Setting the Record Straight on Medicaid Emergency Room Use

There are more than a few misconceptions in the health care world, including that many Medicaid patients are using hospital emergency rooms in place of family doctors. While that does take place in some cases, the percentage is not nearly as high as commonly thought. That is among several interesting findings in a new Center for Studying Health System Change report.

Policy makers and providers frequently point to Medicaid patients’ heavy reliance on hospital emergency departments as a problem that contributes to crowded emergency departments, long wait times and high costs, as well as poor management of chronic conditions. Recent research has dispelled misconceptions linking ED use to crowding, finding that most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed—so-called ED boarding—not a high volume of nonurgent ED visits. Other research has dispelled the mistaken belief that most ED users have Medicaid coverage, are uninsured or do not have a usual source of care. In fact, people with private insurance account for most ED use, and people with higher incomes and a private physician as their usual source of care are driving ED visit increases over time.

Other misconceptions about Medicaid patients’ ED use continue to drive policy. In response to state budget crises, some Medicaid programs have sought to cut ED use by denying payment for emergency care viewed as unnecessary, increasing patient cost sharing to discourage visits and penalizing patients for too many ED visits—all based on the assumption that Medicaid patients commonly use EDs to evaluate symptoms that could wait for a primary care clinician to treat. Media coverage of so-called frequent flyers—a small number of people with hundreds of ED visits—may have contributed to commonly held views that Medicaid and uninsured patients often use emergency departments inappropriately.

Nonelderly Medicaid patients do use EDs at higher rates than nonelderly privately insured patients. In 2008, people aged 0 to 64 covered by Medicaid had 45.8 ED visits per 100 enrollees compared with 24.0 visits per 100 nonelderly privately insured people, according to the most recent data available from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (see Table 1 and Data Source). Across children and working-age adults with Medicaid, all age groups mirror a pattern of higher rates of ED use than the privately insured, including children aged 0-12, teens and young adults aged 13-20 and adults aged 21-64.5 However, this study’s findings indicate that Medicaid patients’ higher rates of ED visits are not disproportionately for minor health concerns when compared to privately insured patients.

Detroit: The Good & Possible Bad of Health Care Investments

Can medicine replace motors as the economic engine in the Detroit metropolitan area? Not so fast, says the Center for Studying Health System Change, which recognizes possibilities but warns of potential dangers in high levels of health care capital investment. The Center for Studying Health System Change reports:

Despite a weak economic outlook, Detroit area hospital systems plan to spend more than $1.3 billion in the coming years on capital improvements, leading some to hope that medical care can help revitalize the area’s economy, according to a new Community Report released today by the Center for Studying Health System Change (HSC) and the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Overlooked in the enthusiasm is the possibility that significant expansion of the community’s health care infrastructure may lead to higher health care costs if the hospital systems can’t attract new patients from outside the Detroit metropolitan area, according to the report.

“If all the spending on capital improvements leads to increased use of high-tech services or additional costs from excess capacity, the end result might be higher private health insurance premiums, which could negatively impact employers and employees,” said Paul B. Ginsburg, Ph.D., HSC president and NICHR director of research.

The challenges facing the Detroit metropolitan area’s health care system are intertwined with the challenges facing the community as a whole, including a declining and aging population; major suburban/urban differences in income, employment, health insurance coverage, and health status; and a shrinking industrial base, according to the report.

Throw Away Those Prescription Pads!

I’ve written a few stories for BizVoice magazine on electronic medical records during my tenure here at the Chamber. Over the last few years, I’ve asked three different physicians (our longtime doctor moved too far away and the first choice apparently skipped the bedside manner/communicate with your patients class in medical school; thus, three family docs) about their use of EMRs.

The paraphrased responses, in no particular order: not using them and don’t ever plan to; been using for about a year but it’s been a painful transition; and they are the greatest thing in the world. The latter seemed particularly efficient as she zipped off a prescription to the pharmacy while we were wrapping up our conversation.

E-prescribing is the focus of a new national report. According to the Center for Studying Healthy System Change, few doctors were e-prescribing advocates or using the advanced features that are available. The caveat is that the survey represents 2008 use, a year before federal incentives before put into place and prior to additional government emphasis on all things electronic in health care delivery.

Here’s a portion of the study release and link to the full report.

Even when physicians have access to e-prescribing, many do not routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study released today by the Center for Studying Health System Change (HSC).

Slightly more than two in five office-based physicians reported that information technology (IT) was available in their practice to write prescriptions in 2008, the year before implementation of federal incentives, according to the study funded by the Robert Wood Johnson Foundation (RWJF). And, among physicians with e-prescribing capabilities, about a quarter used the technology only occasionally or not at all.

The study also found that  fewer than 60 percent of physicians with e-prescribing capability had access to three advanced features included as part of the Medicare and Medicaid incentive programs—identifying potential drug interactions, obtaining formulary information and transmitting prescriptions to pharmacies electronically—and less than a quarter routinely used all three features.

“Adoption of e-prescribing remains low, particularly among the half of all physicians who work in solo or two- to five-physician practices, said study author Joy Grossman, Ph.D., an HSC senior researcher. “And, among physicians with e-prescribing capabilities, many do not use the technology routinely, and even fewer use advanced e-prescribing features routinely.”