New Health Claims Analysis Shows Colorado Could Save Millions by Avoiding the Emergency Room for Routine Conditions

Over $800 Million Annually in Potential Savings Possible

Nov 04, 2015, 10:29 ET from The Center for Improving Value in Health Care (CIVHC)

DENVER, Nov. 4, 2015 /PRNewswire/ -- New analysis from the Center for Improving Value in Health Care (CIVHC) based on claims from the Colorado All Payer Claims Database (CO APCD) shows Coloradans visiting the emergency room (ER) for common health concerns are paying more for care.

Analysis of commercial health payer claims data in the CO APCD shows that Colorado could save an average of $1,150 per visit and over $800 million annually if patients used a clinic or doctor's office for non-emergent situations.

The new report also identifies staggering cost differentials between non-urgent health issues seen in an ER versus an outpatient setting such as a physician's office or urgent care center:

  • Common cold - $709 versus $114
  • Acute Bronchitis - $999 versus $126
  • Sore Throat - $929 versus $131
  • Backache - $1,337 versus $188
  • Headache - $2,010 versus $375

According to the Colorado Health Access Survey (CHAS), roughly 40 percent of Colorado's ER visits occur for non-emergent reasons. Given the estimated 1.8 million visits to Colorado's ERs annually, that equates to roughly 720,000 potentially avoidable visits and substantial cost savings.

"If you have a true emergency, it's obviously important to call 911 or go to an ER," said Ana English, CEO and President for CIVHC. "However, this CO APCD analysis shows that patients and the health system in general could save a lot of money while still receiving the care they need."

The 2015 CHAS study found that patients who visit the ER for non-emergent reasons most often do so because of convenience, after-hours availability, referral from a doctor, or their doctor's office wasn't able to see them in a timely manner. National data shows that everyday health complaints like the common cold and headaches consistently rank in the top ten reasons why patients visit the emergency room.

"A number of methods can be deployed to reduce unnecessary emergency department visits including patient education regarding appropriate care settings, enhanced coordination among providers and care givers, and increased access to outpatient office visits at night and on the weekends," the new CIVHC Cost Driver Spot Analysis concludes. To see the Cost Driver Spot Analysis: Avoidable Emergency Department Use, visit

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SOURCE The Center for Improving Value in Health Care (CIVHC)