Pa­tients don’t abuse ED: re­port

Modern Healthcare - - NEWS - By Vir­gil Dick­son

When Med­i­caid ben­e­fi­cia­ries go to the emer­gency de­part­ment, it is al­most al­ways med­i­cally nec­es­sary. They don’t use the ED as their usual provider, and there is no ev­i­dence that ex­pand­ing Med­i­caid will es­ca­late ED use, a new re­port from the Med­i­caid and CHIP Pay­ment and Ac­cess Com­mis­sion found.

MACPAC is­sued the re­port last week to counter claims that Med­i­caid ex­pan­sion un­der the Af­ford­able Care Act will drive up ED use and costs. “Be­cause of the kind of con­ver­sa­tions go­ing on, we de­cided to look at what the ex­perts have to say on this,” said Anne Schwartz, ex­ec­u­tive direc­tor of MACPAC.

Providers say the MACPAC anal­y­sis has pro­vided them with the am­mu­ni­tion needed to chal­lenge un­founded as­sump­tions about Med­i­caid ben­e­fi­cia­ries. “If peo­ple be­lieve these myths, it may lead to a pol­icy that lim­its ac­cess to emer­gency care,” said Dr. Robert O’Con­nor, vice pres­i­dent of the Amer­i­can Col­lege of Emer­gency Physi­cians. “Al­ready, you hear about states at­tempt­ing to cap the amount of (ED) vis­its that they’ll re­im­burse for at some ar­bi­trary num­ber.”

The re­port found that most ED vis­its by Med­i­caid en­rollees are for ur­gent symp­toms and se­ri­ous med­i­cal prob­lems that re­quire prompt at­ten­tion, with nonur­gent vis­its ac­count­ing for just 10% of all Med­i­caid-cov­ered ED vis­its for non-elderly pa­tients.

Many be­lieve in­ap­pro­pri­ate ED use is ram­pant be­cause of stud­ies show­ing that large per­cent­ages of ED vis­its paid for by Med­i­caid were deemed avoid­able. But those stud­ies don’t cap­ture the ex­pe­ri­ence of ED care in real time, MACPAC said.

Many Med­i­caid re­cip­i­ents strug­gle to find reg­u­lar doc­tors, the re­port noted, but those is­sues are com­mon to many com­mer­cially in­sured peo­ple. They of­ten have trou­ble get­ting an ap­point­ment, reach­ing their doc­tor af­ter hours, over­com­ing lan­guage bar­ri­ers, or find­ing trans­porta­tion, the re­port found.

The re­port said there is not enough ev­i­dence to show that Med­i­caid ex­pan­sion would lead to any last­ing in­crease in ED use. In states that of­fered lim­ited Med­i­caid ex­pan­sion prior to the ACA, some ex­pe­ri­enced no in­crease in ED use and oth­ers saw short­lived in­creases.

But op­po­nents of Med­i­caid ex­pan­sion re­main un­con­vinced. Dr. Roger Stark, a health­care pol­icy an­a­lyst at the con­ser­va­tive Wash­ing­ton Pol­icy Cen­ter, said it’s “com­mon sense” that if mil­lions more peo­ple join Med­i­caid, ED use will in­crease.

“This is an is­sue that sort of re­quires myth-bust­ing, be­cause what we hear in pop­u­lar press and even pol­icy cir­cles, is that (ED) use among this group is al­ways a neg­a­tive thing.”

DR. MARIA RAVEN, AS­SIS­TANT PRO­FES­SOR OF EMER­GENCY MEDICINE AT THE UCSF SCHOOL OF MEDICINE, SAN FRAN­CISCO

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