First, this is a poll and not a study on what ER (emergency room) doctors are seeing in emergency departments (ED). You will see the headlines of ‘Thanks, Obama’ for the busier emergency rooms, and Obamacare was sold as a way to reduce dependency on costly ER visits.
Having said that, polling evidence will end up matching hard numbers. Why? Cost. With more people insured, the barrier to ER visits has been lowered.
The poll, commissioned by the EM Action Fund (a branch of the American College of Emergency Physicians), shows ER doctors are feeling the increased volume since the requirement to be insured went into effect on January 1, 2014.
Doctors feeling the squeeze are increasingly worried their departments are not set up to handle the influx of patients.
“The reliance on emergency care remains stronger than ever. It’s the only place that’s open 24/7, and we never turn anyone away.”
Obamacare ER Poll
The devil is in the details of how the polls are structured, so here’s the general layout:
24,427 member physicians were sent surveys on the changes in emergency department volume. 2099 responded, for a response rate of nine percent.
Nice to know patients aren’t the only ones struggling for a response.
Top states participating in the study give a fair representation of the country. California, New York, Texas, Pennsylvania, Ohio, Florida and Illinois were among the top respondent states.
47 percent of ER doctors reported seeing a slight increase in patient volume while 28 percent reported a significant increase in patient volume.
Here’s where the poll diverges over how the ER doctors and emergency departments respond. 56 percent of respondents say the volume of Medicaid patients is higher, and 70 percent fear their departments cannot handle the load. But, 83 percent are concerned about efforts being made to reduce ER visits. The doctors (44 percent) are concerned people are delaying care or going to less skilled clinics.
It’s a catch-22. ER docs know they can’t handle the load, but do not want patients delaying care.
Looking at the headline numbers, it’s easy to assign blame to the increases in people on Medicaid. Context is key here. While Medicaid rolls have swelled, some states have slow-walked Medicaid expansion or put in place punitive actions against Medicaid patients.
Dr. Orlee Patch, chair of the Emergency Medicine Action Fund, pushed back against states restricting access. “There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the [ED].”
“Hospitals received less Medicare funding for charity care when the [Affordable Care Act] took effect because more people were supposed to have health insurance coverage. But in states that didn’t expand Medicaid, hospitals are hurting. For example, the closure of a hospital in Baton Rouge resulted in a crisis for another hospital that inherited all the patients, many of whom are uninsured, and now this hospital may close as well. The average reimbursement for a Medicaid patient in the [ED] is about $43.00, but it’s much lower in many states.”
The easiest would be to expand specialty and primary care access for Medicaid patients. Don’t let their only line of healthcare become the ER.
Better awareness for those insured, but not on Medicaid. Take my insurance. An ER visit for me? $75. Sure, I bought a plan that offers good benefits, but the cost barriers to ER visits are dropping.
So, while some can point to Medicaid access and blame President Obama, there’s another issue. Consumers. Why wait for your primary care doctor to open in the morning? We live in a ‘right the hell now’ society and that could bring a host of issues for ER doctors and emergency departments.
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