ER Visits Jump Under ACA
|By Bernard J. Wolfson, The Orange County Register|
|McClatchy-Tribune Information Services|
Initial signs, however, point in the opposite direction.
In other words, many people are seeking care at emergency rooms not because they are uninsured but precisely because they now have insurance.
In a recent survey by the
"When I speak with other emergency physicians, it seems as if volume has increased faster since the Affordable Care Act than in the past," said
Not all hospitals are seeing an increase, which may reflect the demographics of their patients and the hospitals' contracts with insurers. And where ER visits are rising there may be other factors at play, including lack of primary access, an improving economy and patients' attitudes about where to seek care.
Some industry executives and observers caution against drawing early conclusions. The whole health care system is evolving rapidly under Obamacare, they note, and with a public education campaign and greater access to primary and urgent care, people may eventually kick the habit of going to the ER for symptoms that could be easily treated elsewhere.
But so far, the general trend in ER visits is upward. And financially speaking that is not good news, since visiting the ER costs about
Many people who visit the emergency room don't need to be there, but studies diverge widely on exactly how many. One survey shows that nearly half of patients visiting the ER can wait longer than an hour to be seen. Another says 76 percent could have been treated at a doctor's office or urgent care clinic. A third puts that figure at only about 10 percent.
Countywide, the ER patient load has risen by an average of 4.4 percent since January, according to data provided by the county's Emergency Medical Services agency. By contrast, the volume of ER visits in
"So we are above anything we would have expected from the previous years' trend," said
Stratton believes the economic recovery could help explain the rise in ER use. "During recessions, emergency department traffic drops, and when the economy is improving, it goes up," he notes. "So it could be that or it could be the Affordable Care Act. We don't really know."
--Visits to the emergency room at
Wait times are also up, and the hospital's emergency department is seeing more insured people who show up for the sake of convenience rather than for true emergencies, said spokesman
Statewide, 1.4 million bought health plans through the state's exchange, Covered California, which was created under the health reform law. And more than 2 million Californians are newly insured -- or expect to be -- due to more generous eligibility criteria for
Across the U.S., more than 15 million people have obtained insurance through one of the Obamacare insurance exchanges, through
Studies show that MediCal patients are more likely to visit the ER than the uninsured or people with commercial insurance. That's because they tend to have higher rates of chronic disease and often have less access to primary care. Many doctors have stopped accepting MediCal patients, and the ones that do may have such large caseloads that getting a quick appointment with them is extremely difficult.
Many hospitals say their emergency departments are seeing a significant number of newly insured MediCal patients.
Emergency room use is also higher, though more moderately, at its sister hospitals in
While many hospitals are seeing rising ER volumes, some are not. At
For some, rising ER visits have been the norm for some time.
Indeed, a large part of the reliance on emergency rooms is built into the health care system, says
"Some of this may be a temporary phenomenon and could change as people begin to use their coverage better," Rosenbaum says. "But to the extent that the health plans and networks are sending people to the ER, it's not going to change."
"But if it was after hours, he probably would have told me to come to the ER," Gonzalez says.
Rosenbaum said the health system has to change in some fundamental ways before Obamacare can deliver on the cost savings it has promised.
"Are we turning out enough primary care doctors? Are doctors working in practices that can offer at least some evening and weekend hours?" she asks.
Some hospital executives believe that with a public education campaign and greater availability of alternatives, such as urgent care clinics and appointments with primary care physicians, the use of ERs can ultimately be limited to the most serious cases.
"I think over time you will see it work out so that people will figure out which access point they need to go to," says
Hendel notes that at Long Beach Memorial and its sister hospitals, patients who come into the ER are given a followup appointment with a primary care doctor. Second visits to the ER are down 50 percent among patients who have a primary care appointment after their first trip to the ER, she says.
"That is really telling and bodes well for the future," Hendel says. "It could eventually reduce ER use and lower costs."
Contact the writer: 714-796-2440 or [email protected]
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