6 Reasons Why Healthcare Reform Won't Reduce ED Overcrowding

Even though health reform will allow 32 million previously uninsured Americans to get regular care from physicians, many of these patients are expected to continue crowding into emergency departments.

In a recent survey of members by the American College of Emergency Physicians, 71 percent expect ED visits to increase under reform and 47 percent also think conditions will worsen for ED patients.

"Health insurance coverage does not equal access to medical care, especially with an aging population and physician shortages," ACEP President Angela Gardner, MD, said in a news release about the survey.

Here are six reasons why EDs will continue to be overcrowded under the reform law, the Patient Protection and Affordable Care Act.

1. Insured patients visit EDs at the same rate as the uninsured. Despite beliefs by some that coverage for preventative care will reduce ED visits, a recent report by the CDC's National Center for Healthcare Statistics found insured people are just as likely to visit an ED as the uninsured. In addition to visiting the ED for true emergencies, insured patients may go to an ED because they can't get in to see their physician or haven't found a physician in their community.

2. The primary care physician shortage could continue to grow. An impending shortage of primary care physicians will make it difficult for the newly insured to find a physician when the expansion under the reform law starts in 2014. With fewer medical students choosing primary care, the American Academy of Family Physicians predicts the shortage of family physicians will reach 40,000 in about 10 years.

3. The newly insured will still face access challenges. About half of the newly insured under health reform will be paid by Medicaid, and they are expected to have trouble finding a physician because many physicians do not accept new Medicaid patients. In a recent survey by UnitedHealth Group's Center for Health Reform & Modernization, 67 percent of primary care physicians thought Medicaid patients wouldn't be able to find a suitable primary care provider under reform. They felt this way even though the reform law will raise Medicaid payments for primary care to Medicare levels.

4. EDs remain crowded in Massachusetts. When Massachusetts mandated health insurance for all residents a few years ago, ED visits rose 7 percent and ED costs increased 17 percent over two years, according to the Boston Globe.

5. ERs are closing down despite increases in visits nationally. ACEP said hundreds of EDs have closed in recent years, while the number of ED visits has increased.

6. The federal reform law will further open access to the ED. After Sept. 23, 2010, the law will require insurers to: 

  • cover the costs of emergency treatment at the same rate, regardless of whether the site is in or out of the insurer's network.
  • stop requiring prior authorization for emergency services.
  • pay for an ED visit if the patient has cause to believe he or she is in a health emergency. This "prudent layperson" requirement has been enacted by many states.

ED waiting times continue to be high. A 2009 report by the Government Accountability Office found that it takes 37 minutes on average to see patients who need to be seen in one to 14 minutes.

Contact Leigh Paige at leigh@beckersasc.com.

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