Emergency Physicians Say Narrow Networks Push Patients to ED

October 26, 2015

High out-of-pocket expenses are causing insured patients to delay or skip needed medical care, and when they seek it, narrow provider networks are driving them to hospital emergency departments (EDs), according to a new poll of emergency physicians released today.

Steep deductibles are a hallmark of health plans sold on exchanges created by the Affordable Care Act (ACA). Unfortunately, they are making care unaffordable, says ED physician Rebecca Parker, MD, who chairs the board of directors of the American College of Emergency Physicians (ACEP), which conducted the poll.

"The typical silver plan under the ACA has an annual deductible of $6000," said Dr Parker in an interview with Medscape Medical News. "But the average person has only $700 in the bank for any kind of emergency."

The survey, taken last month, found that seven in 10 emergency physicians are seeing patients who have health insurance, including coverage under the ACA, but have delayed or forgone medical care because of high deductibles, coinsurance, and other out-of-pocket expenses.

"This is a scary environment for patients," said ACEP President Jay Kaplan, MD, in a news release. "Many patients are motivated by fear of costs and not by the seriousness of their medical conditions. The insurance companies are shifting costs onto patients and medical providers as they attempt to increase their bottom lines, and this threatens the foundation of our nation's medical care system."

Narrow Networks Translate Into ED Visits

Narrow networks, another hallmark of ACA health plans, also work against the best interests of patients, according to the ACEP. Such networks field a smaller number of providers deemed more cost-efficient than their peers. Roughly eight in 10 emergency physicians say they have treated patients who struggled to find a specialist for their problem because their health plan does not have a deep roster of providers.

Another 65% report treating more insured patients whose health plans do not offer an adequate number of primary care physicians. The ACEP's Dr Parker said she treated one patient with ACA exchange coverage because the nearest primary care physician in his network was an hour's drive away.

Roughly the same percentage of emergency physicians say their primary care colleagues are sending them insured patients for tests and procedures that insurers do not cover during an office visit.

ED physicians have a big picture view of the nation's healthcare system, and can see when it is working and when it is not, said Dr Parker.

"We're often the canary in the coal mine," she said.

More information on the ACEP survey is available on the association's website.

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