• Introduction
  • Conclusions
  • Article Information

A, Emergency department visit counts in 5 EDs in New York and US coronavirus disease 2019 (COVID-19) cases (plotted on a log scale) are shown. B, Hospital admission rates from the ED and New York’s new daily confirmed COVID-19 cases per 1 million population are shown. New York data are plotted separately to avoid obscuring trends in states with lower daily ED visit counts.

Emergency department visit counts in 19 EDs in 4 states and US coronavirus disease 2019 cases (plotted on a log scale) are shown. Circles indicate specific daily values for each variable. UCHealth indicates University of Colorado Health; UNC, University of North Carolina.

Hospital admission rates from the ED in 4 states and each state’s new daily confirmed coronavirus disease 2019 cases per 1 million population are shown. Circles indicate specific daily values for each variable. UCHealth indicates University of Colorado Health; UNC, University of North Carolina.

eFigure 1. Daily Emergency Department Visit and Admission Counts in 5 EDs in NY

eFigure 2. Daily Emergency Department Visit and Admission Counts in 5 EDs in CO

eFigure 3. Daily Emergency Department Visit and Admission Counts in 4 EDs in CT

eFigure 4. Daily Emergency Department Visit and Admission Counts in 5 EDs in MA

eFigure 5. Daily Emergency Department Visit and Admission Counts in 5 EDs in NC

  • Changes in Patterns of Acute MI or Ischemic Stroke Hospitalization During COVID-19 Surges JAMA Research Letter July 6, 2021 This study evaluates changes in rates of patients hospitalized for acute myocardial infarction (AMI) or suspected stroke during COVID-19 surges in the US as a measure of willingness to seek care during the pandemic. Matthew D. Solomon, MD, PhD; Mai Nguyen-Huynh, MD; Thomas K. Leong, MPH; Janet Alexander, MSPH; Jamal S. Rana, MD, PhD; Jeffrey Klingman, MD; Alan S. Go, MD
  • Learning from the Decrease in US Emergency Department Visits in Response to the COVID-19 Pandemic JAMA Internal Medicine Invited Commentary October 1, 2020 David L. Schriger, MD, MPH

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Jeffery MM , D’Onofrio G , Paek H, et al. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Intern Med. 2020;180(10):1328–1333. doi:10.1001/jamainternmed.2020.3288

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Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US

  • 1 Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
  • 2 Department of Health Care Policy Research, Mayo Clinic, Rochester, Minnesota
  • 3 Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 4 Information Technology Services, Yale New Haven Health System, New Haven, Connecticut
  • 5 Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill
  • 6 Department of Emergency Medicine, University of Massachusetts Medical School–Baystate, Springfield
  • 7 Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora
  • 8 Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • Invited Commentary Learning from the Decrease in US Emergency Department Visits in Response to the COVID-19 Pandemic David L. Schriger, MD, MPH JAMA Internal Medicine
  • Research Letter Changes in Patterns of Acute MI or Ischemic Stroke Hospitalization During COVID-19 Surges Matthew D. Solomon, MD, PhD; Mai Nguyen-Huynh, MD; Thomas K. Leong, MPH; Janet Alexander, MSPH; Jamal S. Rana, MD, PhD; Jeffrey Klingman, MD; Alan S. Go, MD JAMA

Question   How did emergency department visits and hospitalizations change as the coronavirus disease 2019 (COVID-19) pandemic intensified in the US?

Findings   In this cross-sectional study of 24 emergency departments in 5 health care systems in Colorado, Connecticut, Massachusetts, New York, and North Carolina, decreases in emergency department visits ranged from 41.5% in Colorado to 63.5% in New York, with the most rapid rates of decrease in visits occurring in early March 2020. Rates of hospital admissions from the ED were stable until new COVID-19 case rates began to increase locally, at which point relative increases in hospital admission rates ranged from 22.0% to 149.0%.

Meaning   The findings suggest that clinicians and public health officials should emphasize to patients the importance of continuing to visit the emergency department for serious symptoms, illnesses, and injuries that cannot be managed in other clinical settings.

Importance   As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known.

Objective   To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US.

Design, Setting, and Participants   This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states’ COVID-19 case counts.

Exposures   Time (day) as a continuous variable.

Main Outcomes and Measures   Daily counts of ED visits, hospital admissions, and COVID-19 cases.

Results   A total of 24 EDs were studied. The annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York. The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about COVID-19. Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally; the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina.

Conclusions and Relevance   From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.

As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, the delivery of acute care changed to accommodate an influx of patients with a highly contagious infection about which little was known. Initial public health messaging advised avoiding unnecessary health care use to reduce transmission of the virus and to ensure capacity to accommodate surges in COVID-19 cases. 1 An early report 2 suggested that use of health care services for elective and emergency conditions decreased during this period. Reductions in emergency department (ED) use could reflect (1) failure by patients with serious or life-threatening conditions to seek care, including conditions unrelated to COVID-19 3 ; (2) avoidance of the ED for nonemergency conditions; or (3) displacement of ED care to other venues, such as telemedicine visits. 4 We studied changes in ED use in 5 health care systems representing geographically diverse areas in 5 states in the first months of the COVID-19 pandemic in the US.

This cross-sectional study used data from a number of large US health care systems that were collected as part of an ongoing trial of ED prescribing practices for opioid use disorder; the original study protocol was approved by the Western Institutional Review Board with reliance agreements by the individual institutions’ institutional review boards. 5 The Western Institutional Review Board approved an amendment to this study protocol with an exemption of informed consent to collect data on ED visits and hospital admissions to better understand the association of COVID-19 with trial enrollment. The study also used deidentified quality improvement data from Mount Sinai Health System (New York City) that were collected to assess staffing and resource use during the COVID-19 outbreak and were considered exempt from institutional review board review under 45 CFR §46.101(b)(4).

For January 1 to April 30, 2020, we examined trends in daily ED visits and the rate of hospital admissions from EDs that are part of 5 large, independent health care systems in 5 states. One data set came from Mount Sinai Health System (New York), and four came from health systems in the EMBED trial: Baystate Health (Massachusetts), University of Colorado Health (UCHealth, Colorado), Mount Sinai Health (New York), University of North Carolina (UNC) Health, and Yale New Haven Health (Connecticut). We analyzed these trends in the context of publicly reported national and state COVID-19 case counts. We abstracted visit data from electronic health record databases at each health care system with structured queries of their local Epic Clarity databases (Epic Systems), with the exception of Baystate Health, which uses Cerner (Cerner Corporation). We retrieved daily COVID-19 case counts from the Johns Hopkins University Center for Systems Science and Engineering public data feed. 6 We standardized new confirmed state COVID-19 cases to state populations using US Census Bureau data on estimated population as of July 1, 2019. 7

We display the data as scatterplots with overlaid nonparametric smoothed curves generated with a locally weighted scatterplot smoothing (LOWESS; bandwidth 0.2) method. This method computes a separate least-squares regression for each data point, using a subset of points around the central data point in the regression and applying greater statistical weight to nearer points. 8 In addition to being a useful visualization technique, LOWESS can be used to estimate fitted values of the dependent variable for each value of the independent variable. These values were used to compute relative changes in admission rates and case counts to minimize the effect of outliers by estimating minima and maxima based on a local weighted mean, rather than using the more extreme observed maxima and minima; relative changes were calculated based on the LOWESS-estimated extrema. All analyses were performed using Stata statistical software, version 16.1 (StataCorp).

The 24 EDs varied widely in size and setting; data came from 5 EDs in Connecticut, Massachusetts, New York, and North Carolina and 4 EDs in Colorado. Annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; 15 of the EDs were in urban areas, 5 were suburban, and 4 were rural; 7 were academic and 17 were community sites ( Table ).

In all 5 states, there were large decreases in ED visits, with the most rapid decrease beginning the week of March 11, 2020, as the increase in the US case count for COVID-19 accelerated ( Figure 1 and Figure 2 ). The largest decrease in LOWESS estimates of visits was seen in New York (63.5%), followed by Massachusetts (57.4%), Connecticut (48.9%), North Carolina (46.5%), and Colorado (41.5%). In 3 states, (Massachusetts, Colorado, and North Carolina), small increases in ED visits occurred in late April 2020. Trends in rates of hospital admissions from the ED were associated with state-level new COVID-19 case counts ( Figure 1 and Figure 3 ). Hospital admission rates were stable in each state until that state’s COVID-19 case rate began to increase. The largest relative increase in LOWESS estimates of admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina.

Hospital admission rates were initially steady despite decreasing ED visits because trends in hospital admission counts were associated with ED visit counts (eFigures 1-5 in the Supplement ). The temporal association between the increase in each state’s COVID-19 caseload and hospital admission rates was less apparent when hospital admission counts were plotted. The exception is in the Mount Sinai Health System, where smoothed hospital admission counts appeared to peak approximately 1 week before the peak of the New York COVID-19 case rate. The ED visit count in the Mount Sinai Health System continued to decrease as hospital admission counts and state COVID-19 cases increased; there was a similar although less pronounced pattern for Yale New Haven Health.

As the COVID-19 pandemic developed and intensified in the US during the first 4 months of 2020, we found that ED visit counts decreased and the rates of hospital admissions from the ED increased in 5 health care systems in 5 states. From their height in January to their lowest point in April, ED visits decreased by more than 40% in all the health care systems and by more than 60% in New York, where the pandemic was most severe. Rates of hospital admission from the ED were stable until COVID-19 cases increased locally, suggesting lower patient volume and higher acuity in the ED as the COVID-19 pandemic spread. Despite different timing and increased rates of COVID-19 cases locally, we observed similar patterns and timing of ED visits across the 5 health care systems, with the steepest decrease in visits beginning the week of March 11, 2020. A possible explanation for these temporal associations is that the public responded more to national-level risk messaging about COVID-19 than to changes in the local situation with regard to reported cases. For example, individuals may have avoided seeking emergency care because of a fear of being exposed to COVID-19 in the ED, concerns about the possibility of extended wait times, or a sense of civic responsibility to avoid using health care services that others may have needed. 2

Even as ED visits decreased most rapidly, initial admission rates from the ED were initially stable, indicating that admission counts were decreasing as well. However, a temporal association was found between the increase in each state’s COVID-19 caseload and admission rates. We did not attempt to identify ED visits possibly associated with COVID-19, so we cannot report the decrease in non–COVID-19 ED visits. The association between COVID-19 and ED visits by patients seeking care for reasons unrelated to COVID requires further study.

Although our study could not establish the reasons for the changes in ED visits and hospital admissions that we observed, it provides insight into the COVID-19 pandemic for the medical community and the public during the COVID-19 pandemic. First, practitioners and public health officials should emphasize the importance of continuing to visit the ED for serious symptoms, illnesses, and injuries that cannot be managed in other settings, such as telemedicine visits. Second, infection control measures that protect patients and staff are essential in the ED and other clinical settings. Third, public health authorities and health care systems should provide guidance and resources to help patients determine the best place to receive care as the available health care capacity changes during the pandemic. 9

Among the limitations of our study is that the findings may not be generalizable outside the 5 health care systems that we studied. Moreover, the study data did not include diagnoses; therefore, we could not assess how the ED patient case mix may have changed during the study period. Although the data revealed a steep decrease in the use of the ED in the 5 health care systems from the middle of March to the middle of April 2020, they cannot be used to determine whether people with serious symptoms, illnesses, and injuries went untreated because of the COVID-19 pandemic. 10

From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.

Accepted for Publication: June 6, 2020.

Published Online: August 3, 2020. doi:10.1001/jamainternmed.2020.3288

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2020 Jeffery MM et al. JAMA Internal Medicine .

Corresponding Author: Edward R. Melnick, MD, MHS, Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Ste 260, New Haven, CT 06519 ( [email protected] ).

Author Contributions: Drs Jeffery and Melnick had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jeffery, D’Onofrio, Nath, Melnick.

Acquisition, analysis, or interpretation of data: Jeffery, Paek, Platts-Mills, Soares, Hoppe, Genes, Melnick.

Drafting of the manuscript: Jeffery, D’Onofrio, Paek, Hoppe, Genes, Nath, Melnick.

Critical revision of the manuscript for important intellectual content: Jeffery, D’Onofrio, Paek, Platts-Mills, Soares, Hoppe, Melnick.

Statistical analysis: Jeffery, Paek, Soares, Nath, Melnick.

Obtained funding: D’Onofrio, Melnick.

Administrative, technical, or material support: Paek, Platts-Mills, Hoppe, Nath, Melnick.

Supervision: D'Onofrio, Hoppe, Melnick.

Conflict of Interest Disclosures: Drs. Jeffery, D'Onofrio, Platts-Mills, Soares, Hoppe, Nath, and Melnick reported receiving grants or contracts from the National Institutes of Health (NIH) during the conduct of the study. No other disclosures were reported.

Funding/Support: This work is supported within the NIH Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director and cooperative agreement UH3DA047003 from the National Institute on Drug Abuse.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Additional Contributions: Bill K. Ross, North Carolina Translational and Clinical Sciences Institute, University of North Carolina School of Medicine; Haiping Li, MD, Department of Emergency Medicine, University of Massachusetts Medical School–Baystate; and Sean S. Michael, MD, Department of Emergency Medicine, University of Colorado, School of Medicine, assisted with data collection, and Oliver Hulland, MD, Department of Emergency Medicine, assisted with editing. None of these individuals were compensated for their work.

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Maternal & Child Health Data

Emergency room visits, 2020–2021.

Frequent emergency room visits can indicate unmet health needs, barriers to accessing pediatric care, or unsafe living environments for children. Population Health Management, 22 (3), 262–271. https://www.liebertpub.com/doi/10.1089/pop.2018.0089"> Nationally, 15 percent of children under age 18 visited the emergency room between 2020 and 2021. In 2015, children under age 5 and from households with low incomes had disproportionate rates of emergency room visits. Overview of pediatric emergency department visits, 2015 (HCUP Statistical Brief No. 242). Agency for Healthcare Research and Quality. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb242-Pediatric-ED-Visits-2015.jsp"> In 2020, unintentional injuries were a leading cause of death and disability among children aged 1–4. Ten leading causes of death and injury by Age Group-2020 . https://wisqars.cdc.gov/data/lcd/home"> Not all families have equal access to health care and other services that support children’s health. Structural racism in the health care field can also drive differences in access to preventive care across racial and ethnic groups. The table below presents data disaggregated by race and ethnicity to help us identify inequities and work toward solutions that promote equity.

Home Visiting as Part of the Solution. Beyond helping families access health care services, home visitors also provide parents with knowledge and training to increase their awareness of potential safety hazards and make their homes safer for children. For example, educating parents about “baby proofing” their homes can reduce unintentional injuries.

Emergency Room Visits by State, 2020-2021

emergency room visit data

Notes: NA indicates that the total number of respondents to this measure (unweighted denominator) is less than 30, which does not meet Maternal and Child Health Bureau data display criteria. Counts associated with specific racial and ethnic groups (that is, Asian, Black or African American, Hispanic, White) are mutually exclusive.

Definition: Emergency room visits refers to the percentage of children aged 0–5 who visited the emergency room 1 or more times for any reason in the past 12 months. The full population sample, pooled from 2020–2021 data, includes non-institutionalized children in the United States aged 0–17, and is weighted to be representative of that subgroup of the U.S. population.

Source: Child and Adolescent Health Measurement Initiative. 2020–2021 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). www.childhealthdata.org

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Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

Associated data.

Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers.

We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims–based definition, 2) facility claims–based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions.

Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other definitions including 17% more ED visits than the provider definition and 2% fewer visits than the ResDAC definition. Differences in ED visitation counts between each definition occurred for several reasons including the inclusion of critical care or observation services in the ED, discrepancies between facility and provider billing regulations, and operational decisions of each definition.

Current operational definitions of ED visitation using administrative claims produce different estimates of ED visitation based on the underlying assumptions applied to billing data and data set availability. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consistent, consensus ED visitation definitions to standardize research reporting and the interpretation of policy interventions.

Administrative claims data sets are often used by emergency care researchers and policymakers to define cohorts of patients for acute care research, and more commonly, such data sets are used outside of emergency medicine to define emergency department (ED) visits as an outcome for studies of healthcare resource utilization or evaluation of quality improvement interventions such as care coordination. 1 – 5 Despite the high profile of ED visits in analyses using administrative claims, little work has sought to rigorously compare the degree to which estimates based on data created for billing purposes differ in describing the clinical construct of an ED visit in which a patient seeks acute, unscheduled care for undifferentiated clinical scenarios at a hospital-based ED. 6 Previous publications and technical reports have often suggested definitions for an ED visit specific to the limitations of certain data sets with little supporting analyses to provide reassurance to clinicians or policymakers charged with interpreting research findings. 7 , 8 As a result, variations in the definition of ED visitation may overcount ED visits by capturing nonhospital services or under-count ED visits by failing to capture ED visits cooccurring with critical care or observation.

Administrative claims of Medicare beneficiaries are the most frequently used data set for researchers as well as policymakers. An unstructured search of publications in the past 10 years revealed over 135 publications using Medicare data and over 1,500 publications using administrative claims data with mention of the “emergency department.” Similarly, ED visits are defined in the cohort or outcomes of 29 quality measures endorsed by the National Quality Forum that use administrative claims data. Given federal efforts at data transparency, 9 statistics derived from Medicare administrative claims data are also used by public and private organizations seeking to advance policy agendas. Furthermore, recent consensus statements have also supported the increased use of administrative claims data for research in emergency care. 10 However, complicating these efforts has been the consistency in how ED visits are operationally defined.

Therefore, we sought to compare four operational definitions for ED visitation using a comprehensive Medicare data set. We contrasted three established operational definitions used by policymakers and researchers with one we constructed based on emergency care expert opinion and clinician review that utilized all relevant data sources.

Design and Data Set

We used a 20% random sample of the Medicare Chronic Condition Warehouse (CCW) data set. 11 CMS draws the sample for the data set from all Medicare fee-for-service beneficiaries. This data set includes all Medicare claims for each included beneficiary between January 2012 and December 2012. The data set has undergone substantial “cleaning” to ensure that only final, adjudicated claims are included to increase reliability. The Medicare CCW data set is an ideal data source for this study because all Medicare Part A (inpatient hospital and skilled nursing) and Part B (hospital outpatient and physician) services are captured in the data set for each included beneficiary.

Definitions

For this analysis we compared four operational definitions of an ED visit. Three established definitions were identified based on a review of the peer-reviewed literature, federal government–authored research reports, and technical guidance available for national quality measures. One definition, the Yale definition, was developed to utilize these established definitions and additional expert review. All definitions are intended to identify hospital-based ED visits, consistent with the Institute of Medicine’s conceptual focus on hospital-based emergency care 6 that is the current focus of most existing health services research and quality measures:

  • Provider definition : Several researchers have used physician service, or “carrier,” claims to identify ED visits. Provider-defined ED visits are those with Part B claims for Healthcare Common Procedure Coding System (HCPCS) codes 99281, 99282, 99283, 99284, and 99285. 12 – 15
  • Facility definition : hospital inpatient and outpatient facility claims are commonly used by researchers and by CMS to define ED visits. 16 , 17 For this definition, we considered an ED visit presence of ED revenue center codes 0450–0459, 0981 in the hospital outpatient department or hospital inpatient department claims.
  • ResDAC definition : The CMS Research Data Assistance Center (ResDAC) publishes guidance for researchers using Medicare administrative claims data. The most recent definition, published in July 2015, defines an ED visits as a hospital outpatient or inpatient claims with revenue center codes 0450–0459, 0981 or a hospital inpatient claim with an emergency room charge > $0. 8 , 18

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Yale emergency department visit definition derivation. 1 Carrier claim lines with the same BENE_ID, LINE_1ST_EXPNS_DT, PRF_PHYSN_NPI, and TAX_NUM are considered duplicates from coding. 2 Outpatient claim lines with the same BENE_ID, REV_CNTR, and PRVDR_NUM, and both HCPCS_1ST_MDFR_CD and HCPCS_2ND_MDFR_CD not equal to 25 or 27 are considered duplicates from coding. 3 Only the first line in each inpatient claim is considered a real ED visit. The rest in the same claim are considered duplicates within hospitalization. HCPCS = Healthcare Common Procedure Coding System.

Approach to Development of the Yale Operational Definition for ED Visitation

To develop our Yale operational definition of an ED visit we first sought to capture all possible healthcare service use that could represent an ED visit. To do this we first included all physician service claims used for ED services (HCPCS 99281, 99282, 99283, 99284, 99285, 99291) 19 and all hospital outpatient and inpatient claims that indicated use of ED services based on revenue center codes (0450–0459, 0981). As many claims included numerous “claim lines” for distinct healthcare services over broad ranges of time, we consider each individual claim line as a possible visit for this analysis.

For analyses of all definitions we first excluded all duplicate claims likely to reflect billing errors. To exclude duplicate facility claims, we considered hospital outpatient or inpatient facility claims conducted at the same hospital (defined by Medicare provider number) and by the same physician (defined by NPI number) on the same date without use of coding modifier 25 or 27, which indicate unique same-day ED visits, to be duplicate claims. To exclude duplicate provider claims, we considered all provider claims with identical ED location (based on hospital Medicare provider number), identical ED clinician (based on NPI number), and identical date of service to be duplicate claims.

Given that most ED visits include the creation of both a facility claim (hospital outpatient or hospital inpatient) as well as a provider claim we also sought to identify any overlapping claims reflecting the same ED visit. Currently, Medicare regulations for hospital facility care pay for ED services as “bundled” within the single Diagnosis-Related Group (DRG) payment set by the Inpatient Prospective Payment System for admitted patients or as an Ambulatory Payment Classification (APC) set by the Outpatient Prospective Payment System for patients not admitted to inpatient status. At the same time, Medicare pays for provider services in the ED based on HCPCS codes billed to Medicare separately by the provider. To avoid duplicate counting of overlapping claims, we first assumed that each provider claim was likely to represent a unique ED visit because billing guidelines for hospital outpatient visits carry greater ambiguity than provider claims with regards to the definition of emergency services. 20 While one previous study similarly sought to combine facility and provider claims to define ED visitation, our approach allows for repeat ED visitation within 72 hours, which have been shown to be common and were excluded by prior work. 21 – 23 We therefore considered any hospital inpatient or outpatient claim for an ED visit on the same day, previous day, or following calendar day as an overlapping visit that should not be counted as a unique ED encounter ( Table 1 ). Additionally, because providers or facilities claims may often include multiple ED visits on the same claim as a result of the claim adjudication and reporting processes, the number of ED visits captured by each definition can exceed the total number of claims.

Analysis of Related Facility and Provider ED Visit Claims

To select only those claims likely to represent traditional ED care involving care by a physician or mid-level provider in a hospital-based ED open 24 hours a day 7 days a week, we identified several clinical scenarios for further exclusion or inclusion:

  • Use of critical care services outside the ED: As the acuity of patients evaluated in the ED has increased over the past decade, the billing of critical care services (HCPCS 99291) in the ED has also risen. 20 , 24 Because current Medicare Part B guidelines do not allow for the duplicative billing of Critical Care Services and Evaluation and Management Services (HCPCS 99281–99285) in the ED, we excluded all provider claims for HCPCS 99291 in which the place of service was not the ED.
  • Non-ED setting claims: We identified several types of professional provider claims and facility claims that may occur outside the ED setting but billed with similar codes such as services provided in physician offices, urgent care, and nursing facilities and at home. Current provider and facility claims include “place of service” designations that differentiate between these settings and the ED. 25 While these codes are not sensitive, they are quite specific; therefore, we excluded any provider claims with place of service outside the ED (place of service = 23; Data Supplement S1 , available as supporting information in the online version of this paper ).
  • Observation admissions: The majority of observation services are provided by ED-managed observation units and current Part B payment regulation do not allow for physicians of the same tax identification number (TIN) or medical specialty to provide evaluation and management services for both an ED visit and admission to observation. 26 – 28 Therefore, use of ED provider claims may not capture all ED visits resulting in observation. We defined any visit resulting in hospital observation service use (outpatient revenue center 0762 or outpatient revenue center 0760 and HCPCS G0378) in which a hospital revenue center code for ED services is also present (0450–0459, 0981) as evidence of an ED visit. 20 , 30

While these clinical scenarios are not currently specified within existing operational definitions, ED visits captured or excluded by these scenarios are variably captured by each existing provider, facility, and ResDAC operational definitions based solely on select billing criteria.

We present descriptive statistics for each definition and compare our novel definition of an ED visit to existing definitions using 2 × 2 tables of agreement. We report McNemar’s test to assess statistical agreement between our definition and each operational definition. To account for multiple statistical comparisons we utilize the conservative Bonferroni correction with subsequent alpha = 0.0125. As a secondary analysis, we also tested the sensitivity of the Yale definition to provider claim date of service accuracy by re-creating each 2 × 2 table of agreement assuming that a provider claim ±2 days or ±3 days from a facility claim represented a matched ED visits.

A total of 10,717,786 beneficiaries were included in the 2012 Medicare CCW 20% sample data set representing care for over 50 million Medicare fee-for-service beneficiaries across the United States. A description of the sample is seen in Table 2 . A total of 2,356,226 beneficiaries (22%) had any evidence of ED use during the study year including 5,028,314 claims.

Study Sample, the 20% Sample of 2012 Medicare CCW *

CCW = Chronic Condition Warehouse; SNF = skilled nursing facility.

The provider claims–based definition identified a total of 4,199,148 ED visits, the facility claims–based definition 4,795,057 visits, the ResDAC definition 5,278,980 visits, and the Yale definition 5,192,235 ED visits ( Figure 1 and Table 3 ). The Yale definition was statistically different (p < 0.05) from all other definitions ( Table 3 and Figure 2 ). Of note, we did not identify any ED visit claims with revenue center codes 0453, 0454, 0455, 0457, or 0458 in our data set as these revenue center codes are reserved for ED billing use but are not currently used and therefore did not result in the identification of any ED visits under any definition.

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Emergency department visit frequency based on administrative claims definition. ResDAC = CMS Research Data Assistance Center. [Color figure can be viewed at wileyonlinelibrary.com]

Agreement Between Each ED Visit Definition

While no single difference between each administrative claims definition can explain observed differences in ED visit estimates, several of the clinical scenarios resulted in notable differences in the capture of ED visits. For example, inclusion of HCPCS 99291 in the operational definition to capture critical care services performed in the ED resulted in 293,083 ED visits not captured by traditional provider claims HCPCS definitions. Also, the use of facility claims for outpatient observation services captured 40,744 claims, not otherwise captured by previously used provider- and facility-based definitions. A qualitative description of various clinical and billing scenarios that may explain differences between each definition is presented in Table 4 .

Clinical and Billing Scenario Differences Between ED Visit Operational Definitions

E&M = Evaluation and Management.

Sensitivity analyses allowing for broader date of service matching between provider and facility claims demonstrated minimal changes to Yale definition ED visit estimates. Allowing for a 2-day window for matching reduced the total number of ED visits identified by 38,123 (0.73%) while allowing for a 3-day matching window reduced the total number of ED visits identified by 56,833 (1.1%), and all comparisons remained statistically difference ( Data Supplements S2a and S2b , available as supporting information in the online version of this paper ).

Using all relevant sources of administrative claims for Medicare beneficiaries, we found marked differences in estimates of ED visitation between four operational definitions. Operational definitions utilizing all relevant provider- and facility-based data sources capture more ED visits than definitions limited to narrower provider- or facility-specific data sets. Furthermore, our application of clinical review to generate a new operational definition of ED visitation further identified ED visits not captured by previous definitions. These definitional differences underscore the importance of developing and validating consistent, consensus-based definitions of ED visitation for researchers and policymakers.

This work provides several points of guidance to researchers seeking to use administrative claims data for emergency care research. First, use of provider claims without facility claims may identify substantially fewer ED visits. Primarily, traditionally applied provider definitions include the five primary Evaluation and Management (E&M) billing codes (9928x) used by emergency physicians and in turn fail to capture the increasing use of critical care billing codes for ED professional services. Less commonly, there may be scenarios in which ED services are used for suture or packing removal (following either epistaxis or abscess drainage) that would not be billable by a physician but likely by a facility. Also, some triage only services may have been billable by facilities but not in physicians in 2012, although this practice is no longer permitted. For example, if emergency triage services are delivered as part of an advanced treatment protocol such as an EKG then a facility may produce a chargeable event without an associated emergency physician charge. 31

Second, we found that definitions of ED visits that rely on facility claims, including the ResDAC definition, do not capture a potentially meaningful proportion of ED visits in comparison to the operational definition that includes provider claims. This may be the result of a number of potential clinical scenarios involving the ED. For example, there are situations in which an accompanying professional fee E&M claim is not permitted under billing regulations. Such scenarios include ED-operated observation units in which E&M provider claims are not permitted for the initial emergency services will not be identified by the facility definition. In addition, the use of non–ED-specific critical care HCPCS codes by emergency clinicians may not be captured by either the facility or the ResDAC definitions. Also, these facility-based definitions may overcount the number of ED visits by capturing outpatient hospital services labeled as “emergency services” but actually occurring outside the ED on an unscheduled basis such as hemodialysis or infusion services. 32 In addition, facility-based definitions may capture ED visits not captured by the traditional provider definition under exceptional circumstances when a primary care doctor or specialty physician evaluates a patient in the ED without emergency clinician evaluation or when a patient is briefly evaluated in ED triage, such as a patient in active labor, but rapidly moved to another part of the facility for which services are billed instead of emergency services. Conversely, the Yale definition’s use of provider claims in addition to facility claims could estimate a higher number of ED visits than the facility and ResDAC definitions if the matching based on the date of service between the provider and facility files creates inaccuracies. Our approach sought to limit this by setting a ±1-day data range resulting in 92% of facility claims overlapping a provider claim and being considered one ED visit. Our sensitivity analyses confirmed that this assumption did not materially impact results as using a less restrictive overlap of ±2 or ±3 days.

Interestingly, the ResDAC definition’s higher estimate of ED visitation as a result of including some potentially non-ED facility claims was offset by the lower estimation of other ED visits captured in provider claims. The comparable total ED visit count between the ResDAC and Yale definition should not be interpreted as evidence of agreement, or even similarity, but rather as coincidental to various assumptions applied to the data. Furthermore, given variation in coding practices both between and within facilities, it is unlikely that analyses of ED visits for a given clinical condition, geography, or hospital would be similar between the ResDAC and Yale definition as a result of this balancing effect.

Given these differences between facility and provider claims, researchers interesting in studying ED utilization should utilize more comprehensive data sets to improve epidemiologic accuracy and build the foundation for a future consensus definition. As more comprehensive data sets, including all-payer claims databases that include both facility and provider claims from numerous payers, become increasingly available researchers should develop algorithms that better match actual emergency care billing patterns to ensure the validity of findings.

In addition to improving the reporting, specification, and rationale of operational definitions using administrative claims, future work should seek to develop a consistent, common definition for emergency care. The inherent variability in not only the organization of emergency care services, but more importantly the billing and coding of these services, is likely inevitable and necessitates a consensus definition. Previous work in other specialties such as cardiology and infectious diseases have dedicated substantial attention and resources to developing administrative claims–based definitions for clinical entities such as acute myocardial infarction and pneumonia, yet little work has dedicated such attention to health service concept such as ED visitation or intensive care unit services to support national epidemiologic studies and the development of quality measures. 3 , 34 Consistent definitions specific to each data set are also important for the measurement of healthcare services that are not clinically defined as prior work has shown marked differences in hospital readmission measurement based on the data source or administrative claims definition used. 35 – 37 The development of consistent definitions would also permit researchers to conduct meta-analyses and permit policymakers to compare results of studies conducted in disparate states or geographies. Future efforts such as the Society of Academic Emergency Medicine Consensus Conference could be used to establish consensus definitions for acute care researchers. 10

For policymakers seeking to develop metrics of ED utilization the use of a consistent and valid ED visit definition is critical to understanding the scope of quality measures, the actual effects of interventions, and the degree to which subsequent policy changes are necessary. Recent work assessing the validity of hospital-level measures of acute myocardial infarction mortality has shown that attribution based on ED visitation can substantially impact reported hospital mortality scores based on Medicare administrative claims; 38 as such, ensuring that the underlying ED visit is accurately identified is paramount to the credibility of national quality programs.

The development of a single consensus definition of an ED visit within administrative claims would be ideal; however, the sustainability of such a definition will be challenging as billing and coding practices change. Therefore, due to current limitations in data availability, several consistent, consensus definitions may be desirable to support research objectives or policy purposes that require narrower or broader interpretations of emergency care. As CMS payment policy in conjunction with healthcare delivery system changes result in evolving hospital and provider billing practices, users of administrative claims data will need to continually apply clinical reasoning to capture elements of acute care that may not always be considered a traditional ED visit such as hospital-based urgent care, freestanding ED care, or select urgent procedures. Regardless of the clinical nuances of individual studies, however, the use of a consistent base definition is essential to ensuring the validity of emergency care research.

LIMITATIONS

Several limitations of this work warrant mention. First, there is no criterion standard definition for an ED visit in administrative claims; therefore, we cannot conclude that the operational definition developed is more or less accurate than alternative definitions. More detailed review would require comparison with chart abstracted data; however, that is likely to be too resource-intensive to be conducted and further amplifies the need for investigations such as this. Second, our study was conducted on a Medicare data set, which may limit the translation of the Yale definition to other commonly used administrate claims data sets with more constrained data, such as the State Emergency Department Databases (SEDD) and State Inpatient Department Databases (SIDD) assembled by the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project (HCUP), in which only hospital facility claims are available. Regardless, the derivation principles outlined in this work are likely generalizable and provide guidance to both future analyses as well as users of the data. Third, because our study utilized Medicare administrative claims in which facilities and provider groups, identified by CMS certification number (CCN) or TIN may only bill CMS for services once per day, interfacility transfers within the same CCN or TIN may not capture both ED visits in any of the four definitions. Finally, our definition of an ED visit is based in a conceptual model seeking to identify hospital-based emergency care, which may not capture newer forms of emergency care such as some of the care delivered in freestanding EDs or urgent care centers for which services are billed as physician office visits and not as emergency services.

CONCLUSIONS

Operational definitions of ED visitation used for administrative claims–based research and policy widely differ based on underlying assumptions of billing data and data set availability. The use of a comprehensive operational definition that incorporates all relevant data sources as well as expert clinical review generates different estimates of ED visitation than operational definitions traditionally used by researchers and policymakers. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consensus ED visitation definition to standardize research reporting and support health policy evaluation.

Supplementary Material

(a) agreement between each ed visit definition (±2 day); (b) agreement between each ed visit definition (±3 day).

Frequency of place of service codes by ED HCPCS coding.

Frequency of place of service codes by ED HCPCS coding

(a) Agreement between each ED visit definition (±2 day); (b) agreement between each ED visit definition (±3 day).

Acknowledgments

We thank Julia Eichenfeld for her dedicated support as research assistants to this work.

The authors have no relevant financial information or potential conflicts to disclose.

Supporting Information

The following supporting information is available in the online version of this paper

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Preliminary Findings from Drug-Related Emergency Department Visits, 2021

Preliminary Findings from Drug-Related Emergency Department Visits, 2021. An analysis of 2021 preliminary data presents (1) nationally representative weighted estimates for the top five drugs in drug-related ED visits, (2) the assessment of monthly trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals, and (3) the identification of drugs new to DAWN’s Drug Reference Vocabulary.

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Emergency rooms fill up fast. Here are top 10 reasons why people head to hospital

It's something nobody wants to do.

No matter how sick you are, there's nothing worse than having to go to the emergency room. You are sitting with other sick people, it's expensive and you know unless you get lucky or you pick the perfect time to get medical attention, you're going to have to wait.

But why do most people go to the ER?

Kratom enthusiasts Be Happy Go Leafy broke down the numbers and came up with the top 10 reasons people visit the emergency room. 

According to the release, 12,441,000 people go to the ER each year for stomach and abdominal issues. The second most common reason was chest pains and other related symptoms, with an estimated 7,811,000 visits per year. Ranking third was shortness of breath, sending about 5,918,000 visitors per year.  

Top 10 reasons people go to the ER

1. stomach and abdominal pain, cramps, and spasms .

The most common reason for visits to the emergency department was issues relating to the stomach and abdomen, with an estimated 12,441,000 visits per year. 

A range of medical conditions can cause pain, cramps, and spasms in the stomach and abdominal area. These include appendicitis, hernias, viral or bacterial infections, and digestive issues. 

Issues relating to the stomach or abdominal area were the top reason for males and females under 15 years old, with 1,312,000 visits yearly. It was also the most common reason for males and females between the ages of 15 and 64, with 9,354,000 visits yearly. It was also the second most common reason for males and females 65 and over, with 1,774,000 visits per year.  

2. Chest pain and related symptoms 

The second most common reason for people to visit the emergency department was chest pain and related symptoms, with an estimated 7,811,000 visits per year.  

There are many reasons why someone may experience chest pain and related symptoms. Causes can range from anxiety attacks to heart and lung conditions, including a heart attack or experiencing a blood clot in the lungs.  

Chest pain and related symptoms were not common reasons for visits to the emergency department for males and females under the age of 15. It was the second most common reason for males and females aged between 15-64, with an estimated 5,957,000 visits to the emergency department per year.  

For males and females over the age of 65, chest pain and related symptoms were the third most common reason, with an estimated 1,601,000 visits per year.  

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3. Shortness of breath 

The third most common reason for visits to the emergency department was shortness of breath, with an estimated 5,918,000 visits per year.  

The leading causes of shortness of breath are problems relating to the heart and lungs. Causes can include heart attacks, asthma, low blood pressure, pneumonia, and anxiety attacks.  

For males and females aged 65 and over, shortness of breath was the most common reason for visits to the emergency department, with an estimated 2,153,000 visits.  

Shortness of breath was the third most common reason for males aged between 15 and 64 and the fourth most common reason for females aged between 15 and 64, with an estimated 3,314,000 visits per year.  

This symptom was an uncommon cause of visits to the emergency department for males and females under the age of 15, however. 

4. Cough 

Experiencing a cough was the fourth most common reason for people to visit the emergency department, with an estimated 4,655,000 visits annually.   

Viruses such as the common cold and flu are the most common reason for a cough. A cough can also be caused by more severe issues such as asthma, COPD, pneumonia, and bronchitis. 

A cough was the most common reason for visits to the emergency department by males and females under the age of 15, with an estimated 2,354,000 visits per year. It was the eighth most common reason for males and females between the ages of 15-64, with an estimated 1,923,000 visits. A cough was not a common reason for those over 65.  

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5. Fever 

The fifth most common reason for people to visit the emergency department was for a fever, with an estimated 4,650,000 visits per year.  

A body temperature of 100.4F or above classifies as a fever, which is often caused by viral or bacterial infections, heat exhaustion, or certain inflammatory conditions. 

Fevers were only a common reason for emergency department visits for males and females under the age of 15. It was the most common reason, with an estimated 3,402,000 visits per year.  

6. Headache, pain in the head 

The sixth most common reason people visited the emergency department was for a headache or other pain in the head, with an estimated 3,893,000 visits per year.  

Causes of a headache may include stress, dehydration, muscular tension, dental or jaw problems, and eyesight problems. 

It was the third most common reason for females between the ages of 15 and 64 and the seventh most common reason for males in the same age range, with an estimated 2,932,000 visits per year. It was only the eighth most common reason for females aged 65 and over, with an estimated 384,000 visits. Headaches were not a common reason for males and females under 15 to visit the emergency department, however. 

7. Pain, site not referable to specific body system 

The seventh most common reason people visited the emergency department was for pain that is not referable to a specific body system, with an estimated 3,365,000 visits per year.

This can refer to any pain in the body that isn’t directly linked to any of the central body systems. These include skeletal, muscular, nervous, endocrine, cardiovascular, lymphatic, respiratory, digestive, urinary, and reproductive. 

For females between the ages of 15 and 64, this type of pain was the seventh most common reason for visits, and for males aged 15 to 64, it was the fourth most common. The estimated visits for this age range were 2,715,000 per year. For males aged 65 and over, this type of pain was the tenth most common reason for visits to the emergency department, with an estimated 246,000 visits.  

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8. Back symptoms 

The eighth most common reason why people visited the emergency department was for back symptoms, with an estimated 3,050,000 visits per year. 

Back symptoms refer to any pain or discomfort felt in the back area. This can include muscle aches, shooting or stabbing pain, or a burning sensation.  

For males and females between the ages of 15 and 64, back symptoms were the sixth most common reason, with an estimated 2,249,000 visits annually. For females aged 65 and over, back symptoms were the fifth most common reason, and for males aged 65 and over, it was the sixth most common reason. 

9. Vomiting 

The ninth most common reason people visited the emergency department was vomiting, with an estimated 2,810,000 visits per year.   

Causes of vomiting may include infections, pregnancy, food poisoning, reaction to medication, and overeating.  

Vomiting was only a common reason for males and females under the age of 15, ranking as the fourth most common cause, with an estimated 1,212,000 visits per year.  

10. Psychological and mental disorders 

Rounding out the top ten are other symptoms or problems relating to psychological and mental disorders, with an estimated 2,429,000 visits per year.  

This can include hallucinations, restlessness, delusions, panic attacks, and persistent feelings of sadness.  

Symptoms and problems relating to psychological and mental disorders were only common in males between the ages of 15-64, with an estimated 993,000 visits, the fifth most common reason in this age range. 

This article originally appeared on Asbury Park Press: Emergency rooms fill up fast. Here are top 10 reasons why people head to hospital

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HHS Statement Regarding the Cyberattack on Change Healthcare

The U.S. Department of Health and Human Services (HHS) is aware that Change Healthcare – a unit of UnitedHealth Group (UHG) – was impacted by a cybersecurity incident in late February. HHS recognizes the impact this attack has had on health care operations across the country. HHS’ first priority is to help coordinate efforts to avoid disruptions to care throughout the health care system.

HHS is in regular contact with UHG leadership, state partners, and with numerous external stakeholders to better understand the nature of the impacts and to ensure the effectiveness of UHG’s response. HHS has made clear its expectation that UHG does everything in its power to ensure continuity of operations for all health care providers impacted and HHS appreciates UHG’s continuous efforts to do so. HHS is also leading interagency coordination of the Federal government’s related activities, including working closely with the Federal Bureau of Investigations (FBI), the Cybersecurity and Infrastructure Security Agency (CISA), the White House, and other agencies to provide credible, actionable threat intelligence to industry wherever possible.

HHS refers directly to UHG for updates on their incident response progress and recovery planning. However, numerous hospitals, doctors, pharmacies and other stakeholders have highlighted potential cash flow concerns to HHS stemming from an inability to submit claims and receive payments. HHS has heard these concerns and is taking direct action and working to support the important needs of the health care community.

Today, HHS is announcing immediate steps that the Centers for Medicare & Medicaid Services (CMS) is taking to assist providers to continue to serve patients. CMS will continue to communicate with the health care community and assist, as appropriate. Providers should continue to work with all their payers for the latest updates on how to receive timely payments.

Affected parties should be aware of the following flexibilities in place:

  • Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.
  • CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.
  • CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State. 
  • If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.
  • CMS has contacted all of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While we recognize that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method.

CMS has also heard from providers about the availability of accelerated payments, like those issued during the COVID-19 pandemic. We understand that many payers are making funds available while billing systems are offline, and providers should take advantage of those opportunities. However, CMS recognizes that hospitals may face significant cash flow problems from the unusual circumstances impacting hospitals’ operations, and – during outages arising from this event – facilities may submit accelerated payment requests to their respective servicing MACs for individual consideration. We are working to provide additional information to the MACs about the specific items and information a provider’s request should contain. Specific information will be available from the MACs later this week.

This incident is a reminder of the interconnectedness of the domestic health care ecosystem and of the urgency of strengthening cybersecurity resiliency across the ecosystem. That’s why, in December 2023, HHS released a concept paper that outlines the Department’s cybersecurity strategy for the sector. The concept paper builds on the National Cybersecurity Strategy that President Biden released last year, focusing specifically on strengthening resilience for hospitals, patients, and communities threatened by cyber-attacks. The paper details four pillars for action, including publishing new voluntary health care-specific cybersecurity performance goals, working with Congress to develop supports and incentives for domestic hospitals to improve cybersecurity, increasing accountability within the health care sector, and enhancing coordination through a one-stop shop.

HHS will continue to communicate with the health care sector and encourage continued dialogue among affected parties. We will continue to communicate with UHG, closely monitor their ongoing response to this cyberattack, and promote transparent, robust response while working with the industry to close any gaps that remain.

HHS also takes this opportunity to encourage all providers, technology vendors, and members of the health care ecosystem to double down on cybersecurity, with urgency. The system and the American people can ill afford further disruptions in care. Please visit the  HPH Cyber Performance Goals website for more details on steps to stay protected.

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Terrorism: Reducing Vulnerabilities and Improving Responses: U.S.-Russian Workshop Proceedings (2004)

Chapter: the role of the russian ministry of emergency situations and executive branch agencies of the city of moscow in dealing with emergency situations arising from acts of terrorism, the role of the russian ministry of emergency situations and executive branch agencies of the city of moscow in dealing with emergency situations arising from acts of terrorism.

Aleksandr M. Yeliseev *

Moscow Main Administration for Civil Defense and Emergency Situations

The problems of ensuring the security of people and territory are a top priority for executive- and legislative-branch agencies of the Russian Federation. The major radiation accident at the Chernobyl Atomic Power Station in 1986 and the destructive Spitak earthquake in 1988 demonstrated the need for creating a Russian system for preventing and eliminating the consequences of emergency situations. The Ministry for Civil Defense, Emergency Situations, and Elimination of the Consequences of Natural Disasters (MChS) became the central component in this system. Territorial subunits of the MChS are among the executivebranch agencies of the various republics and oblasts that make up the Russian Federation, and they act at the local level to implement state policy with regard to protecting people and territory from emergency situations.

Moscow has historically represented the spiritual center of the Russian land. It is Russia’s largest industrial center, making a substantial contribution to the country’s overall economic indicators. Our city is the country’s most important transport hub, on which the operation of the entire Russian transportation system is dependent. It represents the most important concentration of financial and information flows, which has a significant impact on the development of the state as a whole. Moscow is the center of scientific and cultural life, the focal point of a significant part of our national heritage, and a unique world-class historical and architectural center. All of these factors determine the level of the threat to the vital interests of citizens, social groups, and the city as a whole.

The following types of threats are most typical: criminal, terrorist, social, political, infrastructural, natural, industrial, environmental, informational, and psychological. These threats are of a complex and interrelated nature, with the majority being transnational in scale. These circumstances are characteristic of almost all the world’s major megacities; therefore, they call for a great deal of attention to be devoted by the city leadership to problems of ensuring the security of urban facilities and residents of the capital.

Here, we proceed from the belief that ensuring the security of the population against emergency situations resulting from terrorism, natural and industrial disasters, and other causes is a difficult and complex task, and carrying it out successfully can be done only with the active involvement of all city departments, agencies, and organizations. Therefore, the Moscow City System for Preventing and Eliminating the Consequences of Emergency Situations was created in 1996, functionally linking the city’s various district and departmental services units. City policy for ensuring the security of the population and the urban infrastructure is implemented through the Commissions on Emergency Situations, which have been established in each agency and department of the city administration and which are headed by leaders at the corresponding level. This operating principle facilitates management of the actions of city units in preventing emergencies as well as responding to threats and responding to emergencies once they have occurred. It is also helpful in coordinating the actions of the various services and organizing and efficiently carrying out emergency rescue operations.

In connection with the implementation of a special law passed by the city of Moscow, work is under way citywide to implement a comprehensive targeted program for improving the Moscow city system for preventing and eliminating the consequences of emergency situations. The program was developed on the initiative of the Moscow City Government and the MChS and was supported by the deputies of the Moscow City Duma. The basic goals of the program include

implementing a set of measures aimed at preventing emergency situations, including the establishment of an effective system for monitoring and predicting accidents, catastrophes, and natural disasters

modernizing the management and communications system through the widespread use of the latest information technologies

improving the speed and efficiency of emergency response by creating a highly mobile and technically well equipped rescue service and by developing aviation technologies for use in emergency rescue operations

improving the citywide system for educating the population on the appropriate actions to be taken during emergency situations

However, in recent years terrorism has been one of the main threats to public security. It presents a special danger to major cities and political, economic, and cultural centers. Terrorist acts are taking on ever-increasing scale and

becoming more and more diverse both in form and in the goals for which they are carried out.

Since 1998, Moscow has been subjected to terrorist attacks on more than one occasion. We remember the bombings of apartment buildings on Guryanov Street and Kashirskoe Shosse, the shopping mall at Manezh Square, the underground passageway at the Pushkinskaya metro station, and the seizure of hostages during the performance of the musical Nord-Ost , in which more than 3,000 people were victims, of whom about 600 were killed.

These events have shown that terrorist acts are ever more frequently moving from the realm of potential threats to that of real emergency situations. In our view it is the world community’s failure to respond appropriately to the terrorist acts committed in Moscow in the fall of 1999 that led to the tragic events of September 11, 2001, in the United States. Those events demonstrated once again that terrorism has no nationality but rather is international in nature, and not a single state is secure against it.

Expert assessments highlight the broad scope of this phenomenon, and many believe that at present in the various countries of the world there are about 100 major terrorist organizations, which maintain contacts among themselves. Therefore, the problem goes beyond the bounds of individual states. Furthermore, in recent years terrorism has acquired the capability of using the achievements of science and technology to further its criminal aims.

We have great understanding for the position of the New York City authorities, as we ourselves were on the scene only minutes after the bombings of the Moscow apartment buildings in 1999. Under the leadership of Moscow Mayor Yury M. Luzhkov and Russian Emergency Situations Minister Sergei K. Shoigu, we organized efforts to deal with the consequences of these explosions. We provided detailed reports on these incidents to the European community at an international conference in Vienna in 2000.

Antiterrorism activities in Moscow are conducted at all levels of the city government. This work is coordinated by an antiterrorism commission operating under the leadership of the city’s mayor, and includes the following activities:

improving laws related to the struggle against terrorism

increasing the effectiveness of preventive measures

ensuring the secure operations of industrial facilities and sites where large numbers of people gather

I would like to say that we have done a certain amount of work to ensure the security of residents and of the capital in general, primarily with regard to the creation of laws and regulations addressing these matters.

The city has recently enacted a Law on Protecting the Population and Territory of the City of Moscow from Emergency Situations of Natural and Industrial Origin. A strategy for the security of Moscow has also been adopted, outlining in

systematic form the views of the city’s leadership on ensuring the safety of its residents. In the process of developing this strategy, the programs Moscow Radiation Security and Moscow Chemical Security were also created and adopted to deal with matters related to protecting potentially dangerous facilities against terrorism. In the past few years, Moscow has passed more than 100 regulations governing matters related to the city’s security, and we are prepared to acquaint representatives of the international community with them.

Executive-branch agencies are devoting special attention to monitoring and controlling the activities of all officials involved in implementing preventive measures against emergency situations. In 2002 alone, the State Inspectorate for Protecting the Population and Territory from Emergency Situations conducted checks at more than 10,000 enterprises, organizations, and institutions. Those guilty of violating urban security regulations face administrative penalties and are prosecuted through the civilian court system.

City policy regarding new construction is pursued rather effectively. Moscow has established a system of measures that prohibits the construction or reconstruction of any industrial buildings, housing, or other public facilities that do not include design features intended to prevent possible emergency situations, including potential terrorist acts.

The city has created the Center for Monitoring and Forecasting Emergency Situations, for which the main objectives are the prevention and early detection of emergencies. The components of this system include stationary and mobile Lidar units, which use laser, infrared, and visual observation methods to detect fires and atmospheric emissions of harmful substances.

In accounting for the large amounts of special cargo (gasoline, reagents for refrigeration systems, and so forth) that pass through Moscow and other world cities, cargo that also represents a potential threat of the commission of terrorist acts, we have tightened controls on the transport of such materials by road and rail within the city limits. The city’s law enforcement agencies are paying special attention to the safety of capital residents in locations where large numbers of people gather, such as markets, fairs, and the sites of large cultural events and sports competitions.

The quality of efforts to prevent and eliminate the consequences of emergency situations depends primarily on the level of preparedness of the leadership, specialists, and city residents. This matter is being addressed by providing training to almost all categories of city residents at special educational institutions, enterprises, and places of residence. For example, in 2002, about 30,000 people received special training at educational centers and more than 2 million blue- and white-collar personnel received training at their worksites.

Training games represent the most effective form of preparation for individuals in positions of leadership. Such games allow participants to practice dealing with matters such as procedures for notification and assembly of senior officials, technologies for application in emergency rescue operations and oth-

er urgent activities, organization of assistance to city service providers in eliminating the consequences of emergency situations, comprehensive provision of aid and services to the affected population, and a number of other citywide undertakings.

Earlier this year, a special tactical training exercise was conducted at a Moscow subway station to focus on coordinating the activities of city services in eliminating the consequences of a possible terrorist act involving the use of dangerous chemical substances. During the training exercise, a number of practical measures were developed with the aim of improving the efficiency of emergency rescue efforts under such conditions, and these measures have now been submitted to the Moscow City Government for review.

Efforts to train young people occupy an important place in our work. Last year, in cooperation with the Moscow Educational Committee, we began training students from the capital’s higher educational institutions to serve as reserve rescue personnel. A class entitled “Principles of Everyday Safety” has also been introduced for students in all grades in elementary and secondary schools. The number of participants in “Safety School” competitions is constantly on the rise. Each year, more and more secondary school students participate in “Young Rescuer” summer camps.

Regarding measures to prevent emergencies, we must not forget that the city must also be prepared to eliminate their consequences. The main element of this system is the Center for Crisis Situation Management, which is designed to gather and process information about emergency situations, inform the population, and make well-founded decisions on how to handle such situations.

At present, plans call for the creation of a Unified Monitoring and Dispatch Center for the city of Moscow on the basis of the facilities of the Moscow City Crisis Situation Management Center and the Force Management Center of the State Fire Service Administration of MChS. This new center, which would be reachable by dialing 01, would facilitate the efficient collection and processing of emergency reports, analyze an enormous amount of information under extremely time-critical conditions, and coordinate the actions of all dispatch services included in the city’s unified dispatch system.

The current combined daily volume for the two centers mentioned above is approximately 6,000 calls. After the switch to the single telephone number 01, it is predicted that the number of calls alone will rise to 18,000 per day. This will require a large set of organizational and technical changes to be made, taking into account foreign experience in operating rescue services using single telephone numbers such as 112 and 911.

Creating, training, and developing forces for eliminating the consequences of emergency situations is of enormous significance in the functioning of the system. To this end, the Moscow City Search and Rescue Service has been created in the capital. Also operating in cooperation with us in the city are various MChS rescue units and a number of commercial entities. If a major emer-

gency occurs, plans call for augmenting the rescue service by calling in specialists and equipment from other city organizations.

Since the city search and rescue service was established, rescuers have carried out about 60,000 rescue operations and have saved more than 25,000 people. In 2002 alone, Moscow firefighters handled about 7,000 fires. The timely and skillful actions of personnel from the city’s medical service have saved the lives of thousands of Muscovites involved in emergency situations and accidents.

Unfortunately, Muscovites have been forced to confront inhuman acts of terrorism in practice. We profoundly share the pain and suffering of other nations affected by emergency situations of any kind. Therefore, the government of Moscow is devoting a great deal of attention to humanitarian operations, including those of international scope. We are providing humanitarian aid to the suffering population in various regions of Russia and in other countries, including Kosovo, Afghanistan, Korea, Bolivia, the Balkans, Germany, the Czech Republic, and others.

Overall, we may conclude that the government of Moscow has a great focus on international cooperation in combating terrorism and crime and eliminating the consequences of terrorist acts and natural and industrial disasters. In recent years, stable contacts have been established among counterpart police and emergency services agencies at the municipal level as part of the comprehensive cooperation between Moscow and foreign cities, including those in Europe. Close cooperation is under way with the cities of Vienna, Berlin, Madrid, Dublin, Helsinki, and others in the form of information sharing, exchanges and training of specialists, and joint training exercises.

In May 2002, on the initiative of Moscow Mayor Yury M. Luzhkov, a meeting of police officials from European countries was convened to promote better coordination in the struggle against terrorism. Moreover, an international meeting on matters of security in major cities is to be held in Moscow in June 2003.

In conclusion, I would like to say that the system that has been created in Moscow for preventing and eliminating the consequences of emergency situations stands ready to cooperate closely in the twenty-first century with any who treasure the ideals of humanism and defense of the most important human right, the right to life.

This book is devoted primarily to papers prepared by American and Russian specialists on cyber terrorism and urban terrorism. It also includes papers on biological and radiological terrorism from the American and Russian perspectives. Of particular interest are the discussions of the hostage situation at Dubrovko in Moscow, the damge inflicted in New York during the attacks on 9/11, and Russian priorities in addressing cyber terrorism.

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  • ALL MOSCOW TOURS
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emergency room visit data

Healthcare in Moscow – Personal and Family Medicine

Emergency : 112 or 103

Obstetric & gynecologic : +7 495 620-41-70

About medical services in Moscow

Moscow polyclinic

Moscow polyclinic

Emergency medical care is provided free to all foreign nationals in case of life-threatening conditions that require immediate medical treatment. You will be given first aid and emergency surgery when necessary in all public health care facilities. Any further treatment will be free only to people with a Compulsory Medical Insurance, or you will need to pay for medical services. Public health care is provided in federal and local care facilities. These include 1. Urban polyclinics with specialists in different areas that offer general medical care. 2. Ambulatory and hospitals that provide a full range of services, including emergency care. 3. Emergency stations opened 24 hours a day, can be visited in a case of a non-life-threatening injury. It is often hard to find English-speaking staff in state facilities, except the largest city hospitals, so you will need a Russian-speaking interpreter to accompany your visit to a free doctor or hospital. If medical assistance is required, the insurance company should be contacted before visiting a medical facility for treatment, except emergency cases. Make sure that you have enough money to pay any necessary fees that may be charged.

Insurance in Russia

EMIAS ATM

Travelers need to arrange private travel insurance before the journey. You would need the insurance when applying for the Russian visa. If you arrange the insurance outside Russia, it is important to make sure the insurer is licensed in Russia. Only licensed companies may be accepted under Russian law. Holders of a temporary residence permit or permanent residence permit (valid for three and five years respectively) should apply for «Compulsory Medical Policy». It covers state healthcare only. An employer usually deals with this. The issued health card is shown whenever medical attention is required. Compulsory Medical Policyholders can get basic health care, such as emergencies, consultations with doctors, necessary scans and tests free. For more complex healthcare every person (both Russian and foreign nationals) must pay extra, or take out additional medical insurance. Clearly, you will have to be prepared to wait in a queue to see a specialist in a public health care facility (Compulsory Medical Policyholders can set an appointment using EMIAS site or ATM). In case you are a UK citizen, free, limited medical treatment in state hospitals will be provided as a part of a reciprocal agreement between Russia and UK.

Some of the major Russian insurance companies are:

Ingosstrakh , Allianz , Reso , Sogaz , AlfaStrakhovanie . We recommend to avoid  Rosgosstrakh company due to high volume of denials.

Moscow pharmacies

A.v.e pharmacy in Moscow

A.v.e pharmacy in Moscow

Pharmacies can be found in many places around the city, many of them work 24 hours a day. Pharmaceutical kiosks operate in almost every big supermarket. However, only few have English-speaking staff, so it is advised that you know the generic (chemical) name of the medicines you think you are going to need. Many medications can be purchased here over the counter that would only be available by prescription in your home country.

Dental care in Moscow

Dentamix clinic in Moscow

Dentamix clinic in Moscow

Dental care is usually paid separately by both Russian and expatriate patients, and fees are often quite high. Dentists are well trained and educated. In most places, dental care is available 24 hours a day.

Moscow clinics

«OAO Medicina» clinic

«OAO Medicina» clinic

It is standard practice for expats to visit private clinics and hospitals for check-ups, routine health care, and dental care, and only use public services in case of an emergency. Insurance companies can usually provide details of clinics and hospitals in the area speak English (or the language required) and would be the best to use. Investigate whether there are any emergency services or numbers, or any requirements to register with them. Providing copies of medical records is also advised.

Moscow hosts some Western medical clinics that can look after all of your family’s health needs. While most Russian state hospitals are not up to Western standards, Russian doctors are very good.

Some of the main Moscow private medical clinics are:

American Medical Center, European Medical Center , Intermed Center American Clinic ,  Medsi , Atlas Medical Center , OAO Medicina .

Several Russian hospitals in Moscow have special arrangements with GlavUPDK (foreign diplomatic corps administration in Moscow) and accept foreigners for checkups and treatments at more moderate prices that the Western medical clinics.

Medical emergency in Moscow

Moscow ambulance vehicle

Moscow ambulance vehicle

In a case of a medical emergency, dial 112 and ask for the ambulance service (skoraya pomoshch). Staff on these lines most certainly will speak English, still it is always better to ask a Russian speaker to explain the problem and the exact location.

Ambulances come with a doctor and, depending on the case, immediate first aid treatment may be provided. If necessary, the patient is taken to the nearest emergency room or hospital, or to a private hospital if the holder’s insurance policy requires it.

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119019 Moscow, Russia, Filippovskiy per. 7, 1

Mon - Sun 10.00 - 18.00

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moscow community Created with Sketch. A member of the public created this dataset. CDP Open Data Portal has not reviewed or endorsed any changes, including filters or updates to the title and description. COMMUNITY CREATED

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created Feb 2 2017

updated Sep 21 2018

In 2015, 120 global cities publicly disclosed their annual city-wide emissions. Includes information about how cities measured emissions (primary protocol), as well as why emissions rose/fell since prior reporting period.

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Ambulatory Health Care Data

Ambulatory Health Care Data

Photo

The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital emergency and outpatient departments and ambulatory surgery locations. Findings are based on a national sample of visits to the emergency departments,  outpatient departments, and ambulatory surgery locations of noninstitutional general and short-stay hospitals.

The National Health Care Surveys (including NAMCS, NHAMCS, and NHCS) are working with the Centers for Medicare and Medicaid Services Electronic Health Record Incentive Programs: Promoting Interoperability (PI) (formerly known as Meaningful Use (MU)) and the Merit-based Incentive Payment System (MIPS). Click here to find out more.

Data Products

  • 2021 NHAMCS Emergency Department Summary Tables [PDF – 831 KB] NOTE: Table 1 of this document was revised on October 11, 2023, to correct visit estimates for nursing home and homeless patients and update footnotes 2 and 3. (10/13/2023)
  • National estimates of office-based physician characteristics and practice characteristics by physician type [PDF – 118 KB] (8/2023)
  • 2021 NHAMCS Emergency Department Public Use File (7/10/2023)
  • 2021 Data Available on Emergency Visits (7/10/2023)

Publications

  • Trends in Emergency Department Visits Among People Younger Than Age 65 by Insurance Status: United States, 2010–2021 [PDF – 508 KB] (1/18/2024)
  • Emergency Department Visit Rates by Adults With Diabetes: United States, 2020–2021 (12/19/2023)
  • Emergency Department Visit Rates for Assault: United States, 2019–2021 (10/12/2023)
  • Emergency Department Visit Rates by Selected Characteristics: United States, 2021 ( 8/24/2023)
  • Sampling Procedures for the Collection of Electronic Health Record Data From Federally Qualified Health Centers, 2021–2022 National Ambulatory Medical Care Survey (6/26/2023)
  • Emergency Department Visits Among Children Aged 0–17 by Selected Characteristics: United States, 2019–2020 (6/6/2023)
  • Emergency Department Visit Rates for Motor Vehicle Crashes by Selected Characteristics: United States, 2019–2020 (4/21/2023)
  • Characteristics of Office-based Physician Visits by Age, 2019 [PDF – 412 KB] (4/19/2023)
  • Surveys and Data Collection Systems
  • National Health Care Surveys

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IMAGES

  1. Emergency Room Statistics In the U.S.

    emergency room visit data

  2. Urgent Care vs Emergency Room Costs, Differences and Options

    emergency room visit data

  3. Emergency Room Visit Cost Without Insurance in 2023

    emergency room visit data

  4. States with the Longest Emergency Room Wait Times [New Data]

    emergency room visit data

  5. STATISTICAL BRIEF #111: Expenses for a Hospital Emergency Room Visit, 2003

    emergency room visit data

  6. Data Shows 145.6 Million Emergency Room Visits Per Year

    emergency room visit data

COMMENTS

  1. Estimates of Emergency Department Visits in the United States, 2016-2021

    This visualization depicts both counts and rates of emergency department visits from 2016-2021 for the 10 leading primary diagnoses and reasons for visit, stratified by selected patient and hospital characteristics. Rankings for the 10 leading categories were identified using weighted data from 2021 and were then assessed in prior years ...

  2. FastStats

    Number of visits per 100 persons: 42.7. Number of emergency department visits resulting in hospital admission: 18.3 million. Number of emergency department visits resulting in admission to critical care unit: 2.8 million. Percent of visits with patient seen in fewer than 15 minutes: 41.8%. Percent of visits resulting in hospital admission: 13.1%.

  3. Products

    Data from the National Hospital Ambulatory Medical Care Survey. The overall emergency department (ED) visit rate was 40 visits per 100 people in 2020. The ED visit rate was highest for infants under age 1 year (68 visits per 100 infants), followed by adults aged 75 and over (63 per 100 people). The ED visit rate for non-Hispanic Black or ...

  4. Who Makes More Preventable Visits to the ER?

    People in vulnerable populations — as defined by socioeconomic characteristics — made more preventable visits to emergency rooms than others from 2013 to 2017, according to a U.S. Census Bureau working paper. The study analyzed census data linked with emergency visit records in the state of Utah. It found that factors including lower income ...

  5. NEDS Overview

    The NEDS is the largest all-payer emergency department (ED) database in the United States, yielding national estimates of hospital-owned ED visits. Unweighted, it contains data from over 28 million ED visits each year. Weighted, it estimates roughly 123 million ED visits. Developed through a Federal-State-Industry partnership sponsored by the ...

  6. PDF Most Frequent Reasons for Emergency Department Visits, 2018

    Highlights. In 2018, there were 143.5 million emergency department (ED) visits, representing 439 visits per 1,000 population. Fourteen percent of ED visits resulted in hospital admission (61 per 1,000 population). Circulatory and digestive system conditions were the most common reasons for these visits. The majority of ED visits (86 percent ...

  7. Trends in Emergency Department Visits and Hospital Admissions in Health

    Importance As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known.. Objective To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the ...

  8. ER Visits Data 2022

    Definition: Emergency room visits refers to the percentage of children aged 0-5 who visited the emergency room 1 or more times for any reason in the past 12 months. The full population sample, pooled from 2019-2020 data, includes non-institutionalized children in the United States aged 0-17, and is weighted to be representative of that ...

  9. Research Using Emergency Department-related Data Sets: Current Status

    The 2009 Academic Emergency Medicine consensus conference focused on "Public Health in the ED: Surveillance, Screening and Intervention." One conference breakout session discussed the significant research value of health-related data sets. This article represents the proceedings from that session, primarily focusing on emergency department (ED)-related data sets and includes examples of ...

  10. ER Visits Data 2021

    Definition: Emergency room visits refers to the percentage of children aged 0-5 who visited the emergency room 1 or more times for any reason in the past 12 months. The full population sample, pooled from 2018-2019 data, includes non-institutionalized children in the United States aged 0-17, and is weighted to be representative of that ...

  11. Products

    Data from the National Hospital Ambulatory Medical Care Survey, 2019. The overall emergency department (ED) visit rate (47 visits per 100 people in 2019) and visit rates by metropolitan statistical area (MSA) status did not change between 2009 and 2019. The ED visit rate was highest for infants under age 1 year (123 visits per 100 people ...

  12. ER Visits Data 2023

    Definition: Emergency room visits refers to the percentage of children aged 0-5 who visited the emergency room 1 or more times for any reason in the past 12 months. The full population sample, pooled from 2020-2021 data, includes non-institutionalized children in the United States aged 0-17, and is weighted to be representative of that ...

  13. Identification of Emergency Department Visits in Medicare

    Administrative claims data sets are often used by emergency care researchers and policymakers to define cohorts of patients for acute care research, and more commonly, such data sets are used outside of emergency medicine to define emergency department (ED) visits as an outcome for studies of healthcare resource utilization or evaluation of ...

  14. Hospital Emergency Room Visits per 1,000 Population by Ownership Type

    Providers & Service Use. Hospital Utilization. Hospital Emergency Room Visits per 1,000….

  15. Preliminary Findings from Drug-Related Emergency Department Visits

    Preliminary Findings from Drug-Related Emergency Department Visits, 2021. An analysis of 2021 preliminary data presents (1) nationally representative weighted estimates for the top five drugs in drug-related ED visits, (2) the assessment of monthly trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals, and (3) the identification of drugs new to DAWN's Drug ...

  16. Emergency Department Visits

    Monitoring emergency room visits helps to understand trends and promote prevention based on the reasons for those visits. In 2022, the age-adjusted rate per 100,000 of Emergency Department Visits in Alachua County was 37465.8 compared to Florida at 41054.8. The line graph shows change over time when there are at least three years of data.

  17. Visiting a Russian hospital: what to expect

    Emergency treatment in Russia. You can get emergency care in the emergency departments of Russian hospitals, most of which are open 24 hours a day all year round. Hospitals will provide you with emergency care regardless of insurance; however, you will have to pay for any treatment yourself if you don't have health insurance.

  18. Products

    Data from the National Hospital Ambulatory Medical Care Survey, 2018. The overall emergency department (ED) visit rate (39 visits per 100 persons) and visit rates by metropolitan statistical areas did not change between 2007 and 2018. The ED visit rate was highest for infants under age 1 year (101 visits per 100 infants) followed by adults aged ...

  19. Emergency rooms fill up fast. Here are top 10 reasons why people head

    Kratom enthusiasts Be Happy Go Leafy broke down the numbers and came up with the top 10 reasons people visit the emergency room. According to the release, 12,441,000 people go to the ER each year ...

  20. HHS Statement Regarding the Cyberattack on Change Healthcare

    Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment.

  21. The Role of the Russian Ministry of Emergency Situations and Executive

    Aleksandr M. Yeliseev *. Moscow Main Administration for Civil Defense and Emergency Situations. The problems of ensuring the security of people and territory are a top priority for executive- and legislative-branch agencies of the Russian Federation.

  22. PDF Table 37. Emergency department visits within the past 12 months among

    2Includes all other races not shown separately, unknown health insurance status, and unknown disability status. 3Estimates are for persons aged 18 and over and are age adjusted to the year 2000 standard population using five age groups: 18-44 years, 45-54 years, 55-64 years, 65-74 years, and 75 years and over.

  23. Healthcare in Moscow

    3. Emergency stations opened 24 hours a day, can be visited in a case of a non-life-threatening injury. It is often hard to find English-speaking staff in state facilities, except the largest city hospitals, so you will need a Russian-speaking interpreter to accompany your visit to a free doctor or hospital.

  24. moscow

    CDP Open Database License. Actions. Flag Dataset. Contact Dataset Owner. In 2015, 120 global cities publicly disclosed their annual city-wide emissions. Includes information about how cities measured emissions (primary protocol), as well as why emissions rose/fell since prior reporting period.

  25. NAMCS/NHAMCS

    Click for more information. The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital emergency and outpatient departments and ambulatory surgery locations. Findings are based on a national sample of visits to the emergency departments ...