Despite Obamacare's Expanded Coverage, More Patients Going to the ER
(CNSNews.com) – Despite expanded health insurance coverage under the Affordable Care Act (ACA), more people are going to hospital emergency rooms (ER) for treatment because they can’t get an appointment with a primary care physician, according to the American College of Emergency Physicians (ACEP).
“Nearly half of emergency physicians responding to a poll are already seeing a rise in emergency visits since January 1 when expanded coverage under ACA began to take effect,” according to ACEP, which gives overall emergency care in the U.S. “a dismal D+ grade.”
In addition, 86 percent “expect emergency visits to increase over the next three years,” and 77 percent say their ERs “are not adequately prepared for significant increases” in patient volume, according to the online poll.
“Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care,” ACEP’s president, Dr. Alex Rosenau, explained. “But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low.”
“When people can’t get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care,” Rosenau added.
In some areas, wait times for a doctor’s appointment are already quite long, says Dr. Michael Murphy, an ER physician from New Jersey.
“With the Medicaid expansion and the Affordable Care Act, people have insurance but they can’t get in to see their primary care physician. So they’re going to the emergency department” with minor conditions, even though “the whole intent [of the ACA] was to get the sore throats, coughs, congestion and whatnot” out of the ERs.
“One thing that the Affordable Care Act did, and I think, you know, it’s a great thing for everybody to have health insurance, but what we’ve seen just recently, and all the data from Q1 and Q2 right now, 2014, shows that volumes have increased dramatically. They’re predicting about a 15 to 20 percent rise in [patient] volumes across the country, people with insurance, and now they’re flooding to their physicians,” Murphy told CNSNews.com.
“Well, the physicians can’t [handle the increased volume]. It doesn’t make financial sense to hire another physician or another nurse practitioner with decreased reimbursements, so what they’re doing is, they’re trying to see the same 15 to 20 percent bump in volume with the same providers that they have."
“And what that does is, it just creates greater wait times. That access to care is not there. And the frustrating part is that for patients immediately with new insurance, is that you can’t even get in.”
“What if you have a horrible diagnosis from the emergency department of cancer and you need to go see a family practitioner to get a referral to go see an oncologist? Well, the first time you can get in to see a family practitioner might be three months.”
And with more patients and less revenue coming into already struggling hospitals, ER doctors are constantly being pressured to speed things up, Murphy said.
“We get daily pressure to do more with less, and to see your patient in seven minutes or less, get your patient out of the emergency department. They’re always telling you to move, move move and see more patients in the same amount of time,” he told CNSNews.com.
“You have to. It’s a simple financial game. If you’re getting paid less per patient, you have to see more patients to keep the lights on.” But “when you are pressured, and you have to see five, six, seven patients an hour, and you have to do all your own documentation, you’re going to miss stuff,” he said.
However, even going to the nearest ER will soon not be a viable option, Murphy warned.
“Hospitals are closing left and right, and all that volume has to go somewhere,” he said, predicting that health care in the U.S. will be “rationed” within the next decade.
“We fought a couple of wars and you had this massive increase of patients at the VA [Veterans Administration]. And I think that just as private practices are closing, you’re also seeing large hospital systems close down and merge with other large hospital systems. And when that happens on a larger scale, that’s when you get these massive influxes into other facilities and that’s when it can hit the fan. And I think we’re going to get to that point.”
“I think there’s going to be a point where there’s not enough to go around and care is going to be rationed unless you’re paying premium top dollar. And that’s just an unfortunate reality. It probably won’t happen for another five or ten years unless we have some dramatic thing that happens in the meantime,” he told CNSNews.com.
Murphy, who is also co-founder of ScribeAmerica LLC, a group that trains physician assistants to help doctors maintain their medical records, noted that there has been “a dramatic decrease” in the number of solo practitioners since the 1980s due to a “cumulative effect” of lower government reimbursements and the “ever surmounting pressures of more regulation.”
Currently, only 18 percent of physicians in the U.S. are Marcus Welby-style solo practitioners, and many of them are selling their practices, he said, adding that it won’t be long before they are replaced by giant health care groups employing hundreds of physicians.
“I can only imagine this trend will continue and soon there will only be a very few personalized, custom private practices. And the ones that will be there will be in very affluent areas, they’ll be kind of that concierge practice,” Murphy told CNSNews.com.
“And the rest will be large group centers,” he predicted. “And then even those will go to the next round of consolidation." But the consolidations will come at a cost to patients, he warned.
The result will be a kind of “factory medicine” where doctors work 9-to-5 and are less personally invested in their patients, he said.
“Once you lose that vested interest [as owner of a private practice], and adopt that employee mindset instead of an owner mindset, you stop caring and you lose that personal touch. At the end of the day, it’s not personal anymore."