Hospital emergency departments are increasingly treating sicker Medicare patients with more complex medical conditions, according to a new report from the American Hospital Association.

The report, which is based on an analysis of Medicare claims data, found that between 2006 and 2010, the average severity of illness for fee-for-service beneficiaries rose by 9 percent. Also, with heightened federal scrutiny on short inpatient stays, the use of observation units saw a dramatic climb — 72 percent between 2006 and 2010. "The overall shift in care from inpatient to observation status means that the claims of these patients are now being counted as part of the ED population," the report noted. As we reported in our Clinical Management series last year, observation units can help improve throughput and cut down on readmissions, but hospitals need to be careful in how they plan for their use.

Other findings in the AHA report include:

  • ED visits per 1,000 fee-for-service beneficiaries rose by nearly 12 percent
  • The percent of beneficiaries with three or more visits in a year climbed to 15.5 percent, up from 13.5 percent
  • Dual-eligibles account for 40 percent of all Medicare fee-for-service ED visits (these patients  far more likely than the general Medicare population to have a chronic condition or be disabled)
  • Visits for a behavioral health diagnosis increased by nearly 50 percent

"The reality is that seniors who come to the hospital ED are sicker and have more chronic illnesses," said AHA President and CEO Rich Umbdenstock. "Hospitals are striving to meet their communities' needs, which means caring for patients who need more — and more intensive services — than ever before."