Most Emergency Visits by Medicaid Patients are for Urgent or More Serious Symptoms, American College of Emergency Physicians

New Report Dispels Conventional Wisdom about Emergency Department Use

WASHINGTON, July 12, 2012 /PRNewswire-USNewswire/ -- The majority of Medicaid patients ages 21 to 64 who seek emergency care have the symptoms of urgent or more serious medical conditions, according to a new report from the Center for Studying Health System Change (HSC).  According to the HSC, many assessments of "unnecessary" use of emergency care incorrectly look at patients' diagnoses, instead of patients' symptoms and why they are choosing to seek emergency care.


"More than 136 million people seek emergency care each year, and most of them, including Medicaid patients, need medical care within 2 hours," said David Seaberg, MD, FACEP, president of the American College of Emergency Physicians.  "According to the report, Medicaid patients use emergency care at higher rates than patients with private insurance, but that's because they wait until their symptoms get so serious that they require emergency care.  This often happens because they can't find doctors who will accept their insurance, most likely because the reimbursement rates are so low.  It isn't fair to say 'don't go to the emergency room' without providing available medical alternatives, which currently are woefully inadequate."

The report found that adults with Medicaid insurance (under age 64) use emergency departments at more than double the rate of adults with private insurance.  They are three times more likely to have visits for diagnoses indicating potentially complex problems stemming from pregnancy and disabling conditions, such as cerebral palsy, cardiomyopathy and chronic hepatitis.  In addition, they more often have secondary diagnoses of mental disorders, and a higher percentage of their emergency visits involve more than one major diagnosis, such as diabetes and congestive heart failure.

"The HSC report makes a crucial point about assessing emergency room use, and that is to look at the patient's symptoms," said Dr. Seaberg.  "If you have the symptoms of chest pain, you should seek emergency care.  And if it turns out that your chest pain was a nonurgent condition, such as a hiatal hernia, then your health insurance plan should still cover it.  This is called the prudent layperson standard, which Congress enacted in 1997 and then included in the Affordable Care Act.  Emergency physicians fought for decades to make sure this standard was a law because patients should never be diagnosing themselves."

Dr. Seaberg also said that emergency physicians are committed to delivering the highest quality care in the most cost-effective and efficient way for the millions of emergency patients who visit ERs each year.

"Emergency physicians are masters of efficiency and ingenuity and provide more uncompensated care than any other physicians," said Dr. Seaberg.  "Emergency care constitutes just 2 percent of all health care spending in the United States. We provide a tremendous amount of care for that two cents out of every dollar."

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

SOURCE American College of Emergency Physicians (ACEP)