Three-quarters of emergency physicians report that emergency visits are going up, according to a new poll [PDF]. This represents a significant increase from just one year ago when less than half reported increases. Rather than trying to keep people out of emergency departments, policymakers need to recognize the value of this model of medicine that people want and clearly need, according to ACEP.

Most of the respondents to the poll report little or no reductions in the volume of emergency visits due to the availability of urgent care centers, retail clinics, and telephone triage lines. About 90 percent of more than 2,000 respondents also say the severity of illness or injury among emergency patients has either increased (44 percent) or remained the same (42 percent).

“The reliance on emergency care remains stronger than ever,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP. “It’s the only place that’s open 24/7, and we never turn anyone away. Rather than trying to put a moat around us to keep people out, it’s time to recognize the incredible value of this model of medicine that people need.”

More than one-quarter (28 percent) report significant increases in all emergency patients since the requirement to have health insurance took effect. In addition, more than half (56 percent) say the number of Medicaid patients is increasing.

These data correlate with another new report issued by Health Policy Alternatives, which found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments and into primary care are not working. More than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees, despite a provision in the ACA boosting pay to primary care physicians treating Medicaid patients. The median wait times was two weeks but over one-quarter of providers had wait times of more than a month for an appointment.

The reliance on emergency care remains stronger than ever…Rather than trying to put a moat around us to keep people out, it’s time to recognize the incredible value of this model of medicine that people need.
—Michael J. Gerardi, MD, FAAP, FACEP

“There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the emergency department,” said Orlee Panitch, MD, FACEP, chair of EMAF and emergency physician for MEPHealth in Germantown, Maryland. “In addition, states with punitive policies toward Medicaid patients in the ER may be discouraging low-income patients with serious medical conditions from seeking necessary care, which is dangerous and wrong.”

The report—commissioned by the Emergency Medicine Action Fund  (EMAF)—is titled “Review of the Evidence on the Use of the Emergency Department by Medicaid Patients and the Evolving Role of Emergency Medicine Physicians” [PDF].

“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Dr. Gerardi. “Just because people have health insurance does not mean they have access to timely medical care.”

In addition, Dr. Gerardi raised concerns about the closure of hospitals and emergency departments in states that have not expanded Medicaid.

“Hospitals received less Medicaid funding for charity care when the ACA took effect, because more people were supposed to have health insurance coverage,” said Dr. Gerardi. “But in states that didn’t expand Medicaid, hospitals are hurting. For example, the closure of a hospital in Baton Rouge resulted in a crisis for another hospital that inherited all the patients, many of whom are uninsured, and now this hospital may close as well. The average reimbursement for a Medicaid patient in the ER is about $43.00, but it’s much lower in many states.”

When asked what would happen if federal subsidies for health insurance coverage were to be eliminated in their states—which might occur  if the U.S. Supreme Court decides in favor of the plaintiff in King v. Burwell—42 percent of emergency physicians said they expect emergency visits to increase. Additionally, 65 percent expect reimbursement for emergency care will decrease if those federal subsidies are eliminated.