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Medicaid Patients Prefer “One-Stop Shop” of Emergency Department

Patient preferences may snarl switch to primary care physicians

Patient preferences may complicate efforts to redirect Medicaid enrollees from hospital emergency departments to primary care physicians for visits that aren’t truly emergencies, a new study indicates.

More than half of Medicaid enrollees prefer the “one-stop shop” of a hospital emergency department to receive care for conditions that could be treated effectively at a primary care clinic, according to an article by a researcher at the University of Colorado School of Medicine’s Anschutz Medical Campus.

The finding exposes a gap in the services provided to Medicaid enrollees. From a patient’s perspective, going to the hospital emergency department may be less expensive because patients can avoid costs of travel and time away from work. At the same time, reliance on the emergency department can add costs to the overall health care system because those patients do not get the ongoing chronic disease management and preventive care they would get at a primary care clinic.

“From a patient’s perspective, having all imaging and laboratory studies done in one place is likely more cost-effective than going to a [primary care provider] clinic and having gone elsewhere to get further testing,” Roberta Capp, Assistant Professor of Emergency Medicine at the CU School of Medicine, writes in the journal Medical Care.

Capp and her co-authors conducted a cross-sectional study of 150 Medicaid enrollees 18 years of age and older who visited a large, urban, academic emergency department from June to August 2012 with low-acuity conditions.

They asked patients if they preferred to go to their primary care provider’s office if an immediate appointment was available or to stay in the emergency department to receive care. More than 50% opted to receive care in the hospital emergency department because of convenience, access to technology and specialty care. Specific findings included the following:

  • Forty-five percent stated they would prefer to use their primary care physicians rather than the emergency department if an appointment was available at that time.
  • Forty-eight percent said the emergency department had more technology or specialty care services available when compared with their primary care physicians’ clinic.
  • Twelve percent felt the care they received in the emergency department was better than what they would receive in their primary care physicians’ clinic.
  • Fifteen percent were in significant pain

Capp and her co-authors say that the health care system is not patient-centered, and in many ways the emergency department is the logical place for Medicaid enrollees to seek health care. The authors suggest health care transformation must happen in conjunction with the provision of services such as community health workers and case managers, based in emergency departments, to help patients navigate the health care system.

“This type of work brings great value to Medicaid,” they write, “and potentially the health care system, as it will likely improve primary care utilization for chronic disease management and preventive services.”

With the rates of annual visits for adult Medicaid enrollees to the emergency department increasing, many programs throughout the country are focused on engaging patients in the use of their primary care providers rather than the emergency department for low-acuity conditions.

Sources: University of Colorado School of Medicine; May 14, 2015; Medical Care; June 2015.

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