One of the main selling points of the Affordable Care Act (ACA) was the contention that it would reduce the number of people going to the emergency room (ER) for non-emergency services. When a patient does not have health insurance, these costs are often subsidized by taxpayers. And even when there is insurance coverage, an ER visit is much more expensive (by 5-10 times) than a doctor’s office or walk-in clinic visit.
After the ACA’s first two years, it appears that the law has had the opposite impact on patient behavior—and ER visits are increasing. A lot.
The root cause is theorized to be the lack of medical providers, combined with an increase in Medicaid and insured people. We already have a shortage of doctors, which is projected to be 46,000 to 90,000 by 2025. Many doctors will not accept Medicaid patients. The result is patients who now have coverage, but no doctor, so patients feel comfortable going to the ER for smaller issues.
According to a Wall Street Journal article on a survey of 2,098 emergency-room doctors conducted by the American College of Emergency Physicians (ACEP):
Many doctors don’t accept Medicaid patients because the state-federal coverage provides lower reimbursement rates than many private health-insurance plans. The waits for primary and specialty care by participating doctors appear to be leaving some Medicaid patients with the ER as the only option, according to ACEP.
This unexpected trend provides our industry with another metric to focus on going forward—reduced ER visits. It will be a good future indicator of the effectiveness of initiatives such as early intervention, case management and providers panels, as well as direction of care. These are the tools that will help us to avoid the unintended consequences of the ACA.