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CDC: Improving Inappropriate ER Use Is Still an Uphill Battle

Study finds little change since implementation of Affordable Care Act

Reducing excessive emergency room (ER) use was one of the key objectives of the Patient Protection and Affordable Care Act (PPACA), but the law has barely made a dent in the problem, according to a new report from the Centers for Disease Control and Prevention (CDC). Using the 2013 and 2014 National Health Interview Surveys, the CDC examined the percentage of adults who had an ER visit and their reasons for their most recent visit.

The researchers created a hierarchy to classify respondents’ reasons for their last ER visits into three mutually exclusive categories: the seriousness of the medical problem; the doctor’s office or clinic was not open; and the lack of access to other providers.

The investigators found that the percentage of adults (18 to 64 years of age) who had visited the ER one or more times during the past 12 months remained unchanged at approximately 18% in both 2013 and 2014. In 2014, 14% of adults with private coverage visited the ER one or more times during the past 12 months, whereas 35% of adults with Medicaid and 17% of uninsured adults had visited an ER.

Differences in ER use by demographic characteristics were generally consistent in 2013 and 2014. In both years, younger adults (18 to 29 years of age) were more likely than older adults (ages 45 to 64 years) to have visited the ER one or more times during the past 12 months (20% versus 18%, respectively) in 2014.

The seriousness of the medical problem was the reason for the most recent ER visit for approximately 77% of adults 18 to 64 years of age who had visited the ER at least once in the past 12 months. There were no overall changes or changes within insurance coverage status between 2013 and 2014. Uninsured adults (72%) were less likely than adults with private coverage (78%) and Medicaid (77%) to have the seriousness of the medical problem as the reason for their most recent visit.

Among adults who used an ER during the past year, 12% indicated that the doctor’s office or clinic was not open as the reason for their most recent ER visits. There were no significant changes between 2013 and 2014 overall and within health insurance coverage status. In 2013, the percentage of adults whose most recent visit to an ER was because the doctor’s office wasn’t open was lowest among the uninsured (9%) and did not differ significantly between adults with private coverage and adults with Medicaid (approximately 13%). In 2014, differences between uninsured adults and those with private coverage or Medicaid were no longer significant.

In 2014, for 7% of adults who used an ER during the past year, the lack of access to other providers was the reason for the most recent ER visit (8% in 2013). There were no significant changes between 2013 and 2014 overall or by health insurance coverage status. In both years, a higher percentage of uninsured adults’ last visit to the ER was due to lack of access to other providers (15%) compared with adults with private coverage (5%) or Medicaid (8%). In 2014 only, adults with Medicaid were more likely than adults with private coverage to have lack of access to other providers as the reason for the most recent ER visit.

After adjusting for demographic factors, adults with Medicaid had almost four times the odds of one or more ER visits during the past 12 months compared with privately insured adults, but there was no difference when compared with uninsured and privately insured adults.

The authors noted that a recent study of young adults (Akosa et al., Ann Emerg Med 2015;65:664–672) had indicated that small downward shifts in ER use––especially ER use for nonurgent visits––could be expected after expansion of private coverage under the PPACA. Their new analysis of adults’ ER visits, however, found little change in ER use during and immediately after PPACA implementation.

Source: National Health Statistics Report; February 18, 2016.

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