ER Visits Continue to Rise Since Implementation of Affordable Care Act – May 4, 2015

WASHINGTON, May 4, 2015 /PRNewswire-USNewswire/ — Three-quarters of emergency physicians report that emergency visits are going up, according to a new poll.  This represents a significant increase from just one year ago when less than half reported increases.  Rather than trying to keep people out of emergency departments, policymakers need to recognize the value of this model of medicine that people want and clearly need, according to the American College of Emergency Physicians (ACEP).

Most of the respondents to the poll report little or no reductions in the volume of emergency visits due to the availability of urgent care centers, retail clinics and telephone triage lines.  About 90 percent of more than 2,000 respondents also say the severity of illness or injury among emergency patients has either increased (44 percent) or remained the same (42 percent).

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These data correlate with another new report issued by Health Policy Alternatives, which found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments and into primary care are not working.  More than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees, despite a provision in the ACA boosting pay to primary care physicians treating Medicaid patients.  The median wait times was 2 weeks but over one-quarter of providers had wait times of more than a month for an appointment.

“There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the emergency department,” said Orlee Panitch, MD, FACEP, chair of EMAF and emergency physician for MEPHealth in Germantown, Maryland.

The report — commissioned by the Emergency Medicine Action Fund  (EMAF) — is titled “Review of the Evidence on the Use of the Emergency Department by Medicaid Patients and the Evolving Role of Emergency Medicine Physicians.”

Source: ER Visits Continue to Rise Since Implementation of Affordable Care Act – May 4, 2015

The increase in non emergent ED visits correlates with the experience in Massachusetts after that state expanded access to private and Medicaid coverage in 2006, serving as a template for the federal Patient Protection and Affordable Care Act that became law four years later. According to state data, emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year. Both the ACA’s and Massachusetts’ reforms on the payor side postulated more access to coverage would translate to fewer people turning to the ER for non emergent care.

But Nancy Turnbull, a senior lecturer at the Harvard School of Public Health, told the Boston Globe the increase in Massachusetts was due to lack of access to primary care — not coverage. “I don’t think the increase has anything to do with health care reform,’’ she said. “It’s much more reflective of [primary care] access problems.”

The ACEP poll notes Medicaid patients aren’t benefiting from the growth in channels providing convenient access to primary care such as retail clinics and telemedicine aimed at those covered under commercial insurance plans who want to consult with a provider outside usual office hours. Instead, it points to a population health basis, suggesting Medicaid patients are in poorer health and suffering from chronic conditions that flare up and require urgent attention that is most readily available at hospital EDs. The poll results also point up a need for community health clinics to play a larger role in serving Medicaid patients and in the management of their chronic conditions and helping improve their overall health status, particularly given that many private providers don’t accept Medicaid patients.

Separately, California Healthline reports ED visits by California Medicaid beneficiaries increased by 50 percent between 2013 and 2014 when that state’s Medicaid expansion took effect.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email or call 530-295-1473. 

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Frederick Pilot

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