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Hospital EDs Seeing Sicker Medicare Patients

John Commins, for HealthLeaders Media, May 8, 2013

"Unfortunately most of the RAC denials are occurring beyond a one-year timeframe. You can do it, but it is not going to help because that's when all the denials are happening," she says.

The AHA report is limited to Medicare claims data, but Steinberg says the advent of expanded health insurance coverage in 2014 under the Affordable Care Act means that EDs will probably see an uptick in usage from other demographics "as more patients become insured and there is still limited access to primary care in many areas particularly in poor neighborhoods."

"We haven't looked at what is going on in terms of other populations, but we would imagine that everybody is getting sicker because it's not like it all happens the day you enter the Medicare program. The obesity and the sedentary lifestyle and the high-stress environment—all those things are risk factors long before you enter Medicare, and a lot of that is exacerbated in the Medicaid population," Steinberg says.

The AHA report, based on an analysis of Medicare claims data conducted by The Moran Company, also found that use of the emergency department by Medicare/Medicaid "dual-eligible" patients is rising, and; EDs are serving more Medicare patients with behavioral health diagnoses.


John Commins is a senior editor with HealthLeaders Media.

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