February 19, 2020
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ED visits for dialysis by uninsured patients contribute to system burden

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Uninsured patients with ESRD who visited Texas emergency departments for hemodialysis treatments contributed to high hospital costs and increased strain on the health care system, according to an analysis of 2017 statewide hospital data.

“Patients with end-stage renal disease require regular hemodialysis (HD) treatment, which is nearly universally covered by Medicare in the United States,” Julianna West, BS, of the department of emergency medicine at McGovern Medical School, the University of Texas Health Science Center at Houston, and colleagues wrote in a research letter. “However, Medicare coverage is not available for individuals who are not U.S. citizens or permanent residents. For many uninsured individuals with ESRD, intermittent dialysis through the emergency department (ED) is the sole treatment option.”

They argued that when this is the only means to access treatment, already overcrowded EDs are subject to higher patient volume, hospital dialysis resources may be taxed and health care costs rise. Furthermore, they wrote, while a scheduled outpatient session costs $250, a visit to the ED for hemodialysis costs approximately $2,000.

To more fully examine the health care burden due to lack of insurance, researchers identified 10,390 ED visits by uninsured patients and 23,439 visits by insured patients who required hemodialysis (limiting the analysis to a length-of-stay of 1 day or less to ensure the visit was “most likely associated with HD for an acute indication”).

red circle around the word uninsured 
Uninsured patients with ESRD who visited Texas emergency departments for hemodialysis treatments contributed to system burden.
Source: Adobe Stock

They found the Arlington and Houston regions had the most uninsured ED visits for hemodialysis (66.1% and 20.4% of total visits, respectively), and uninsured patients were more likely to be younger and to be white or Hispanic.

Total hospital costs for uninsured visits were determined to be $21,837.047.40.

“To our knowledge, these are the largest estimates of the statewide burden of uninsured HD,” the researchers wrote. “... In addition to increasing patient numbers and cost, uninsured HD-associated ED visits cause health care system strain because the determination of the need for HD often requires additional diagnostic tests, and individuals with ESRD not undergoing regular HD often present in clinical crisis, requiring significant inpatient stabilizing care in addition to HD.”

As a cost-effective alternative, they suggested providing scheduled or after-hours outpatient hemodialysis sessions to uninsured patients. – by Melissa J. Webb

Disclosures: West reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.