ED Visits on the Rise, but Access to Care Still an Issue

The increased availability of urgent care centers, retail clinics, and telephone triage lines has not affected emergency department (ED) visits. In fact, three-fourths of emergency physicians report ED visits are going up, according to a poll from the American College of Emergency Physicians (ACEP).

Of the more than 2000 respondents, 90% said the severity of illness or injury among patients has either increased or stayed the same. Furthermore, 28% said there have been significant increases in all emergency patients since the Affordable Care Act’s requirements that all Americans have health insurance took effect.

Michael Gerardi

"The reliance on emergency care remains stronger than ever," , MD, FAAP, FACEP, president of the ACEP, said in a statement. "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."

He added that just because more people not have health insurance, does not mean that they have timely access to medical care. In particular, this can be difficult for Medicaid patients, because many physicians won’t accept them. More than half of respondents said the number of Medicaid patients is rising.

"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 the Emergency Medicine Action Fund 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."

More than one-third (38%) of respondents said that their community or state is making efforts to reduce the number of emergency patient visits, while 21% were unsure if that was the case. In addition, 83% of physicians said they have concerns about efforts being made to reduce emergency visits, mostly because they are concerned patients will delay medical care or go to a less skilled site (44%), but also because these efforts do not actually reduce the volume of patients (44%) nor do they significantly reduce spending (41%).

In the event that the Supreme Court sides with the plaintiffs in the case of King v. Burwell and does away with the subsidies for consumers on the federally facilitated marketplace, 42% of respondents expect emergency visits will increase, but 65% indicated that reimbursement for emergency care would decrease.