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PPACA driving up ER visits

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The number of emergency visit rooms has increased since the implementation of the Patient Protection and Affordable Care Act — and most doctors expect it to get even worse over the next few years.

In a poll of some 1,800 emergency physicians by the American College of Emergency Physicians, nearly half said more patients have been coming through their ER doors since Jan. 1, when many of PPACA’s key provisions went into effect.

Another 27 percent said the numbers haven’t changed, while 23 percent said they’ve seen a decline in ER visits.

Over the next three years, 86 percent of these doctors believe emergency room use will increase. And what’s more, 77 percent say their ERs are not adequately prepared for significant increases in traffic.

The poll’s findings about increasing ER visits are noteworthy given the law’s promise that it would reduce costly emergency room visits, because it was designed to encourage patients to seek care in a doctor’s office or clinic settings. Though the fact that ERs are experiencing flooding isn’t surprising, given the number of newly insured patients, emergency room doctors say the increase points to a number of issues.

One such problem, doctors say, lies in the fact that physicians are in short supply and cannot properly deliver care to the vast numbers of newly insured patients.

The Association of American Medical Colleges predicts a shortage of 90,000 doctors by 2020.

“Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care,” said Alex Rosenau, president of ACEP.  

“But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low,” he said. “When people can’t get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care.”

Emergency-room doctors reported seeing more Medicaid patients, and fewer private insured patients since the start of the year. 

University of Colorado School of Medicine researchers earlier this year similarly found that more Medicaid and Medicare patients are visiting emergency rooms because they can’t get a hold of a primary care practitioner when they need routine care.

Moreover, the survey revealed concern over the country’s “mental health crisis,” with 84 percent of emergency room physicians reporting that psychiatric patients are being boarded in their ER.

“People having a mental health crisis seek care in emergency departments because other parts of the health care system have failed them,” Rosenau said. “Because of the critical shortage of mental health resources, some of these vulnerable patients wait for days in emergency departments.”

In a news release, the ACEP urged Congress to make “a firm commitment to emergency patients by holding a hearing to examine whether additional strains are occurring in the emergency department safety net as a consequence of the Affordable Care Act.”

Doctors polled said the best way to improve emergency medical care would be to place restrictions on lawsuits stemming from such treatment.  

Enacting liability reform was the top choice for improving emergency care (cited by 32 percent of those surveyed), while 18 percent of respondents cited providing adequate reimbursements and 17 percent cited boosting the number of primary care providers.

See also: Arkansas hospitals like Medicaid alternative