An estimated 22,072 nondiscretionary emergency department visits during 2011 involved young adults who were newly insured under the Patient Protection and Affordable Care Act’s dependent-coverage provision, according to a study published in the May 30th New England Journal of Medicine. In September 2010, the ACA extended the eligibility age for dependent coverage under private health plans to all adults under age 26.
The study estimates the provision extended private coverage of nondiscretionary ED visits by 3.1 percentage points, compared with similar visits by adults aged 26 to 31. “Our findings show that young adults not only are more likely to have insurance coverage after the provision went into force, but they and hospitals also have improved financial protection,” said lead author Andrew Mulcahy, a health policy researcher at RAND.
Sicker, more complex Medicare patients are driving up the intensity of emergency department care, according to an American Hospital Association report released May 2. The report, which is based on an analysis of Medicare claims data conducted by The Moran Company, found that the number of ED services provided to Medicare beneficiaries is growing and patients’ needs are shifting toward services that demand the use of more resources.
“The reality is that seniors who come to the hospital ED are sicker and have more chronic illnesses,” said AHA President and CEO Rich Umbdenstock. “Hospitals are striving to meet their communities’ needs, which means caring for patients who need more – and more intensive – services than ever before.”
While some policymakers have raised concerns that the shift toward ED services that require more resources is leading to higher Medicare spending, the report shows that the overall use of ED services is also increasing, and EDs are serving more Medicare patients with behavioral health diagnoses and more patients enrolled in both Medicare and Medicaid.
A Brown University researcher says the true cost of emergency
department care may account for 10% of total healthcare spending, not 2% as a
widely accepted federal report claims. Read a summary of the findings from HealthLeaders Media here.
Patients who have difficulty accessing their primary care provider after-hours are more likely to end up in the emergency department or go without care, according to a study published online Dec. 12 by Health Affairs. Based on a 2010 survey by the Center for Studying Health System Change, the study found that one in five people who attempt to contact their primary care provider after-hours find it very or somewhat difficult.
The rate was higher among people who are uninsured (42%), covered by Medicaid or the Children’s Health Insurance Program (31%), or report poor health (52%). About 38% of people who had difficulty contacting their primary care physician after hours reported visiting a hospital ED in the past 12 months, compared with 30% of those who had little or no difficulty. They also were more than twice as likely to report having an unmet medical need.
About four in 10 people reported that their primary care practice offered extended hours, such as at night or on weekends.
About one in five adults under age 65 visited an emergency department in the past year, 27% of whom were admitted to the hospital, according to the Centers for Disease Control and Prevention's 2011 Health Interview Survey. Among those who were not admitted to the hospital, the most common reasons cited for the last ED visit were: only a hospital could help (55%), the doctor's office was not open (48%), or there was no other place to go (46%). Uninsured adults were more likely than those with public or private health insurance to say they had no other place to go.
Questions on reasons for ED use were added to the survey in 2011.
"Our findings suggest that increased enrollments in Medicaid between 1999 and 2007 have had substantial effects on ED volume and crowding, and that at least part of this may reflect limited access to primary care services for Medicaid enrollees," the authors state. While the study includes the latest available data, the authors say a critical concern is what has happened in more recent years.
"One of the nation's most severe recessions started in 2008, and with record job losses in 2008 and 2009, an estimated additional 5.8 million Americans became uninsured and an estimated 5.4 million enrolled in Medicaid and SCHIP [State Children's Health insurance Program]."
One in four emergency department patients in 2006 waited longer than recommended to be evaluated by a physician, up from one in five in 1997, according to a study in the Nov. 9 Archives of Internal Medicine. Researchers from Yale-New Haven Hospital and Yale University School of Medicine analyzed data from the National Hospital Ambulatory and Medical Care Survey to examine the percentage of patients seen by a physician within the time recommended at triage, when ED patients are prioritized on arrival based on the seriousness of their condition.
The percentage of emergent (highest priority) patients who saw a physician within the recommended 14 minutes declined to 48% in 2006 from 59% in 1997. Rising wait times are likely due to a variety of factors, including growing ED use and declining access to primary care, the authors say. They call for comparative research into the most effective methods of reducing ED crowding.
A recent federal report casts more concern that hospital emergency rooms are having increasing difficulty treating all comers, especially because federal payments and the uninsured don't pay their full cost of care. "There is a growing concern that EDs will not be able to sustain care for all persons in the current economic environment," according to the report, entitled Payers of Emergency Department Care, 2006, that was published by the U.S. Agency for Healthcare Research and Quality.
"Between 1993 and 2003, there was a 23% increase in ED visits and a closure of 425 hospital EDs. In addition, a recent Institute of Medicine report notes that EDs have become increasingly overcrowded, overburdened, and underfunded. Yet little is known about who is paying for ED care, what the charges are for the care, and how to potentially relieve this pressure," the report said.
ED visits for sports-related injuries are higher in rural than urban areas, and three times higher for boys than girls. The findings are based on 2006 data from the agency’s Healthcare Cost and Utilization Project.
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