UCSF STUDY FINDS BIG JUMP IN ER VISITS

Mon Aug 23 19:12:50 PDT 2010

 CAL/AAEM: California Chapter of the American Academy of Emergency
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August 11, 2010

EMERGENCY ROOMS ARE GETTING MORE CROWDED EVERYWHERE, STUDY FINDS

Karen Kaplan -- Los Angeles Times - August 11, 2010

Last week, the Los Angeles Times reported that the already busy
emergency room at Los Angeles County-USC Medical Center -- one of the
biggest public hospitals in the country -- is getting even more
crowded. This week, a report in the Journal of the American Medical
Assn. shows that County-USC is hardly alone in experiencing more
demand from patients.

Among the findings:

The number of patient visits in emergency rooms nationwide rose from
about 95 million in 1997 to 117 million in 2007 -- an increase of 23%.

Only about half of that increase can be attributed to population
growth.

The average wait time in ERs rose from 22 minutes to 33 minutes over
that period. 

Meanwhile, as demand was growing, the number of ERs dropped 5% from
4,114 in 1997 to 3,925 in 2007.

In 1997, about 43% of emergency rooms were considered "safety net" ERs
(because roughly one-third or more of their patients were on Medicaid
or uninsured). By 2007, the proportion had risen to 63%.

The researchers found that most of the increased demand for emergency
room services came from adults covered by Medicaid, the government
insurance program for the poor. In 1999, there were 693.9 ER visits
per 1,000 Medicaid enrollees; by 2007, that number had ballooned to
947.2 visits per 1,000 enrollees. In part, that's because 4.8 million
adults were added to the Medicaid rolls during that time -- an
increase of 35%.

During the same 8-year period, the number of children covered by
Medicaid jumped 42% thanks to the introduction of the State Children's
Health Insurance Program (better known as SCHIP, and now known simply
as CHIP). Although SCHIP represented the biggest expansion of Medicaid
in its 40-year history, those additional 6.2 million children did not
clog up ERs, probably because the program was effective in steering
kids to primary care doctors, according to the study.

ER visit rates were stable for people with Medicare, private
insurance, and even the uninsured, the study found.

But things have probably gotten worse -- perhaps much worse -- since
2007, the study authors warned.

"One of the nation's most severe recessions started in 2008, and with
record job losses in 2008 and 2009, an estimated additional 5.8
million Americans became uninsured and an estimated 5.4 million
enrolled in Medicaid and SCHIP," they wrote. "An additional 16 million
individuals are expected to obtain Medicaid coverage through the
Patient Protection and Affordable Care Act of 2010." How ERs deal with
these patients is "a critical concern," they concluded.

August 11, 2010

UCSF STUDY FINDS BIG JUMP IN ER VISITS

Victoria Colliver - San Francisco Chronicle

PDT SAN FRANCISCO -- Emergency room visits to U.S. hospitals increased
more than 23 percent from 1997 to 2007 - double what researchers
expected the rise would be based on population growth, according to a
UCSF study released today.

Total annual visits to the country's emergency departments rose from
94.9 million in 1997 to an estimated 116.8 million over the next
decade, the study found. Visit rates for adults on Medicaid accounted
for the jump, while rates for adults with private insurance and those
on Medicare showed no significant change.

Relatively low reimbursements to physicians who care for patients on
Medicaid, the federal-state health program for the poor who meet
certain criteria, were believed to be a key factor behind the
increase.

"There are many physicians who refuse to accept new patients with
Medicaid," said Dr. Ning Tang, assistant clinical professor at UCSF
and lead author of the study. "This doubling in emergency department
visits by adults with Medicaid suggests they might not have adequate
access to outpatient care."

According to the study, which appears in the Journal of the American
Medical Association, adults enrolled in Medicaid, known as Medi-Cal in
California, visited emergency rooms at the rate of just over 947 per
1,000 in 2007, up from 694 visits per 1,000 in 1999. The number of
visits by Medicaid recipients nearly doubled from 9.6 million in 1997
to 17.7 million in 2007.

The emergency room study, which comes on the heels of similar
emergency department numbers released last week by the National Center
for Health Statistics, underscores concerns about the growing strain
on America's safety-net services, particularly in light of the
recession and the impact of the national health care overhaul law.

The law will increase coverage to an estimated 16 million Americans by
expanding the Medicaid program in 2014, raising questions about
whether there will be enough physicians and services to accommodate
them.

Because the emergency room statistics in the reports cover the years
through 2007, they don't capture the impact of the recession. Millions
of workers lost their jobs and employer-sponsored health insurance,
which may have caused an even further increase in visits to emergency
rooms by newly uninsured people.

A report released last year by the California Hospital Association, a
trade group representing the state's hospitals, showed the economic
downturn was starting to take a toll. In the survey of hospital chief
financial officers conducted in the second quarter of 2009, 57 percent
of hospitals reported an increase in visits to their emergency rooms
over the previous year.

The federal health law increases Medicaid reimbursement rates to
encourage more primary-care physicians to accept Medicaid, but those
federally funded increases could last just two years. Meanwhile,
hospitals are concerned about lower payments in the law, such as
reduced reimbursements for care of the uninsured when more patients
have coverage in 2014.

"Over next 10 years, California hospitals are facing $17 billion in
new payment reductions as a direct result of the reform measures,"
said Jan Emerson, spokeswoman for the California Hospital Association.

The UCSF study also noted the number of U.S. emergency departments
decreased by 5 percent from 1997 to 2007.

Dr. Angela Gardner, president of the American College of Emergency
Physicians, said it's not fair to blame the increase in emergency room
visits on Medicaid recipients or any other particular population.

"The fact of the matter is people are sicker than they used to be,
they're older than they used to be and have more illnesses than they
used to have," Gardner said.

Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine

Contact us at:  <mailto:somcaaem at uci.edu> somcaaem at uci.edu

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