Emergency room patient volume on the rise post-ACA

In stark contrast to the healthcare industry's increasing efforts to curb emergency department (ED) overuse, the American College of Emergency Physicians (ACEP) says new research proves how much Americans value their access to emergency care, even though they often face steep barriers to such access.

In a poll of ACEP's member physicians, 75 percent of the 2,099 respondents indicated that the volume of patients in their EDs had increased since Jan. 1, 2014, when the Affordable Care Act (ACA) health coverage mandate first took effect. Of those, 28 percent reported that the volume had "increased greatly," and 47 percent said it "increased slightly." While 17 percent reported that patient volume held steady and 5 percent reported a slight decrease, none of the respondents said volume "decreased greatly."

Another ACEP survey released in May 2014 found that about half of ED physicians reported an increase in patient volume since Jan. 1 of that year. Because even more doctors report a rise in ED visits in the latest survey, it's clear that Americans' reliance on emergency care is stronger than ever, ACEP President Michael Gerardi, M.D., told FierceHealthcare in an exclusive interview. "People prefer to come to the ED because they trust the providers, they know that we get things done, they know that we're most likely to make the correct diagnosis," he said.

What the numbers don't mean, according to Gerardi, is that the ACA has increased access the way it promised.

"I like the fact that they've expanded the coverage, but you're not increasing access with high deductibles, you're not increasing access with the Medicaid rates that don't even cover a fraction of the cost," he said, adding that for many Americans, deductibles that range in the thousands of dollars for ED visits is tantamount to not having insurance at all.

A large portion of the blame for this falls on both the structure of the ACA--which allows insurance companies to charge such high deductibles--and the insurers themselves, because "healthcare plans and the government have somehow gotten it in their heads that EDs are expensive," Gerardi said.

Indeed, hospitals and government entities have increasingly worked to solve the problem of ED "super-users," who often struggle with chronic conditions and have been blamed for driving up healthcare costs, FierceHealthFinance has reported. Previous studies have shown that ED costs comprise as much as 5.8 percent of total healthcare spending, and an increase in Medicare patients who turn to EDs continues to put financial strain on hospitals.

For all patients except the "highly complex group" of super-users, however, Gerardi argues that the ability of EDs to quickly diagnose and treat patients means that they actually "provide tremendous value."

He also took issue with providers' and payers' efforts to redirect patients to urgent care centers, which Gerardi says rely too much on patients to "self-diagnose" and can result in dangerous delays in care. Primarily, though, the ACA needs to do a better job of expanding patients' access to emergency care, according to Gerardi.

"What they should do tomorrow is say, you know what, for a bona-fide emergency, or a presumed emergency, deductibles aren't in play," he said. "Shame on you, insurance companies, for preventing people from going to the emergency department."

To learn more:
- here's the survey results (.pdf)
- read the announcement