ArticleJournal of general internal medicine2026
Variation and Drivers of Spending Within 30-Day Emergency Department-Based Episodes of Care.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundEmergency department (ED) visits are a common starting point for treatment of acute illness and may set a trajectory of care with substantial implications for quality and cost. Yet ED visits are rarely used to define episodes of care.
objectiveTo examine hospital-level variation in ED-based episode spending and its drivers for commonly encountered conditions of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia.
designClaims-based, cross-sectional study of 83 Michigan hospitals.
participantsAdult ED patients with CHF (n = 150,385), COPD (n = 156,833), and pneumonia (n = 114,867) between 2017 and 2022. MAIN MEASURES: Outcomes were risk-adjusted, price-standardized, 30-day total and component (index ED and hospitalization if present, post-acute care, post-index hospitalization, professional services) ED-based episode payments. KEY
resultsHospitals in the highest vs lowest payment quartiles had mean total episode payments of $19,397 vs $14,601 for CHF (difference 24.7%, P < 0.001), $13,048 vs $8,723 for COPD (difference 33.1%, P < 0.001), and $13,466 vs $9,168 for pneumonia (difference 31.9%, P < 0.001). For CHF, high-payment hospitals had 33.3% higher index ED/hospitalization costs, 15.3% higher post-acute care costs, and 33.4% higher professional fees, with similar post-index hospitalization costs. Patterns were consistent across conditions, although post-index payments varied more for COPD and pneumonia. Index ED/hospitalization payments were strongly correlated with total episode payments (CHF: r = 0.82; COPD: r = 0.90; pneumonia: r = 0.80; all P < 0.001).
conclusionsED-based 30-day episode payments vary substantially across hospitals for CHF, COPD, and pneumonia, largely driven by costs from the ED visit and associated hospitalization. Future work should assess whether this variation reflects differences in quality or efficiency.
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