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Admiral’s Corner

Rear Admiral Elizabeth Niemyer, Regional Director, TRO-West

This month, I will address Emergency Department (ED) utilization, which is an area of concern for all of us in the Military Health System (MHS).

Rising utilization costs were discussed in various forums at the MHS conference and continue to be a major focus area for TRICARE Management Activity (TMA) and the MHS.

TMA and TRICARE Regional Office-West (TRO-W) contracted with Deloitte Consulting LLP (Limited Liability Partnership) and Zogby International (“the Contractors”) to conduct a telephone survey with West Region TRICARE beneficiaries who visited the emergency room during April - June 2009. The survey assessed the potential causality of ED over-utilization, with the purpose of contributing to a better understanding of MHS patient preferences for urgent care and how to provide better access, safety and quality at lower costs.

The ED Utilization Survey results of more than 1,800 West Region patients showed nearly nine of 10 respondents said they went to an ED because they believed their problem warranted ED attention. Two-thirds of the respondents from the survey stated they went to the ED during the business week between the hours of 8 a.m. and 8 p.m. These numbers suggest time and day are not primary reasons for going to the ED. One-third of the respondents called their primary care managers (PCM) to make an appointment prior to going to the ED, and 55 percent said they go to the ED because it has convenient hours.

West Region military treatment facility (MTF) and Network Prime patients use the ED at an average rate similar to that of Medicare and uninsured patients in the general U.S. population. However, only 5 percent of the West Region’s ED patients are admitted to the hospital, compared with 14.7 percent of national ED patients. This data suggests that MTF and Network Prime ED patients use the ED for less acute care than the private-sector population visiting the ED.