ER Visits Have Not Decreased Since ACA Implementation

Emergency visits are increasing despite the implementation of the Patient Protection and Affordable Care Act (ACA), with key reasons including seriousness of medical problems and lack of access to other medical providers.

​A new report by the Centers for Disease Control and Prevention found "few changes in ER use" between 2013 and 2014, which is the full year since the implementation of the ACA.

"Emergency departments provide an incredibly valuable service that people rely upon," said Jay Kaplan, MD, FACEP, president of ACEP. "Just because you have health insurance does not mean you have access to timely medical care, America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately.  Instead of putting a moat around the nation's emergency rooms and trying to keep people out, policymakers need to recognize the value of this model of medicine that people need and facilitate its use."

Key findings in the CDC report for why a majority of patients used the emergency department between 2013 and 2014 include:
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• The patient's lack of access to other medical providers (such as primary care physicians)
• The seriousness of a patient's medical problem prompted the ER visit
• The patient's doctor's office or clinic was not open at the time when the patient needed it.

This CDC report mirrors a 2015 ACEP poll where three-quarters of emergency physicians reported that emergency visits were going up since the implementation of the ACA. Most of the respondents to that poll found little to no reductions in the volume of emergency visits due to the availability of urgent care centers, retail clinics and telephone triage lines.  About 90 of those emergency physicians polled also said the severity of illness or injury among emergency physicians had either increased or remained the same.

These data also correlate with other studies, which found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments and into primary care are not working. More than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees, despite a provision in the ACA boosting pay to primary care physicians treating Medicaid patients.  The median wait times was 2 weeks but over one-quarter of providers had wait times of more than a month for an appointment.  There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the emergency department.

"I treat patients in the emergency department every shift that couldn't access a primary care physician and had no choice but to come to the emergency department for treatment because their condition worsened dramatically," said Dr. Kaplan.  "The reliance on emergency care remains stronger than ever.  It's the only place that's open 24/7, and we never turn anyone away."

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.