ER visits rise after ACO expansion

[secants]

http://online.wsj.com/news/article_...4579574390961658638-lMyQjAxMTA0MDIwMTEyNDEyWj

Essentially half of the EM physicians surveyed claimed that ED visits have risen since Jan of this year with forecast of continual rise as more people get coverage. Good time for students to go into EM? Good time for EM vets to maybe pull back?

---

Members don't see this ad.

 

[secants]

Not sure if pay wall with the link, I'll copy/paste if needed.

 

[RustedFox]

In related news; summer is actually much warmer than winter.

 

[WilcoWorld]

Our visits dropped significantly for the first 3 months. Now they're coming back. I don't think there's enough good data at this time to draw sound conclusions.

 

[scummie]

Similar thing happened in Massachusetts after they "reformed".

http://newsatjama.jama.com/2014/03/20/emergency-visits-up-in-massachusetts-after-reforms-enacted/
http://www.reuters.com/article/2011/06/02/us-health-reform-er-idUSTRE7514VX20110602

Notice Reuters article is from 2011 and the study JAMA references was 2004-2009.

 

[iatros]

http://www.studentdoctor.net/2014/04/faq-on-acos-accountable-care-organizations-explained-2/

just fyi because it's confusing

aco =/= aca

aco: accountable care organization
aca: affordable care act

 

[EctopicFetus]

VOlumes up.. been going up. After MassCare aka RomneyCare their ED visits rose at a rate faster than the national average.

If you got new access to medicaid you will use the ED more. on top of that old people are getting older and there are more of them.. another cause for increased ED visits.

What I really want to know is WHO is coming to the ED. If it is medicaid patients thats bad, they pay like crap and if you already work in a busy ED thats not a win, if it is people with private insurance who are paying their high deductibles then thats a win. I dont see why these people would increase their utilization. Granovsky estimated that the move from self pay to medicaid is worth about 150k for a 40k visit ED. I estimate that to be worth about 10k per doc.

I am amazed though how many people get their "Obamacare" insurance through the exchange, show up in my ED and are shocked they have a deductible. It would be hilarious if it wasnt so sad that people were so ignorant about what they buy.

 

[WilcoWorld]

I heard from a colleague with inside knowledge of this survey that my region (upper midwest) experienced a trend different from the rest of the country…it really was a terrible winter.

 

[Old_Mil]

I'd say that our volumes are up 10%-20% year over year, with the largest increase being Medicaid patients...and yes, Mark Plaster was right. They use the department for anything and everything, at all hours...and they like Demerol.

 

[RustedFox]

I'd say that our volumes are up 10%-20% year over year, with the largest increase being Medicaid patients...and yes, Mark Plaster was right. They use the department for anything and everything, at all hours...and they like Demerol.

This. At my shop.

 

[Hercules]

This. At my shop.

We went from 30 K in 2012 up to 40 K in 2013. It looks like this year on pace to be about 45 K so I guess about 10% growth for us. We have also seen a disturbing trend of increasing Medicaid and self-pay. Increasing volume is great but decreasing collections per patient is not so great

 

[Birdstrike]

We went from 30 K in 2012 up to 40 K in 2013. It looks like this year on pace to be about 45 K so I guess about 10% growth for us. We have also seen a disturbing trend of increasing Medicaid and self-pay. Increasing volume is great but decreasing collections per patient is not so great

Obvious and predicted by many including myself, prior to the ACA being passed. Many that were bullish on the ACA for EM ignored this obvious inevitability. The uninsured being covered by Medicaid expansion and diluting down patients with better insurance and diluting down collections percentages.

 

[RustedFox]

We went from 30 K in 2012 up to 40 K in 2013. It looks like this year on pace to be about 45 K so I guess about 10% growth for us. We have also seen a disturbing trend of increasing Medicaid and self-pay. Increasing volume is great but decreasing collections per patient is not so great

10K a year is huuuuge.

 

[Hercules]

10K a year is huuuuge.

Yes it was. The amazing thing was that we actually didn't increase our physician staffing. We just got more efficient. To be fair though, I felt we were grossly overstaffed when I got here 5 years ago.

 

[GeneralVeers]

I warned this would happen. The majority of ACA expansion of "coverage" has been through medicaid. Many people (we don't have an exact number) lost private insurance and had to get a Medicaid plan through the exchanges. If this trend continues, it will actually drive down reimbursement rather than increase it as optimists predicted.

Glad I work salaried jobs now in underserved areas, so I will be largely immune from this trend in the short term.

 

[Hercules]

I warned this would happen. The majority of ACA expansion of "coverage" has been through medicaid. Many people (we don't have an exact number) lost private insurance and had to get a Medicaid plan through the exchanges. If this trend continues, it will actually drive down reimbursement rather than increase it as optimists predicted.

Glad I work salaried jobs now in underserved areas, so I will be largely immune from this trend in the short term.

I agree with Birdstrike and GeneralVeers. Most of us did predict this would happen. I'm just confirming that I'm seeing it in my shop and interested to see if others are having the same experience. GV is right to point out that this will likely affect everyone's reimbursement in the long term.

 

[The White Coat Investor]

There are so many things that go into increasing volume. How can you possibly blame it on ACOs, or ACA for that matter? The trend over the last few years has been toward more and more ED visits per year. The trend has also been toward a worsened payor mix. How is this any different?

Our volume hasn't been increasing the last few years. Decreasing if anything. But the main thing affecting our volumes is the other 3 EDs that were built on this side of town in the last 6 or 8 years.