More ER patients, but fewer on-call specialists available post-ACA

Tue Oct 4 19:36:21 PDT 2016

September 12, 2016

More ER patients, but fewer on-call specialists available post-ACA

<http://www.fiercehealthcare.com/healthcare/post-aca-er-use-falls-whie-call-
specialists-less-available?utm_medium=nl&utm_source=internal&mrkid=905528&mk
t_tok=eyJpIjoiTkRkaE1qWXpNelEyT0dVMCIsInQiOiIrT056cW1LOFpsTG9QZ1pidkFRVXFwY0
dkYndTMzZsV0RSMTdzYjZTQmcyZzNXdElSNDZueGVJNVFtd1wvK0JGZm9Qb0RkMExpcHNaWDRiT0
Q5cEJJWjBSSG54TEJrQU10d0xqTTEzcWo1Ym89In0%3D> Fierce Healthcare

By Zack Budryk 

In the wake of the Affordable Care Act, emergency department patient volume
has increased, but the number of available on-call specialists has fallen.

In Massachusetts, even as post-ACA ER use rose between 2005 and 2014, ED
consultations with general surgeons fell from 98 percent of visits to 83
percent, according to a study published in the Annals of Emergency Medicine.
More specifically, researchers from Massachusetts General Hospital found
24-hour availability of psychiatric specialists in EDs fell from 56 percent
to 33 percent, with steep declines for pediatricians, plastic surgeons and
orthopedic surgeons as well. Meanwhile, the proportion of Bay State EDs
reporting patients cared for predominantly in the hallway increased nearly
20 points during the same period, from 70 percent to 89 percent.

In Illinois, while ED use by uninsured patients fell in the wake of the ACA,
adult ED visit volume increased 8.1 percent from 2011 to 2015, according to
a separate Annals of Emergency Medicine study. Monthly ED visit volume rose
5.7 percent compared to the pre-ACA period. Meanwhile, the state's
population in general and overall hospitalizations saw no significant
changes.

"Emergency departments continue to be squeezed by pressures inside and
outside the hospital," lead author Scott Dresden, M.D., of Chicago's
Northwestern University Feinberg School of Medicine, said in a statement.
"The changes are larger than can be explained by population changes alone
and are significantly different from trends in ED use prior to
implementation of the ACA."

The findings echo other research indicating ED use continued to increase
even in the wake of the ACA's implementation, FierceHealthcare previously
reported, as well as a study that found the ACA's Medicaid expansion didn't
reduce utilization. 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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