Poor, nonurgent patients not the cause of ER crowding

Despite worries routine cases are clogging up the emergency department, most Medicaid ED patients go because they have to, seeking emergent or urgent care for serious medical problems, according to a study by the Center for Studying Health System Change (HSC), released yesterday.

Calling it a misconception, the study notes that poor patients may not be the source of ED overcrowding. Although researchers did find that nonelderly Medicaid patients use the ED more than privately insured patients (about 46 ED visits per 100 Medicaid enrollees compared with 24 visits per 100 privately insured people), the study suggests Medicaid patients use the ED appropriately for problems like troubled breathing or high fevers, Reuters reported.

Only about a tenth of nonelderly Medicaid ED patients were for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people in 2008.

"If you picked a Medicaid recipient and a privately insured patient out of an ED waiting room and asked them both why they were there, the likelihood that they described symptoms we would call non-urgent is pretty similar," HSC researcher Emily Carrier told Reuters.

If poor patients seeking routine care aren't the cause of ED crowding, what is? Most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed--ED boarding--not a high volume of nonurgent ED visits, study authors noted.

The research could have implications for policymakers, who are targeting payments for "unnecessary" ED visits in light of the budget crisis.

However, as HSC authors indicated, fixing the primary care problem might not be the practical solution in all cases because practices cannot see patients quickly enough for urgent problems or do not have the appropriate equipment. The study did suggest using alternative settings, such as urgent care centers and patient-centered medical homes.

Researchers also called on hospitals to reevaluate their marketing strategies and ED use.

"Some hospitals actively seek to draw patients with minor problems to their emergency departments by advertising short wait times on billboards and through mobile phone applications," the study notes. "Broader payment reforms, such as accountable care organizations, that move away from fee-for-service payment could alter incentives for hospitals to market their EDs as aggressively and prompt greater development of lower-cost settings that can deal with urgent medical needs."

For more information:
- read HSC statement
- check out the HSC report
- here's the Reuters article