Emergency Docs Fear Surge of Patients Under ACA

May 21, 2014

Emergency medicine has been in a state of emergency, it seems, for several decades now, and a new survey of its practitioners suggests that healthcare reform could make things worse.

Since January 1, when insurance coverage expanded under the Affordable Care Act (ACA), 46% of emergency department (ED) physicians have seen visits increase, with 9% calling the increase significant, according to a survey released today by the American College of Emergency Physicians (ACEP). Eighty-six percent foresee the number of visits climbing over the next three years. Of the 41% who think that visits will increase greatly, 77% warn that their EDs aren't ready for the higher volume.

ACEP leaders point to Medicaid expansion in half the nation's states as a major source of the problem. Thirty-one percent of emergency physicians report an increase in the number of Medicaid patients, and 7% describe the increase as significant. In contrast, only 2% say their Medicaid volume has declined in any way.

Many new Medicaid patients are coming to EDs because they can't get an appointment with a primary care physician about their condition, said Rebecca Parker, MD, a member of the ACEP board of directors.

"Coverage doesn't equal access," Dr. Parker told Medscape Medical News. "People get a Medicaid card, but they don’t have a primary-care physician who will accept them."

Motivating primary care physicians with higher pay to treat Medicaid patients could take some strain off EDs, according to ACEP. A more long-range solution is training more primary care physicians.

Logjam of Psychiatric Patients

Exacerbating the latest ED crisis is a logjam of psychiatric patients, according to the ACEP survey.

Eighty-four percent of emergency physicians say their units "board" psychiatric patients while the ED attempts to find them an inpatient bed somewhere. Of this group, 91% consider such boarding detrimental because it results in tied-up ED beds, violent behavior by distraught psychiatric patients, and distractions for clinicians. Fifty-two percent of emergency physicians report that they've spent more time and effort on getting psychiatric patients admitted since the beginning of 2014.

ACEP supports a bill in Congress called the Helping Families in Mental Health Crisis Act of 2013 that would tighten the nation's safety net for psychiatric patients, particularly on the outpatient side.

"People having a mental health crisis seek care in emergency rooms because other parts of the healthcare system have failed them," said ACEP President Alex Rosenau, DO, in a news release. "Because of the critical shortage of mental health resources, some of these vulnerable patients wait for days in emergency departments.

"It is simply inhumane."

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