Association between patient perceived patient-centered medical homes and cost saving magnitude in nonurgent emergency department care

Purpose: Nearly half of all emergency department (ED) visits in the US are for nonurgent conditions. This study was the first to examine to what extent access to and use of patient-centered medical home (PCMH) practices can achieve cost savings in nonurgent ED care among the uninsured population nationwide. Methodology: This retrospective cohort study used the 2010-2011 Medical Expenditure Panel Survey data. Difference-in-difference methods, multivariate logit model, marginal effect, and survey procedures were employed. Findings: The cost savings amounted up to $586 million for the full PCMH group than the “no regular provider” group (95% CI: $225 million, $947 million) among the uninsured population at the national level. The mean nonurgent ED costs for the full PCMH group and the “no regular provider” group were $455.3 (95% CI: $55.9, $854.8) and $760.1 (95% CI: $527.6, $992.7) respectively among the uninsured population nationwide, with an average of $304.8 lower costs for each patient each year in the full PCMH group. Conclusions: PCMH models demonstrate higher odds of reduced nonurgent ED care costs among the uninsured individuals, compared to insured enrollees. The room for improvement in nonurgent ED care cost reduction had large magnitudes. Originality: For the PCMH models to effectively reduce nonurgent ED care costs, priority should be given to target the uninsured population.