In the wake of the Affordable Care Act, hospitals have increasingly sought strategies to reduce inappropriate emergency room use, but, despite some progress, work remains for hospital leaders and policymakers.
Since the ACA’s passage, states that expanded their Medicaid programs under the law have seen slower growth in ER use, according to a report from Deloitte. The states that expanded prior to 2014--California, Colorado, New Jersey, Washington, Minnesota and Connecticut, along with the District of Columbia--all saw slight increases in the first year, but over the next two to three years their rates stabilized or fell slightly.
Medicaid expansion also reduced the use of the ER as a primary care provider, according to the report; as of 2014, only four percent of new enrollees in the program said the ER was their usual care provider, compared to 30 percent of uninsured patients, and 90 percent of new beneficiaries saw a primary care physician that year, compared to 51 percent of the uninsured.
However, in 2015, new Medicaid beneficiaries were more likely to chalk up an ER visit to lack of access to other providers than 2014 enrollees, according to researchers, with 1 in 3 2015 enrollees saying they sought emergency care because they had no other options, compared to only about a quarter of new enrollees in 2014.
The emergency of alternative providers such as urgent care centers also appear to have reduced inappropriate ER use, according to the report. From 2011 to 2014, median ER visits were lower in markets with higher concentrations of UCCs. However, markets with lower concentrations of UCCs often had high rates of Medicaid beneficiaries among the population; this echoes concerns that the similar standalone emergency room model primarily benefits higher-income patients, FierceHealthcare previously reported.
Going forward, the researchers state, health system leaders must make an effort to expand care access in lower-cost settings, such as recent acquisitions of UCCs by major systems, including HCA and Tenet. In 2015, urgent care use leapt 500 percent to 1 million visits at HCA, according to the report.