Patients don’t abuse ED: report

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