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ER visits rising despite Affordable Care Act

Michael Sandler  | January 17, 2015
Modern Healthcare

Patient emergency room visits rose sharply at hospitals with the highest ER use in 2013, the last year before the Affordable Care Act's insurance expansion kicked in, according to Modern Healthcare magazine's latest By The Numbers. And many of the hospitals with the busiest ERs in 2013 are reporting even higher volumes in 2014 despite the nation's declining uninsured rate.
“We're seeing a failure of access to care,” said Dr. Howard Mell, a practicing ER physician in northeast Ohio and spokesman for the American College of Emergency Physicians.

Millions of Americans now have medical coverage, but because primary-care doctors are closing their offices and not accepting Medicare patients, even mild health crises are being pointed toward the ER, Mell said. “Obamacare isn't failing, but we knew it wouldn't handle ER visits,” he said. The nation's 24 busiest emergency rooms reported 18.7% more visits in 2013 over 2012, according to data supplied by the American Hospital Association for the By The Numbers list. And it appears that number will continue to rise in 2014.

At Lakeland (Fla.) Regional Health Medical Center, for instance, more than 200,000 people visited its emergency room in 2014, nearly 7% more than the 187,425 in 2013, when it ranked 16th on the BTN list.Florida did not expand Medicaid. And Polk County—the region served by Lakeland—had a 27.2% uninsured rate in 2012.“These factors make it difficult to isolate and statistically correlate the impact of the ACA,” said Janet Fansler, Lakeland's chief operating officer. To meet high demand, the hospital has reorganized its ER from two service areas (critical and noncritical) to nine care pods: one for triage, one for children, six for adults and one for fast-track patients, Fansler said. The hospital now also uses a registered nurse “bed-traffic controller” and pod nurse supervisors to keep patient care moving.

Even some hospitals on the busiest ER list that saw ER visits fall in 2013 are reporting an uptick in 2014. Children's Medical Center in Dallas, ranked 24th, saw its ER visits drop by 5.5% to 163,630 in 2013. But visits rebounded 5.6% to 172,839 in 2014, according to COO Doug Hock. He blamed timing and the flu season's severity for the decline in 2013, and noted the ACA has had little effect on Texas in 2014. The state also failed to expand Medicaid.

Analysts say that trend of rising ER visits across the nation will continue until the newly insured become more familiar with the process. “More people have insurance, but the cultural norm has been to wait until they're sick to seek care,” said Dr. Mitchell Morris, a provider consultant at Deloitte Consulting. “As they get educated, ER use will go down over a period of years.”

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