The Financial Burden of Unnecessary Primary Care in the Hospital Emergency Department: Is there a solution?

Background: Emergency Departments (EDs) in Alberta are frequently used for the management of patients whose conditions could be safely treated in non-hospital primary care settings. Such utilization has been associated with unnecessary healthcare expenditures, longer patients' wait times.

Objective: To compare the cost of providing healthcare services by Family Physicians (FPs) in privately owned Community Clinics versus Emergency Departments, and to estimate potential healthcare cost savings without compromising quality of care.

Methods: A retrospective review of 1,780 randomly selected Emergency Department visits at Wetaskiwin Hospital between November 2021 and October 2022 was conducted. All patients were managed by the same FP who also practiced concurrently at a local Community Clinic. Visits were stratified by Canadian Triage and Acuity Scale (CTAS) scores, diagnostic codes, and disposition. Costs were compared using Alberta Health Service Codes (HSCs) and hospital billing data.

Results: Forty-four percent of ED visits were triaged as CTAS levels 4 and 5, representing hemodynamically stable patients suitable for community-based management. The cost of managing these visits in EDs was 417% higher than in Community Clinics, with a per-visit cost difference of $331.59. Extrapolation suggested potential annual provincial savings exceeding $176 million by shifting care location.

Conclusion: A substantial proportion of ED visits in Alberta could be safely and cost-effectively managed in Community Clinics. Strategic policy reforms targeting care location, primary care access, and billing structures could result in significant healthcare savings without compromising patient outcomes.

Key Notes / Key Points

• 44% of reviewed ED visits were CTAS 4–5 and clinically appropriate for community management

• Cost of ED-based care for stable patients was over four times higher than Community Clinic care

• Identical physicians provided care in both settings, isolating facility-related cost differences

• Limited access to primary care contributed to ED overutilization

• Province-wide savings could exceed $176 million annually with care redistribution

• Policy alignment of billing codes could incentivize community-based care expansion