Emergency Physicians Busier Than Ever Since ACA, Poll Shows

Megan Brooks

May 04, 2015

Most emergency physicians in the United States have noticed an increase in the volume of patients since January 1, 2014, when the requirement to have health insurance went into effect, and they do not think their emergency department (ED) is prepared to handle it, according to a new poll.

"The reliance on emergency care remains stronger than ever," Michael Gerardi, MD, president of the American College of Emergency Physicians, said in a news release. "It's the only place that's open 24/7, and we never turn anyone away."

To gauge changes in ED patient volume and care since the Affordable Care Act went into effect, the American College of Emergency Physicians invited 24,427 member physicians to complete a poll, 2099 of whom did, for a response rate of about 9%. The top 10 participating states were California, Texas, New York, Michigan, Pennsylvania, Ohio, Florida, Illinois, Washington, and Massachusetts. Most respondents (60%) work for an emergency medicine group.

With the rollout of the Affordable Care Act, 47% of emergency physicians report a slight increase in the number of patients, and 28% report seeing a significant increase in patient volume.

Most respondents report little or no reduction in the volume of emergency visits resulting from the availability of urgent care centers, retail clinics, and telephone triage lines.

More than half of emergency physicians (56%) say the volume of Medicaid patients is up, and 70% fear their ED is not adequately prepared for increased patient volume. Yet, at the same time, 83% have concerns about efforts being made to reduce emergency visits; chiefly, that patients will delay medical care or go to a less skilled site (44%).

"There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the [ED]," added Orlee Panitch, MD, chair of the Emergency Medicine Action Fund, which commissioned the poll.

"In addition, states with punitive policies toward Medicaid patients in the [ED] may be discouraging low-income patients with serious medical conditions from seeking necessary care, which is dangerous and wrong," said Dr Panitch, emergency physician for MEPHealth in Germantown, Maryland.

Dr Gerardi is concerned about the closure of hospitals and EDs in states that have not expanded Medicaid.

"Hospitals received less Medicare funding for charity care when the [Affordable Care Act] took effect, because more people were supposed to have health insurance coverage," he points out. "But in states that didn't expand Medicaid, hospitals are hurting. For example, the closure of a hospital in Baton Rouge resulted in a crisis for another hospital that inherited all the patients, many of whom are uninsured, and now this hospital may close as well. The average reimbursement for a Medicaid patient in the [ED] is about $43.00, but it's much lower in many states."

Forty-two percent of those polled said they expect emergency visits to increase, and 65% expect reimbursement for ED care to decrease if federal subsidies for health insurance coverage were to be eliminated in their states, which might occur if the US Supreme Court decides in favor of the plaintiff in King v. Burwell.

The poll also points to a changing workload for ED physicians: 64% say the time spent organizing patient care after an ED visit has increased since January 1, 2014. Forty-seven percent believe demands for care coordination are increasing because of increased difficulty in finding/arranging timely follow-up with primary care physicians and/or specialists.

A little more than one third of those polled (34%) have considered leaving the profession.

"Review of the Evidence on the Use of the Emergency Department by Medicaid Patients and the Evolving Role of Emergency Medicine Physicians." Published May 4, 2015.

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