Editor’s Note: Read Dr. Cedric Dark’s commentary on this EMRA + PolicyRx Health Policy Journal Club article.

Increase outpatient services and you’ll decrease expensive ED visits, or so the popular axiom goes. This only works, however, if enough outpatient visits are available. A study by Medford-Davis et al examined the availability of outpatient orthopedic ankle appointments by insurance status.¹

Privately insured patients had an 85 percent chance of success in securing appointments. Interestingly, the uninsured had the same odds as the privately insured in getting appointments. Both the insured and uninsured had much higher odds of receiving appointments than patients with Medicaid.

To make matters worse, most clinics were unable to offer Medicaid patients any resources about where they could receive care. When the authors checked the list of orthopedists accepting Medicaid, 15 stated they didn’t accept Medicaid, 11 did not treat ankle injuries, nine did not have working telephone numbers, and only three were able to schedule an appointment.

For the uninsured, just because appointments were available did not necessarily mean they were affordable. On average, uninsured patients were asked to pay $353.74, with only two patients able to secure appointments for less than $100. A quarter of clinics offered discounts for those paying in cash, and 8 percent offered payment plans. Clinics were compensated by privately insured patients at an average rate of $236 for a clinic visit and $36 for an X-ray, $77 less than the average charge to the uninsured. Medicaid, on the other hand, compensated clinics at a rate of $55 to $101 for the office visit and $26.73 for an X-ray. Only one in seven Medicaid patients were able to secure outpatient appointments. Uninsured patients, while better able to schedule appointments, encountered prohibitively high charges.

I’m sure I’m not alone in looking at patient complaints in the electronic medical record and wondering why patients were coming to the ED with problems that could clearly be treated in an outpatient setting. After reading this article and considering the amount of time the researchers must have spent attempting to schedule appointments, I am no longer surprised. When balancing real-life responsibilities such as work and childcare, who has the time to call multiple clinics to schedule an appointment? If we as a health care system truly believe that reducing ED visits and hospitalizations is the way to reduce health care costs, we must ensure that systems are in place to facilitate accessible and affordable outpatient care.

Dr. Eswaran is an EM resident at Northwestern University in Chicago.

Reference

1. Medford-Davis LM, Lin F, Greenstein A, et al. “I broke my ankle”: access to orthopedic follow-up care by insurance status. Acad Emerg Med. 2017;24:98-105.