ED use up since MA instituted healthcare reform

Since Massachusetts implemented statewide healthcare reform in 2006, emergency department (ED) use increased slightly but consistently, according to a new study published in the Annals of Emergency Use.

Researchers, led by Peter Smulowitz, M.D., of Boston's Beth Israel Deaconess Medical Center, analyzed all ED visits submitted annually by 69 hospitals, representing roughly 2 million outpatient visits, 850,000 inpatient admissions and 150,000 observation stays.

They found that emergency room (ER) visits rose as much as 1.2 percent between October 1, 2006 and September 30, 2007, after the Bay State passed its healthcare reform law, and increased by 2.2 percent during the period ending Sept. 30, 2009, according to the study.

"This obviously has implications about what we can expect to see nationally as the roll-out of the Affordable Care Act continues," Smulowitz told News-Medical. "We cannot say for sure why more people came to the ER--whether it's a lack of access to primary care or the result of pent-up demand--but we need to be ready. Other states should be prepared for equal or greater influxes of patients into the ER after reform is fully implemented."

After Massachusetts' healthcare reform, ED visits by uninsured people under the age of 65 fell from 9.5 percent of total visits to 5.7 percent, while visits by those ages 65 and older were consistently around 1 percent, according to the study. The findings fly in the face of the perception that uninsured patients drive ED use, according to Smulowitz.

"Barriers to primary care are serious and persistent across the country," he told News-Medical. "It appears that when people have health insurance, they will seek medical care wherever they can get it, which is sometimes only the ER."

Some healthcare providers expressed concern that Medicaid expansion will have a similar effect on ED use. A 2013 study of increased ED use in California found that adult Medicaid beneficiaries largely drove the increase in visits, FierceHealthcare previously reported.

To learn more:
- here's the study (.pdf)
- read the article