Report: Chronic conditions take big toll in N.J.’s poorest counties

New Jersey’s poorest ZIP codes have the highest frequency of emergency room visits for people with chronic conditions, according to a new analysis from the Center for Health Analytics, Research and Transformation at the New Jersey Hospital Association.

“You can live well with a chronic condition, but that requires access to primary care, a medical home and care management,” Cathy Bennett, NJHA CEO and president, said. “CHART’s study zeroes in on hotspot ZIP codes where there are clear gaps in that level of care. These communities demand greater attention to make sure all individuals have access to the services they need.”

The analysis, Chronic Conditions: Eroding the Fabric of a Healthy Society, examined patient records of more than 3 million New Jersey hospital emergency room visits in 2017.

Hospitals in the state spend more than $2 billion annually providing care to patients that visit the ER and are treated, released and not in need of admission to a hospital bed for more advanced treatment or surgical procedure, the CHART analysis said. In 2017, hospitals in New Jersey serviced 3.1 million of these “treat-and-release” cases.

The report found that 39 percent (1.2 million) of those visits were associated with patients who had one or more chronic conditions, such as hypertension (19 percent), substance abuse (12.1 percent), diabetes (8.1 percent), anxiety (5.2 percent) and more. The 1.2 million patient visits accounted for 53 percent of costs associated with ER department care, which totaled more than $1 billion.

CHART said the average “treat-and-release” visit for a patient without a chronic condition costs approximately $480. However, if those patients had one or more chronic conditions (83 percent of treat-and-release patients), the average cost was 54 percent more, or $738 per visit. If a patients had three to four chronic conditions (16 percent), the cost of care was 158 percent more expensive, or $1,238 per visit. Finally, those with five or more chronic conditions had a cost of care 314 percent higher, or $1,986 per visit.

The ER visits, CHART said, revealed that there is a barrier for individuals trying to manage their chronic conditions and receiving ongoing, supportive care.

The analysis found that Cumberland, Essex and Atlantic counties (the poorest counties in New Jersey) had the highest rates of patients with presenting chronic conditions in ER departments. Even further, the report found that Atlantic City, Jersey City and Trenton were the Top 3 zip codes in this category.

The zip code analysis showed a disproportional impact on African Americans as well as correlations with unemployment rates, access to food and transportation services.

“The statewide average use rate for patient visits where chronic conditions are present is 129.62 visits per 1,000 population,” the report said. “Cumberland County’s use rate is almost double the statewide average at 237.29. Atlantic County is 202.15, and Essex County is 166.”

In 2016, chronic conditions cost New Jersey $29.3 billion in direct health care costs, along with $69.5 billion in lost productivity, said Sean Hopkins, senior vice president of CHART.

“These are real, measurable impacts on our state,” Hopkins said. “But chronic diseases also have a myriad of additional consequences on individuals and communities that are more challenging to quantify. What we do know from our research is that there is a clear relationship between social determinants of health and chronic disease cases in the ED.”