Emergency physicians have sounded another warning cry about overcrowding following results from a March survey showing that 80% of their departments have seen increases in visits in the last year.
The results refute the prevailing but incorrect assumption that when more people have insurance, emergency room visits will go down when in fact, they will more than likely go up, says Sandra Schneider, MD, president of the American College of Emergency Physicians.
Nearly all the doctors responding to the ACEP survey reported that every day, they see Medicaid patients who come to their EDs because they could not find a doctor who would accept their health coverage.
If the healthcare reform bill pays for this population at Medicaid rates, this problem will only be exacerbated, Schneider said.
"This poll confirms what we are witnessing in Massachusetts – that visits to emergency rooms are going to increase across the country, despite healthcare reform, and that health insurance coverage does not guarantee access to medical care," Schneider said.
She is referring to a program enacted in 2006 to provide coverage to the bulk of that state's residents. Instead of reducing crowding, visits to emergency departments went up, according to statistics released by the state.
"Emergency medicine provides lifesaving and critical care to millions of patients each year and yet only represents 2% of the nation's healthcare expenditures."
The survey revealed that two-thirds of emergency room visits occurred after business hours, when doctor's offices are closed. According to the Centers for Disease Control and Prevention, visits to the ED were last reported at an all-time high of 124 million in 2008 and are expected to continue to rise.
"Emergency visits have increased at twice the rate of the U.S. population and less than 8% of those patients have non-urgent medical conditions, meaning the vast majority need to be there," Schneider emphasized. "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."
Other factors affecting care in the ED included an increasing number of patients seeking care who have no health coverage and a growing senior population. Visits from those populations were said to be the biggest reason for the overall increase in ER patients.
More than three-fourths of the doctors who responded to the ACEP survey said they believe their hospitals use resources efficiently, but 44% said fear of litigation was the biggest impediment to reducing department costs. Also, 53% of emergency physicians reported that fear of lawsuits is the main reason for ordering a larger number of tests than they otherwise would.
ACEP said that it sent e-mails of inquiry to 20,687 emergency physicians and received 1,768 responses.