Survey: ER visits on the rise despite healthcare system changes

Eighty percent of emergency physicians said that emergency visits are increasing despite healthcare reform and changes in reimbursement, and almost 97 percent of these visits were referred by primary care physicians, according to a survey released April 28 by the American College of Emergency Physicians (ACEP). These results defy the commonly held assumption that patients are choosing to go to the emergency department for non-emergency care rather than primary care, ACEP stated.

More than 1,768 emergency physicians responded to the poll conducted March 3 to March 11, and 97 percent said that they have treated Medicaid patients who could not find any other doctors to accept their health insurance. “If the new healthcare reform legislation provides insurance coverage that reimburses doctors at Medicaid rates, this could exacerbate a lack of access to medical care,” the society said.

While 79 percent of the responding physicians said that their emergency departments use resources efficiently, 44 percent agreed that fear of lawsuits was the biggest challenge to cutting costs and 53 percent said that their fear of lawsuits was the main reason for ordering the number of tests they perform.

“Emergency departments need more resources, not fewer, and medical liability reform would help reduce overall costs by reducing the need for defensive medicine,” said Sandra Schneider, president of ACEP.

“Emergency medicine provides lifesaving and critical care to millions of patients each year and yet only represents 2 percent of the nation’s healthcare expenditures. Emergency physicians command the resources of a hospital to provide the best care for patients, but we must be prepared for increasing numbers of patients, not fewer, especially given our growing elderly population.”

In 2008, the number of visits to the ER reached 124 million and two-thirds of these ER visits occurred after business hours when primary care offices were closed. That number is expected to rise in the coming years, ACEP reported.

Twenty-eight percent of physicians said that they attributed the increase in emergency room visits to patients without health coverage and 23 percent attributed the rise to the growing elderly population. In addition, 89 percent of physicians said they expect ER visits to rise with healthcare reforms, and 54 percent of physicians said they expect a significant increase.

“Emergency visits have increased at twice the rate of the U.S. population, and less than 8 percent of those patients have non-urgent medical conditions, meaning the vast majority need to be there," said Schneider. “At the same time, hundreds of emergency departments have closed. The new healthcare reform law does not address these problems and with the elderly population and more emergency departments forced to shut down, this crisis will only get worse."