EDs in Illinois, Massachusetts feeling little relief post-ACA

Two state-specific studies of emergency departments (EDs) said the Affordable Care Act (ACA) didn’t decrease patient volume and may have made on-call specialists less available.

The studies, published Aug. 25 in the Annals of Emergency Surgery, dealt with EDs in Illinois and Massachusetts.

The Illinois paper found that after the ACA was implemented, fewer uninsured patients visited the emergency room—a decrease of more than 24,000 uninsured patients in average monthly ED visits between 2011 and 2015. That drop wasn’t enough to offset a large increase in visits by Medicaid beneficiaries (average monthly visit volume increased by 28,000 patients) and a smaller increase among the privately insured (up by nearly 10,000 patients).

“We still don't know if these results represent longer-term changes in health services use or a temporary spike in emergency department use due to pent up demand,” said the study’s lead author, Scott Dresden, MD, MS, of Northwestern University’s Feinberg School of Medicine.

The total number of hospitalizations through the ED was unchanged. Among all payer types, the average monthly visit volume increased by more than 14,000 patients.

The Massachusetts study also showed an increase in ED visits, with a steady rise from around 32,000 patients per month in 2005 to 42,000 in 2015.

In that same period, the study found a significant drop in consultant availability across several categories: The availability of general surgeons dropped from 98 percent to 83 percent among study participants, neurologist availability fell from 70 percent to 59 percent, orthopedic surgeon availability dropped from 85 percent to 70 percent, and, in the largest decrease, availability of 24/7 psychiatry declined from 56 percent to 33 percent.

“During the studied period, the burden of increasing patient volume was clear," said the study’s lead author, Jason Sanders, MD, PhD, of the Department of Emergency Medicine at Massachusetts General Hospital in Boston. "The proportion of emergency departments reporting any patients primarily cared for in the hallway climbed from 70 percent to 89 percent. That is obviously far from ideal and is indicative of an increasingly taxed emergency medical care system."

Sanders and his co-authors wrote that additional research to determine the cause behind the decreased availability, such as whether the actual number of consultants has declined, and whether consultation is cost-effective or increases cost without adding value.