Are “avoidable” ED visits really avoidable?

Dr. Maria Raven and Dr. Renee Hsia in collaboration with Robert Lowe from OHSU received a grant from the Emergency Medicine Foundation (EMF) to support research on state policy to limit ED visits by denying reimbursement. The title of their study is: Are "avoidable" ED visits really avoidable? Use of the NYU ED algorithm for an unintended purpose: denying payment. Currently, multiple states are considering use of the NYU ED algorithm to identify groups of ED discharge diagnosis they deem to be avoidable or unnecessary, as a mechanism to refuse payment for such visits. The algorithm was developed for research purposes and was never intended for use as a tool to make triage or reimbursement decisions. The goal of this research is to empirically evaluate the ability of the NYU ED algorithm to safely and accurately predict the acuity ("necessity") of an ED visit based on discharge diagnosis.