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2011 2012 2011 2012 • ED Encounters Declined in 2012 for All Age Groups Williamson County (Wilco) Frequent Users of Emergency Department Services 2011 - 2012 June 2013 0 Introduction/Scope • A small cohort of individuals in Williamson County (Wilco) account for a disproportionate share of acute medical cases who: . Frequent the Emergency Department (ED) . Consume significant resources yet have poor health outcomes • Methodology . Time Period: Calendar Year 2011 and 2012 . Define FUs of ED based on utilization ≥ 5 ED visits w/in 3 months . Payor mix defined at ED Encounter . Conditions defined by Primary and Secondary Diagnosis . Zip Codes: ‒ Williamson County Zips Only - 76527, 76530, 76537, 76574, 76573, 76578, 78613, 78626, 78627, 78628, 78634, 78641, 78642, 78664, 78665, 78680, 78681, 78717, 78729 ‒ East Williamson County Zip Codes: - 76574 (Taylor), 76578 (Thrall), 78634 (Hutto), 76530 (Granger), 78615 (Coupland, NO DATA) • ICare data contributors: Austin Travis County EMS, ATCIC, CTMC, Seton, St. Davids, CommuniCare, CommUnityCare, El Buen, Lone Star Circle of Care, People’s Community Clinics, Seton Community Clinics, Volunteer Clinic 1 2012 Wilco ED Patient Demographics Age Ethnicity Payor Unique Patients Unique Patients Unique Patients Medicaid 6.9% 0.7% 3.4% 38.3% 6.1% 1.5% 10.0% 0.8% 41.5% Self Pay and 0-17 48.3% 14.2% SFS 25.6% 18-30 White Charity 31-50 Hispanic Unknown or Other 51-64 Black 65+ 35.6% County Other Indigent 38.5% CHIP 28.6% ED Encounters ED Encounters ED Encounters 0.5% 1.8%2.7% Medicaid 6.3% 5.3% 35.0% 9.9% 0.6% 47.9% 12.4% Self Pay and 0-17 48.2% White SFS 26.5% 18-30 Charity Hispanic 31-50 Black Unknown or 51-64 Other Other 65+ 36.6% County Indigent 34.5% CHIP 31.7% Source: 2011 - 2012 ICare Data 2 2011 Wilco ED Frequent Users – Age 1,000 958 20.0 Unique Patients 5.6% 10.3% 900 18.0 839 0-17 Years 800 16.0 33.3% 18-30 Years 700 14.0 31-50 Years 51-64 Years 600 12.0 50.8% 500 10.0 Rate ED Encounters 400 8.0 8.3% 300 6.0 34.0% 0-17 Years Unique Patients/ED EncountersUnique Patients/ED 195 200 4.0 28.2% 18-30 Years 125 99 31-50 Years 100 65 2.0 51-64 Years 20 11 0 0.0 0-17 Years 18-30 Years 31-50 Years 51-64 Years 29.6% Unique Patients ED Encounters Rate Source: 2011 - 2012 ICare Data 3 2012 Wilco ED Frequent Users – Age 1,000 12.0 Unique Patients 6.1% 6.6% 900 872 10.0 0-17 Years 800 18-30 Years 37.6% 700 652 31-50 Years 8.0 49.7% 51-64 Years 600 500 6.0 Rate ED Encounters 400 8.3% 4.0 300 34.0% 0-17 Years Unique Patients/ED EncountersUnique Patients/ED 200 28.2% 18-30 Years 121 2.0 98 31-50 Years 74 100 70 51-64 Years 13 12 0 0.0 0-17 Years 18-30 Years 31-50 Years 51-64 Years 29.6% Unique Patients ED Encounters Rate • 18-30 age group had the largest number of unique patients and encounters Source: 2011 - 2012 ICare Data 4 Wilco ED Frequent Users – Age Compared by Year Unique Patients Encounters 140 1000 958 900 872 120 839 800 99 98 100 700 652 600 80 74 65 500 60 400 40 300 195 20 200 124 121 20 13 12 11 100 70 0 0 0-17 18-30 31-50 51-64 0-17 18-30 31-50 51-64 2011 2012 2011 2012 • ED Encounters declined in 2012 for all age groups Source: 2011 - 2012 ICare Data 5 2011 Wilco Frequent Users – Ethnicity 1,200 1,182 12.0 Unique Patients 6.7% 3.1% 1,000 10.0 White Hispanic Black 800 754 8.0 35.1% 55.2% Other 600 6.0 Rate ED Encounters 400 4.0 8.3% Unique Patients/ED EncountersUnique Patients/ED 34.0% White 200 2.0 28.2% Hispanic 107 120 68 60 Black 13 6 Other 0 0.0 White Hispanic Black Other 29.6% Unique Patients ED Encounters Rate • The White group had the largest number of unique patients and encounters, followed by the Hispanic group Source: 2011 - 2012 ICare Data 6 2012 Wilco Frequent Users – Ethnicity 1,200 12.0 Unique Patients 6.6% 2.6% 1,000 971 10.0 White Hispanic 32.7% Black 800 8.0 58.2% Other 600 574 6.0 Rate ED Encounters 400 4.0 8.3% Unique Patients/ED EncountersUnique Patients/ED 34.0% White 200 2.0 28.2% Hispanic 114 132 64 Black 38 13 5 Other 0 0.0 White Hispanic Black Other 29.6% Unique Patients ED Encounters Rate • The trends from 2011 continue into 2012. The Hispanic and Black groups have higher rates of encounters per patient, however the number of Black patients is only 13 Source: 2011 - 2012 ICare Data 7 Wilco ED Frequent Users – Ethnicity Compared by Year Unique Patients Encounters 140 1200 1182 120 114 1000 971 107 100 800 754 80 68 574 64 600 60 400 40 200 20 13 13 120 132 6 5 60 38 0 0 White Hispanic Black Other White Hispanic Black Other 2011 2012 2011 2012 • While the ED encounter rate went up in 2012, the number of encounters was reduced in 2012 for White and Hispanic groups Source: 2011 - 2012 ICare Data 8 2011 Wilco ED Frequent Users – Payor Mix at ED 1,200 1,183 12.0 Unique Patients ED Encounters Rate 1,000 10.0 800 8.0 600 6.0 530 Rate 400 4.0 250 Unique ED Patients and EncountersPatientsandUnique ED 200 2.0 129 90 107 61 31 8 11 2 15 0 0.0 Medicaid Self Pay and Charity Unknown or County CHIP SFS Other Indigent • Medicaid patients had the highest encounter rate, other than County Indigent patients, however the number of County Indigent unique patients is 11 • Payor at ED encounter, a unique patient could have multiple payors Source: 2011 - 2012 ICare Data 9 2011 Wilco ED Frequent Users – Payor Mix Unique Patients Encounters Medicaid 0.7% 0.7% 5.1% 2.7% 3.7% 1.5% 11.8% Self Pay and 20.3% SFS 42.9% Charity 55.9% Unknown or Other 25.0% County Indigent 29.9% CHIP • Medicaid paid for the majority of encounters Source: 2011 - 2012 ICare Data Payor Mix at ED Encounter 10 2012 Wilco ED Frequent Users – Payor Mix at ED 1,200 9.0 Unique Patients ED Encounters Rate 8.0 1,000 7.0 800 800 6.0 5.0 600 551 4.0 Rate 400 3.0 260 Unique Patients/ED EncountersUnique Patients/ED 2.0 200 104 115 79 99 1.0 2 5 18 0 0.0 Medicaid Self Pay and Charity Unknown or County Indigent SFS Other • Rates of encounters per patients for Medicaid and Self-pay/SFS went down in 2012 Source: 2011 - 2012 ICare Data 11 2012 Wilco ED Frequent Users – Payor Mix at ED Unique Patients Encounters 5.7% Medicaid 0.6% 0.3%5.8% 32.7% 15.2% Self Pay and 24.8% SFS 46.6% Charity Unknown or Other 32.1% 36.2% County Indigent • The percentage of Medicaid patients in the overall payor mix was reduced from 2011 to 2012 Source: 2011 - 2012 ICare Data 12 Wilco ED Frequent Users – Payor at ED Compared by Year Unique Patients Encounters 140 1200 2011 2012 2011 2012 120 1000 100 800 80 600 60 400 40 200 20 0 0 • Medicaid patients and encounters were reduced in 2012 • There is a shift from Medicaid to Self-pay/SFS and Charity funded patients in 2012 Source: 2011 - 2012 ICare Data 13 Demographic Summary • Age . The 18-30 age group had the largest number of unique patients and encounters . ED Encounters declined in 2012 for all age groups • Ethnicity . The White group had the largest number of unique patients and encounters, followed by the Hispanic group . Ethnicity trends from 2011 continue into 2012. The Hispanic and Black groups have higher rates of encounter per patient, however the number of Black patients 13 . While the ED encounter rate went up in 2012, the number of encounters was reduced in 2012 for White and Hispanic groups • Payor . Medicaid patients had the highest rate of encounters per patient, and also the most encounters overall . Total Medicaid patients and encounters for Medicaid and Self-pay/SFS went down in 2012, as did the rate of Medicaid encounter per patient . The percentage of Medicaid patients in the overall payor mix was also reduced from 2011 to 2012 . There is a shift from Medicaid to Self-pay/SFS and Charity funded patients in 2012 14 Wilco ED Frequent Users vs. All ED Users Patients Unique • ED Frequent Users as a percent of all ED users remained about the same from 2011 to 2012 Source: 2011 - 2012 ICare Data 15 Wilco ED Frequent Users with Mental Health Dx Patients Unique • While ED use for patients with MH Dx declined from 2011 to 2012, EDFU patients with MH Dx remained about the same, resulting in a slight increase in percent of EDFU Source: 2011 - 2012 ICare Data 16 Wilco ED Frequent Users with Chronic Dx Patients Unique • Overall, Chronic Patients at the ED declined 12.4% from 2011 to 2012 while EDFU Chronic patients grew by 4.7% Source: 2011 - 2012 ICare Data 17 Wilco vs. E Wilco EDFUs - Clinic & IP Patients Unique • The number of ED Frequent Users from 2011 to 2012 decreased in clinic visits by 8.7%, while inpatient visits decreased by 35% • Percent of clinic and inpatient EDFU patients is for Wilco only Source: 2011 - 2012 ICare Data 18 Wilco EDFUs Frequency as % of all ED Encounters Encounters • The number of EDFU encounters, and the frequency of EDFU encounters as a percent of all ED encounters, declined from 2011 to 2012 Source: 2011 - 2012 ICare Data 19 E Wilco EDFUs Frequency as % of Encounters Encounters • East Wilco also saw a decline in the number of EDFU encounters, and the frequency of EDFU encounters as a percent of all ED encounters from 2011 to 2012 Source: 2011 - 2012 ICare Data 20 Wilco ED Frequent Users with a Mental Health Dx 100% 90% 80% 70% 65.3% 61.9% 60% 50% 40% 30% 20% 10% 0% 2011 2012 • Mental Health Dx at ED visits increased slightly from 2011 to 2012 • Note: Mental Health DX at the ED visit in primary or secondary position Source: 2011 - 2012 ICare Data 21 Wilco ED Frequent Users with a Chronic Health Dx 100% 90% 80.9% 80% 76.5% 70% 60% 50% 40% 30% 20% 10% 0% 2011 2012 • Chronic Dx at ED visits decreased slightly from 2011 to 2012 • Note: Chronic Health DX at the ED visit in primary or secondary position Source: 2011 - 2012 ICare Data 22 ED Service Locations for Patients Residing in Wilco 2011 2012 County Patient Encounter Patient Encounter
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