1 Use of Emergency Department Services by Medical Assistance Recipients Legislative Audit Bureau Legislative Audit Bureau June 2004

2 Costs and Visits u From FY through FY , costs increased by 47.3 percent and averaged $20.1 million annually u Number of visits to emergency departments increased: –30.2 percent increase in fee-for-service visits –28.7 percent increase in managed care visits

3 Increased Visits are the Result of Increased Enrollment u Overall program enrollment increased 31.5 percent from FY through FY u Majority of the increase was the result of the introduction of BadgerCare in July 1999 u Percentage of recipients visiting emergency departments held steady at about 20.0 percent per year

4 Frequent Users – Fee-for-Service u Among fee-for-service recipients, 58.3 percent visited emergency departments only once in FY u In contrast, 5.5 percent of those who visited went six or more times during that year

5 Frequent Users – Managed Care u Among managed care recipients, 60.5 percent of those who visited emergency departments did so only once in FY u In contrast, 2.8 percent of those who visited emergency departments did so six or more times

6 Addressing High Use u Some facilities have instituted fees u Some facilities dedicate a section of their emergency departments for minor illnesses and injuries

7 Future Considerations u DHFS could target efforts to frequent users in order to: –provide health care in a more appropriate setting –reduce emergency department costs

8 Use of Emergency Department Services by Medical Assistance Recipients Legislative Audit Bureau Legislative Audit Bureau June 2004