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Background <p>Emergency department (ED) visits are a common starting point for treatment of acute illness and may set a trajectory of care with substantial implications for quality and cost. Yet ED visits are rarely used to define episodes of care.</p> Objective <p>To examine hospital-level variation in ED-based episode spending and its drivers for commonly encountered conditions of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia.</p> Design <p>Claims-based, cross-sectional study of 83 Michigan hospitals.</p> Participants <p>Adult ED patients with CHF (<i>n</i> = 150,385), COPD (<i>n</i> = 156,833), and pneumonia (<i>n</i> = 114,867) between 2017 and 2022.</p> Main Measures <p>Outcomes were risk-adjusted, price-standardized, 30-day total and component (index ED and hospitalization if present, post-acute care, post-index hospitalization, professional services) ED-based episode payments.</p> Key Results <p>Hospitals in the highest vs lowest payment quartiles had mean total episode payments of $19,397 vs $14,601 for CHF (difference 24.7%, <i>P</i> &lt; 0.001), $13,048 vs $8,723 for COPD (difference 33.1%, <i>P</i> &lt; 0.001), and $13,466 vs $9,168 for pneumonia (difference 31.9%, <i>P</i> &lt; 0.001). For CHF, high-payment hospitals had 33.3% higher index ED/hospitalization costs, 15.3% higher post-acute care costs, and 33.4% higher professional fees, with similar post-index hospitalization costs. Patterns were consistent across conditions, although post-index payments varied more for COPD and pneumonia. Index ED/hospitalization payments were strongly correlated with total episode payments (CHF: <i>r</i> = 0.82; COPD: <i>r</i> = 0.90; pneumonia: <i>r</i> = 0.80; all <i>P</i> &lt; 0.001).</p> Conclusions <p>ED-based 30-day episode payments vary substantially across hospitals for CHF, COPD, and pneumonia, largely driven by costs from the ED visit and associated hospitalization. Future work should assess whether this variation reflects differences in quality or efficiency.</p>

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Variation and Drivers of Spending Within 30-Day Emergency Department-Based Episodes of Care

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月11日

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  • Keith E. Kocher,
  • Alexander T. Janke,
  • Kristen P. Hassett,
  • Chelsea A. Pizzo,
  • Anita A. Vashi,
  • Michael P. Thompson

摘要

Background

Emergency department (ED) visits are a common starting point for treatment of acute illness and may set a trajectory of care with substantial implications for quality and cost. Yet ED visits are rarely used to define episodes of care.

Objective

To examine hospital-level variation in ED-based episode spending and its drivers for commonly encountered conditions of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia.

Design

Claims-based, cross-sectional study of 83 Michigan hospitals.

Participants

Adult ED patients with CHF (n = 150,385), COPD (n = 156,833), and pneumonia (n = 114,867) between 2017 and 2022.

Main Measures

Outcomes were risk-adjusted, price-standardized, 30-day total and component (index ED and hospitalization if present, post-acute care, post-index hospitalization, professional services) ED-based episode payments.

Key Results

Hospitals in the highest vs lowest payment quartiles had mean total episode payments of $19,397 vs $14,601 for CHF (difference 24.7%, P < 0.001), $13,048 vs $8,723 for COPD (difference 33.1%, P < 0.001), and $13,466 vs $9,168 for pneumonia (difference 31.9%, P < 0.001). For CHF, high-payment hospitals had 33.3% higher index ED/hospitalization costs, 15.3% higher post-acute care costs, and 33.4% higher professional fees, with similar post-index hospitalization costs. Patterns were consistent across conditions, although post-index payments varied more for COPD and pneumonia. Index ED/hospitalization payments were strongly correlated with total episode payments (CHF: r = 0.82; COPD: r = 0.90; pneumonia: r = 0.80; all P < 0.001).

Conclusions

ED-based 30-day episode payments vary substantially across hospitals for CHF, COPD, and pneumonia, largely driven by costs from the ED visit and associated hospitalization. Future work should assess whether this variation reflects differences in quality or efficiency.