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Study the Study
The Affordable Care Act has been taking quite a hit for the past several months. The website issues, costs, and conflicting information regarding patients’ ability to stay with their current physician, receive coverage in spite of pre-existing conditions, and patients being dropped by their insurance company are hard to ignore. Additionally, recent media reports indicate the ACA will increase the number of Medicaid patients who unnecessarily use the ER.
Numerous media outlets touted a study from Oregon, which tracked 25,000 low-income adults who received Medicaid through a lottery. According to the authors of the study, in the first 18 months of coverage, Portland area hospitals saw a 40% increase in the use of the ER by Medicaid patients. Visits were for a variety of conditions, including some that could be treated by a primary care physician. While the actual effects the ACA will have on unnecessary ER use will not be known for a while, the increased attention offers an opportunity to openly discuss current conflicts within the healthcare system relating to emergency room use.
Unnecessary use of the ER has been a drain on the US healthcare budget for decades. As ER visits account for about 4% of all health care spending in the US, the government and taxpayershave a vested interest in finding ways to reduce unnecessary ER visits. However, patients without insurance, or those with minimal insurance, are very likely to use the ER for primary care. Part of the reason for this is simply due to a lack of knowledge, and not realizing there are other options. Additionally, some communities lack adequate private care options. And, while theaverage office visit to a physician is approximately $150, and the average ER visit costs nearly $1,000, patients with no money have learned that they cannot be denied ER helpbased ontheir ability to pay. To complicate matters, while emergency departments write off a lot of their service costs due to non-paying patients and minimal reimbursements, from a business perspective, having billable ER visits is essential revenue to maintain their facilities and other critical services that they provide for patients.
Solutions That Serve Everyone?
The solution is not easy, but all parties need to benefit from decreased ER usage, including the hospitals themselves, in order to align everyone’s interests from both a patient care and financial perspective. Therealso need to be good alternatives to ER care sopatients can be diverted after hours to the appropriate level of care – such as urgent carecenters. Telephone nurse triage services in emergency departments can assist in this area. Overall, it seems that by changing traditional procedures, we can find a way to create a healthier ER process that benefits everyone. First, we need to think outside the box.
What ideas do you have for a balanced solution to the ER dilemma?
Kliff, S. (2013).The Washington Post. Study: Expanding Medicaid doesn’t reduce ER trips. It increases them. Retrieved online 1/7/2014 from http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/02/study-expanding-medicaid-doesnt-reduce-er-trips-it-increases-them/
US Department of Health and Human Services. (2013) Health, United States, 2012 With Special Feature on Emergency Care. Retrieved online 1/7/2014 from: http://www.cdc.gov/nchs/data/hus/hus12.pdf