In its continuing disagreement with the Obama Administration, the American College of Emergency Physicians yesterday called on the CDC to release a comprehensive report on emergency room usage, as it usually does, saying that its latest document "is much less comprehensive than previous annual reports."
"It is critical to know, for example, how many patients use the ER, how many are admitted to the hospital from the ER, and the top reasons that people seek emergency care," said Angela Gardner, MD, ACEP president.
"This new format makes it difficult to compare reports from previous years."
ACEP has taken issue with Health and Human Services Secretary Kathleen Sebelius and other Obama officials for their suggestions that emergency room use would fall off greatly if people just had health insurance. Also at issue is the administration's contention that large numbers of people who come to an ED are not urgent and could be treated by their primary care providers if healthcare reform paid primary care doctors more, encouraging more medical students to choose general practice.
"The facts don't bear that out," past ACEP president Nick Jouriles said in an interview last year.
The fault with Sebelius' logic, he and other ACEP representatives say, is that people will still use the emergency room because they won't be able to get an appointment with a primary care doctor when they need one. Also, most of the patients who come to the emergency do, in fact, have symptoms that need prompt evaluation.
In yesterday's statement, Gardner criticized the Centers for Disease Control and Prevention's 2007 report saying it contains "few data points ... that confirm what emergency physicians know from experience: Emergency visits remain at record high levels, and the rate of non-urgent visits is declining.
"Only 10% of emergency visits by people under age 65 were considered non-urgent. Furthermore, uninsured patients are no more likely to be triaged as non-urgent than patients with health insurance," she said.
Gardner added that "it's important to note the report finds that having a usual source of medical care, such as a primary care provider, does not affect the number of times people under age 65 visit the emergency department. It also finds that people over age 65 with a usual source of care are actually more likely to seek emergency care.
"This is one reason why emergency physicians are saying emergency visits are going to increase, despite healthcare reforms that increase payments to primary care physicians."
The new emergency room report, issued by the National Center for Health Statistics, says that the demand for emergency room care has been increasing since 1996, resulting in EDs experiencing higher patient volume, overcrowding, and longer wait times.
The report drew these conclusions:
- Among children and adults age 45-64, the uninsured were no more likely than those with private insurance to have had at least one ED visit in a 12-month period, but among adults 18-44, the uninsured were more likely than those without private insurance to have at least one ED visit.
- One in five people had one or more ED visits in a 12-month period.
- Older adults—those aged 75 and over—were more likely to have had at least one ED visit in a 12-month period than younger people.
- Non-Hispanic blacks were more likely to have had one or more ED visits in a 12-month period than non-Hispanic white or Hispanic people.
- As family income increased, the likelihood of having one or more ED visits in the past year decreased.
The report also said that 10% of ED visits by persons under age 65 were considered non-urgent, but those people were triaged as non-urgent at similar rates among the uninsured, persons with Medicaid, and those with private insurance.