Prepare for Increased ED Usage Under Healthcare Reform

Healthcare reform will provide insurance coverage to millions of Americans who are currently uninsured. Many of them seek access to healthcare only through Emergency Departments. The initial thought would be that once they get health insurance coverage under the new reform law that they would immediately stop using the Emergency Department inappropriately and go instead to primary care physicians thus causing ED visits to decline. But actually just the opposite will likely occur. There are a number of factors that point to a surge in ED volume under healthcare reform. These include:

1) It is a misnomer that the uninsured use the ED more than insured patients. Many of them (though certainly not all) are wary of accumulating large bills. Suddenly having coverage will more likely drive them to seek healthcare. Since they have not established a relationship with a primary care physician or clinic, they will likely begin by going instead to the nearest ED to flash their new health insurance card.

2) Currently the biggest users of EDs are Medicaid recipients. Under reform, their ranks will increase by nearly 16 million. Their trend of using the ED to access the system will continue at least for a significant period until stronger primary care access is established. The new recipients will be much more prone to visit their local ED than they are today.

3) The new healthcare reform law does address improving access to primary care providers over time, but unfortunately it is much more effective in increasing the demand first. There is funding and incentives to create innovative models of care such as medical homes. But first of all these will take time to get approved and developed. Second they will take time to get staffed. And third, it will take time to shift usage patterns into these settings. In the meantime, EDs will stay busy.

Massachusetts has frequently been looked to as a model of what will happen under healthcare reform because they have had a law since 2006 requiring health insurance for almost everyone. They reported a 7% increase in ED visits between 2005 and 2007. Their increases may not be overwhelming but they still remain above the national trends.

How do you prepare for the anticipated increase in patients? A surge plan is certainly beneficial, but we have found it to be much more effective to focus on streamlining your current daily operations. Reducing ED throughput and facilitating earlier discharges has never been more important. We at Compirion Healthcare Solutions have assisted many hospitals to achieve amazing improvements in these areas and would be happy to meet with you to help your hospital prepare for the changes ahead.

More on this later.

Mark Brodeur