virginia Health System. Electronic address: mdw9g@hscmail.mcc.virginia.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Williams
mesh_terms: D000328:Adult; D015897:Comorbidity; D004632:Emergency Medical Services / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D064876:Safety-net Providers / Q000191:economics*; D014193:Trauma Centers / Q000191:economics*