More ER patients, but fewer on-call specialists available post-ACA

In the wake of the Affordable Care Act, emergency department patient volume has increased, but the number of available on-call specialists has fallen.

In Massachusetts, even as post-ACA ER use rose between 2005 and 2014, ED consultations with general surgeons fell from 98 percent of visits to 83 percent, according to a study published in the Annals of Emergency Medicine. More specifically, researchers from Massachusetts General Hospital found 24-hour availability of psychiatric specialists in EDs fell from 56 percent to 33 percent, with steep declines for pediatricians, plastic surgeons and orthopedic surgeons as well. Meanwhile, the proportion of Bay State EDs reporting patients cared for predominantly in the hallway increased nearly 20 points during the same period, from 70 percent to 89 percent.

In Illinois, while ED use by uninsured patients fell in the wake of the ACA, adult ED visit volume increased 8.1 percent from 2011 to 2015, according to a separate Annals of Emergency Medicine study. Monthly ED visit volume rose 5.7 percent compared to the pre-ACA period. Meanwhile, the state’s population in general and overall hospitalizations saw no significant changes.

“Emergency departments continue to be squeezed by pressures inside and outside the hospital,” lead author Scott Dresden, M.D., of Chicago’s Northwestern University Feinberg School of Medicine, said in a statement. “The changes are larger than can be explained by population changes alone and are significantly different from trends in ED use prior to implementation of the ACA.”

The findings echo other research indicating ED use continued to increase even in the wake of the ACA’s implementation, FierceHealthcare previously reported, as well as a study that found the ACA’s Medicaid expansion didn’t reduce utilization.