The Affordable Care Act and Emergency Care

Mark McClelland, DNP, Brent Asplin, MD, MPH; Stephen K. Epstein, MD, MPP; Keith Eric Kocher, MD, MPH; Randy Pilgrim, MD; Jesse Pines, MD, MBA, MSCE; Elaine Judith Rabin, MD; Niels Kumar Rathlev, MD


Am J Public Health. 2014;104(10):e8-e10. 

In This Article

Increased Health Care Integration

The ACA will change payment methods and provide incentives to entities such as accountable care organizations to make health care more efficient. Part of this efficiency will be gained through expanded access to patient-centered medical homes, which provide more integrated care and more timely access to providers. In some areas, these medical homes may reduce ED volumes, particularly for low-acuity cases.[5,19] Historically, patients have been commonly directed to the ED; one study found 82% of patients who called their physician before going to the ED were actually instructed to go to the ED.[5] Many patients with regular sources of care have reported using the ED because of lack of timely access.[5,20] Medical homes aim to reduce these referrals through better access; however, EDs will likely continue to provide care for high- and moderate-acuity patients, and play a large role in off-hours care and in communities where the medical home concept is less embraced or effective.

As the outpatient system evolves to take a more active part in acute care, EDs can support and even drive care coordination by engaging with community providers to improve the flow of patients through the continuum of care.[21] Community level discussions between EDs and primary care providers about their respective roles providing acute unscheduled care could lead to national discussions about standard setting and best practice development, which would significantly advance the goals of the ACA.[21,22]