The AHA says the federal government's more stringent inpatient admissions guidelines and growing claims denials are also putting more pressure on hospitals to treat Medicare patients in the ED rather than admit them.
The RAND report found that increased admissions were highest among people ages 65 and older.
"If you look at the increase in admissions, what you see is that it has more to do with the aging population," Kaplan says. "Patients are being sent to the ED with their acute illnesses and with their complex illnesses. Admissions to the ED are 50% of all hospital admissions and 70% of all non-elective admissions. One of the things that we do know is that it is the Medicare patients, the sicker patients, who are admitting. When I first started practicing, if you saw an 80-year-old, that was relatively rare. These days probably half the patients I see are 80 or 90 and with more complex illnesses too."
"It's a function of an aging population and it is a function of the workforce shortage, particularly among primary care physicians," Kaplan says.
"And the truth is it also relates to the fact that there are many primary care physicians and other physicians who will not take Medicaid and for that matter will not take Medicare. They only want patients with private insurance."