Two studies point to higher demand, crowded EDs, and less access to specialists.
Emergency departments are experiencing higher demand from more patients, but lower availability of specialists, since the implementation of the Patient Protection and Affordable Care Act, according to two new studies published in the Annals of Emergency Medicine.
The studies were state-specific: One focused on Illinois and the other on Massachusetts.
"Emergency departments continue to be squeezed by pressures inside and outside the hospital," Scott Dresden, MD, MS, of Northwestern University Feinberg School of Medicine in Chicago, IL, the lead author of the Illinois paper, said in a statement.
The studies identify four ways the healthcare reform law is squeezing EDs:
- Monthly Visit Volume is Up
When comparing the pre-ACA period (2011 to 2013) to the post-ACA period (2014 to 2015) in Illinois, the researchers found that the average monthly ED visit volume increased by 5.7%, or an additional 14,080 visits. Hospitalization rates were essentially unchanged, as was the size of Illinois' population.
"A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in emergency department visits by uninsured patients," Dresden said. "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."
- Annual Visit Volume is Up
Annual ED visit volume in Illinois increased from 2.9 million in 2011 to 3.2 million in 2015, an 8.1% increase statewide. In Massachusetts, from 2005 to 2015, the median number of annual ED visits increased on average from 32,025 to 42,000.
- Specialist Access is Down
From 2005 to 2015, Massachusetts saw a significant drop in availability of specialists in surgery, neurology, obstetrics-gynecology, orthopedics, pediatrics, plastic surgery, and psychiatry. For example, availability of general surgeons declined by 15%, while 24/7 psychiatry availability declined by 23%.
- There Aren't Enough Rooms
In Massachusetts, there was a 29% increase in EDs caring for patients in areas outside the ED, such as hallways—from 70% of EDs reporting this situation in 2005 to 89% in 2015. "That is obviously far from ideal and is indicative of an increasingly taxed emergency medical care system," Jason Sanders, MD, PhD, of the Department of Emergency Medicine at Massachusetts General Hospital in Boston, said in a statement.