Health Overhaul May Not Keep Patients Out Of ERs

KFF Health News | By Jenny Gold

Published December 17, 2010 at 3:52 PM EST

An oft-repeated claim during the debate over health care overhaul was that insuring more Americans would help keep people out of emergency room and cut costs. "The uninsured will get coverage, no longer left to the emergency room for medical care," House Speaker Nancy Pelosi wrote in Roll Call in May.

But those on the ER frontlines offer an different view. Two-thirds of emergency department administrators believe that the new health law will increase their number of patients going to ERs, while just 5 percent say patient volume will decrease, according to a new survey of more than 600 administrators conducted by the Schumacher Group, a Louisiana firm that manages 187 emergency departments across the country.

Part of the problem may be the shortage of primary care physicians: 64 percent predicted their ERs would see more patients who could not see a doctor fast enough. "I would expect a lot more gridlock" in emergency departments, and "more boarding of patients" while they wait to be transferred to other hospital departments, says Kip Schumacher, chairman and CEO of the Schumacher Group.

Many patients, particularly those with Medicaid, already have a difficult time getting an appointment to see their doctor. As more people gain insurance under the new health law, the problem is likely to get worse.

Studies suggest the administrators' concerns may be well-founded. A 2010 brief by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, found that while the uninsured were slightly more likely than the privately insured to have visited the ER in the past year, Medicaid recipients were far more likely to do so than uninsured and privately insured patients.

And a study by the Robert Wood Johnson Foundation produced similar findings: after adjusting for health, income and other factors, uninsured patients used the ER at the same rate as the privately insured, while Medicaid patients used the ER at much higher rates.

Under the new law, Medicaid will be extended to all adults earning less than 133 percent of the federal poverty level, which will add 16 million more people to the program by 2019, according to the Congressional Budget Office.

There are more than 120 million ER visits each year. Administrators are understandably worried about increases. The idea that health insurance coverage will help keep people healthy and out of the emergency room "sounds great in principle," says Schumacher, "but that's not what happened in Massachusetts." The state's universal health insurance law was passed in 2006, and officials hoped improved coverage would keep people out of the ER. But emergency visits instead rose by 9 percent from 2004 to 2008.

The survey of ED administrators also found:

Nearly three-quarters said that a shortage of specialist physicians available to cover the ER posed at least a moderate risk to their patients.

Seventy-three percent reported that their hospitals had invested in electronic medical records; 56 percent of those who had invested said that it was not worth the cost, but 76 percent believe it will eventually pay off.

Seventy percent reported that they boarded mental/behavioral health patients for 24 hours or more because they were unable to transfer them to an inpatient facility. Ten percent said they had boarded mental health/behavioral patients for as long as a week or more.