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Thursday, 20 March 2014 00:00

Study upends reform wisdom on ER use

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Emergency rooms across the country need to prepare themselves for an increase in ER visits as more uninsured people gain insurance under healthcare reform.

A research team led by Beth Israel Deaconess Medical Center emergency care physician Peter Smulowitz, MD, performed a recent study which found a “small but consistent increase” in emergency room use following implementation of Massachusetts’ individual mandate and insurance subsidy system – a result contrary to the goals of bringing more insured patients primary care access to reduce emergency care use.

"This obviously has implications about what we can expect to see nationally as the roll-out of the Affordable Care Act continues," Smulowitz, also a Harvard Medical School instructor, said in a media release accompanying the study’s publication.

The study, described as the first of its kind, examined data from 13 million emergency department visits in Massachusetts between 2004 and September 2009 at 69 acute care hospitals.

From fall 2006 to fall 2007, after the law took effect, ER visits increased by 1.2 percent and then increased by 2.2 percent between 2007 and September 2009, Smulowitz and colleagues reported in a study published in the Annals of Emergency Medicine.

"We cannot say for sure why more people came to the ER – whether it's a lack of access to primary care or the result of pent-up demand – but we need to be ready. Other states should be prepared for equal or greater influxes of patients into the ER after reform is fully implemented."

One hypothesis the researches do offer is that previously-insured patients may have seen their access to primary care limited slightly – as in longer appointment wait times – due to newly-insured patients coming into the primary care system, and as a result they may be turning more to the ER.

The ER has a certain draw to individuals, Smulowitz and colleagues noted: 24-hour availability (compared to the usual 9-5, Monday to Friday schedule of many primary care services); the “perceived efficiency, technologic expertise, and quality of ED care”; and “increasing awareness of emergency conditions.”

There’s also a body of economic theory and evidence – mostly recently expanded with data from the Oregon Medicaid experiment – suggesting that having health insurance may “increase use of certain healthcare resources, including the ED,” while “greater financial barriers such as increased copayments may result in reduced use of both necessary and unnecessary care,” Smulowitz and colleagues wrote.

“It appears that when people have health insurance, they will seek medical care wherever they can get it, which is sometimes only the ER," he added.

This story is based on a report appearing on Healthcare Payer News.