If new data by researchers at the UCLA Center for Health Policy Research are any indication, central Indiana hospitals are in for even greater emergency room usage in 2015 if Governor Mike Pence’s HIP 2.0 is approved by federal officials. But a slowdown should follow a few months later if the study done in California proves true in the Heartland.
According to the Kaiser Health News article “Spike in ER, Hospitalization Use Short-Lived After Medicaid Expansion,” the UCLA researchers found that subjects who became insured after lengthy periods of being uninsured initially used hospital emergency rooms three times more during the first three months of coverage but then cut back significantly in subsequent months, eventually falling back to average by the end of the second year.
Most hospitals are hoping for a reduced number of ER visits as a way to cut costs in a reform-era that rewards modest spending. The Affordable Care Act held out promise for a reverse of the trend in recent years of increased ER usage. However, many ERs around the country have seen continued growth, not reduction, in visits since the ACA was enacted, including the Community Health Network in Indianapolis which, according to a recent IBJ article, has begun an expansion of its Community East ER to accommodate the increased number of visits.
This recent report by the UCLA Center for Health Policy Research offers new hope for a slowdown to the growth, though Kate Baicker, a health economist at the Harvard School of Public Health, stands by her research from earlier this year that no such retraction occurs when Medicaid is expanded. A study by the Colorado Hospital Association released in September also supported Baicker’s earlier assertions.
Even in looking at subgroups of ER usage, the research varies as to the behavior of the newly insured. A study published last Spring in the Journal of Adolescent Health showed that even with insurance, young adults choose costly emergency room visits over office visits and have the same out-of-pocket expenses as their uninsured counterparts. Contradicting those assertions, however, a study from Stanford University published in September in the journalHealth Affairs showed young adults ages 19 to 25 had a decrease of 2.7 emergency room visits per 1,000 people compared to an older group in the same period. In that study, though, while the relative rates of ER visits decreased, the reductions in overall use were minimal.
“Young adults might still see the ED as an immediate care facility,” said Tina Hernandez-Boussard, assistant professor of surgery and biomedical informatics at Stanford University and lead author of the study. She was quoted in a Modern Healthcare story covering the Stanford study. “If we look more into how they are still using the ED and what they are coming in for, that would be very helpful in developing further policies to address these users,” Hernandez-Boussard added.
Perhaps that’s where the answer lies for all patients. Instead of asking how many people are coming to the ED, maybe the better question is why they are coming.
According to a JAMA Psychiatry study, between 2009 and 2011 an estimated 267,000 patients visited an emergency department because of adverse drug events such as overdose, excessive sleepiness, and head injuries associated with use of psychiatric prescriptions. A study published in September in the Annals of Emergency Medicine said patients discharged from the hospital often return to the emergency department within a few days because they are anxious about their symptoms and have lost trust in other parts of the healthcare system.
But the real problem with increased ER usage is that many people who are newly insured and new to the world of healthcare just don’t have anywhere else to go. According to an August LA Times article, visits to the California Hospital Medical Center’s ER rose 8% in the first half of the year. One in five ER patients doesn’t need emergency care, though, said Bob Quarfoot, the hospital’s vice president of business development. In the same article, Sara Rosenbaum, a health researcher at George Washington University said changing patient behavior will be slow.
“People go to the emergency department because they don’t have choices,” Rosenbaum told the Times.
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