MACPAC: Medicaid enrollees do not overuse the ER

The Medicaid population uses hospital emergency departments (EDs) at a higher rate than patients with other forms of insurance, but for the most part such visits are necessary, according to a new report from the Medicaid and CHIP Payment and Advisory Commission (MACPAC).

The report aims to debunk the notion that Medicaid patients show up at the emergency room (ER) for care because they have been conditioned to do so. "The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention," the report said. It noted that Medicaid patients tend to have much higher rates of chronic diseases and debilitating conditions than those in the privately insured population, or even among those who lack health insurance altogether. In many cases, their conditions are so compromised that even their primary care physicians will refer them to the ER.

Moreover, MACPAC also engaged in a systematic review of all the research regarding ED use and the Medicaid population between 1990 and 2010. It concluded that there was no "consistent association" between Medicaid enrollees and unnecessary ER use.

MACPAC also noted that some conditions treated at the ER that are classified as non-urgent  are best treated there anyway. "Some problems, such as chest pain in a 50-year old or an infant's fever and rash, carry high risks for patients and are best evaluated in an ED," the report said. "This is true even if--after a physician's evaluation and some rapid testing--the vast majority of cases are resolved."

Treating patients in the ER is costly whether they require it or not. The high costs prompted some experiments in reducing ER usage, such as Oregon's attempt at better coordinating care. Other hospital ERs, such as those operated by HCA, simply demand payments upfront from patients and report success in reducing volumes.

However, MACPAC conceded that it was unclear if ER usage by Medicaid patients was on the rise, although it concluded there was "insufficient evidence" that the expansion of Medicaid eligibility under the Affordable Care Act was driving more ER visits. A study published earlier this year in the journal Science concluded there was an increase of ER patients linked to Medicaid expansion.

To learn more:
- read the MACPAC report (.pdf)