Emergency Department Utilization After the Implementation of Massachusetts Health Reform (original) (raw)
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Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments
Western Journal of Emergency Medicine, Volume 20, Issue 5
The emergency department (ED) has long served as a safety net for the uninsured and those with limited access to routine healthcare. This study aimed to compare the characteristics and severity of ED visits in an Illinois academic medical center (AMC) and community hospital (CH) of a single health system before and after the implementation of the Affordable Care Act (ACA).
Changes in hospital service demand, cost, and patient illness severity following health reform
Health Services Research, 2019
ObjectiveTo estimate the effects of the health insurance exchange and Medicaid coverage expansions on hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity, and also to test the association between changes in outcomes and the size of the uninsured population eligible for coverage in states.Data SourcesHealthcare Cost and Utilization Project State Inpatient and Emergency Department Databases, 2011‐2015, Nielsen Demographic Data, and the American Community Survey.Study DesignRetrospective study using fixed‐effects regression to estimate the effects in expansion and nonexpansion states by age/sex demographic groups.FindingsIn Medicaid expansion states, rates of uninsured inpatient discharges and ED visits fell sharply in many demographic groups. For example, uninsured inpatient discharge rates across groups, except young females, decreased by ≥39 percent per capita on average in expansion states. In nonexpansion states, uninsured utiliza...
Access to care after Massachusetts' health care reform: A safety net hospital patient survey
2012
BACKGROUND: Massachusetts' health care reform substantially decreased the percentage of uninsured residents. However, less is known about how reform affected access to care, especially according to insurance type. OBJECTIVE: To assess access to care in Massachusetts after implementation of health care reform, based on insurance status and type. DESIGN AND PARTICIPANTS: We surveyed a convenience sample of 431 patients presenting to the Emergency Department of Massachusetts' second largest safety net hospital between July 25, 2009 and March 20, 2010. MAIN MEASURES: Demographic and clinical characteristics, insurance coverage, measures of access to care and cost-related barriers to care. KEY RESULTS: Patients with Commonwealth Care and Medicaid, the two forms of insurance most often newlyacquired under the reform, reported similar or higher utilization of and access to outpatient visits and rates of having a usual source of care, compared with the privately insured. Compared with the privately insured, a significantly higher proportion of patients with Medicaid or Commonwealth Care Type 1 (minimal cost sharing) reported delaying or not getting dental care (42.2 % vs. 27.1 %) or medication (30.0 % vs. 7.0 %) due to cost; those with Medicaid also experienced costrelated barriers to seeing a specialist (14.6 % vs. 3.5 %) or getting recommended tests (15.6 % vs. 5.9 %). Those with Commonwealth Care Types 2 and 3 (greater cost sharing) reported significantly more costrelated barriers to obtaining care than the privately insured (45.0 % vs. 16.0 %), to seeing a primary care doctor (25.0 % vs. 6.0 %) or dental provider (58.3 % vs. 27.1 %), and to obtaining medication (20.8 % vs. 7.0 %). No differences in cost-related barriers to preventive care were found between the privately and publicly insured.
Medicaid managed care and preventable emergency department visits in the United States
PLOS ONE
Objectives In the United States the percentage of Medicaid enrollees in some form of Medicaid managed care has increased more than seven-fold since 1990, e.g., up from 11% in 1991 to 82% in 2017. Yet little is known about whether and how this major change in Medicaid insurance affects how recipients use hospital emergency rooms. This study compares the performance of Medicaid health maintenance organizations (HMOs) and fee-for-service (FFS) Medicaid regarding the occurrence of potentially preventable emergency department (ED) use. Methods Using data from the 2003-2015 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the non-institutionalized US population, we estimated multivariable logistic regression models to examine the relationship between Medicaid HMO status and potentially preventable ED use. To accommodate the composition of the Medicaid population, we conducted separate repeated cross-sectional analyses for recipients insured through both Medicaid and Medicare (dual eligibles) and for those insured through Medicaid only (non-duals). We explicitly addressed the possibility of selection bias into HMOs in our models using propensity score weighting. Results We found that the type of Medicaid held by a recipient, i.e., whether an HMO or FFS coverage, was unrelated to the probability that an ED visit was potentially preventable. This finding emerged both among dual eligibles and among non-duals, and it occurred irrespective of the adopted analytical strategy.
The Three-Year Effect of Medicaid Expansion on Emergency Department Visits and Admissions
Annals of Emergency Medicine, 2020
Study objective: We examine the effect of the Medicaid expansion in 2014 under in the Patient Protection and Affordable Care Act on emergency department (ED) utilization and ED admission rates (fraction of ED visits that lead to hospital admission) during the first 3 postexpansion years (2014 to 2016). Methods: We compared ED utilization and ED admission rates in 151 EDs in 14 expansion states with those in 376 EDs in 14 nonexpansion states, using difference-indifferences methods with data from 3 national emergency medicine groups from 2013 to 2016. Results: In expansion states, the volume of Medicaid-paid ED visits increased 49% (95% confidence interval 34% to 65%), and the volume of uninsured visits decreased 44% (95% confidence interval-52% to-34%) relative to that of nonexpansion states. Both effects on payer mix leveled off during 2015. There was no significant relative change in overall ED utilization or overall ED admission rates in expansion versus nonexpansion states during the study. However, relative ED admission rates for uninsured patients declined 8% (95% confidence interval-18% to-2%) in expansion states. Conclusion: Large changes in payer mix in expansion versus nonexpansion states were observed but leveled off during 2015, with more Medicaid-paid visits and fewer uninsured visits in expansion states. Despite these large changes, during this 3-year period, there was no evidence that expansion affected either overall ED visit volume or ED admission rates. The relative decline in ED admission rates in expansion states among the uninsured may reflect a selection effect in which, among newly Medicaideligible persons, sicker persons were more likely to enroll than healthier ones. [
Impact of Health Policy Changes on Emergency Medicine in Maryland Stratified by Socioeconomic Status
The western journal of emergency medicine, 2017
On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD's Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue. We stratified our analysis by the socioeconomic status (SES) of the ED patient population. We collected monthly mean data including patient volume, hospitalization percentages, payer mix, and professional revenue from January 2013 through December 2015 from a convenience sample of 11 EDs in Maryland. Using regression models, we compared each of the variables 18 months after the policy changes and a six-month washout period to the year prior to ACA/GBR implementation. We in...
BMC Health Services Research, 2014
Background: Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. Methods: This observational study uses linked administrative-survey data for enrollees of Minnesota Health Care Programs to examine patterns in ED use-specifically, enrollee self-report of the ED as usual source of care, and past-year count of 0, 1, or 2+ ED visits from administrative data. Main independent variables included a count of seven enrollee-reported financial concerns about healthcare costs and coverage, and a count of seven enrollee-reported non-financial, practical barriers to access (e.g., limited office hours, problems with childcare). Covariates included health, health care, and demographic measures. Results: In multivariate regression models, only financial concerns were positively associated with reporting ED as usual source of care, but only non-financial barriers were significantly associated with greater ED visits. Regression-adjusted values indicated notable differences in ED visits by number of non-financial barriers: zero non-financial barriers meant an adjusted 78% chance of having zero ED visits (95% C.I.: 70.5%-85.5%), 15.9% chance of 1(95% C.I.: 10.4%-21.3%), and 6.2% chance (95% C.I.: 3.5%-8.8%) of 2+ visits, whereas having all seven non-financial barriers meant a 48.2% adjusted chance of zero visits (95% C.I.: 30.9%-65.6%), 31.8% chance of 1 visit (95% C.I.: 24.2%-39.5%), and 20% chance (95% C.I.: 8.4%-31.6%) of 2+ visits. Conclusions: Financial barriers were associated with identifying the ED as one's usual source of care but non-financial barriers were associated with actual ED visits. Outreach/literacy efforts may help reduce reliance on/perception of ED as usual source of care, whereas improved targeting/availability of covered services may help curb frequent actual visits, among publicly insured individuals.
Analysis of Emergency Department Utilization in Medicaid Expansion and Non-expansion States
Cureus, 2021
Introduction The Affordable Care Act has been debated since its initial enactment over a decade ago. One of the primary topics for discussion has been Medicaid expansion, which has created a schism across the United States. The effects of Medicaid expansion largely remain unclear. The purpose of this report is to elucidate how Medicaid expansion has impacted emergency department (ED) utilization by analyzing Medicaid expansion and non-expansion states to determine who visited the ED and the reason for the visit. Methods We conducted a retrospective analysis using de-identified electronic medical record (EMR) data from 56,423 patients and 33 different hospitals (18 Medicaid non-expansion and 15 Medicaid expansion) who visited the ED in 2019. We used geographical demographics and insurance status to categorize patients who visited the ED and ambulatory care sensitive conditions (ACSC) to identify the reasons for the visit. Logistic regression and chi-square analysis were used to analyze the data. Results We observed a significant relationship between Medicaid expansion and geographic region such that patients living in rural or semirural regions likely resided in Medicaid non-expansion states. Patients using self-pay were more likely to live in a Medicaid non-expansion state than a Medicaid expansion state (32.3% vs. 21.5%, p-value < 0.0001). Finally, there were no significant differences between the top five ACSC for Medicaid expansion and Medicaid non-expansion states but living in an expansion state was significantly (p < 0.01) related to being diagnosed with an ACSC (OR, 1.056; 95% CI, 1.013-1.100). Conclusion In conclusion, Medicaid expansion was associated with differences in the use of medical resources. Patients using Medicaid insurance who reside in Medicaid expansion states preferentially use the ED. Geographical location does play a role in ED utilization and ambulatory care sensitive condition diagnoses in patients. Despite these findings, the full effects of Medicaid expansion on ED utilization require further investigation. However, our research indicates that Medicaid expansion is not the singular solution in decreasing ED utilization and healthcare costs.
Access to care issues and the role of EDs in the wake of the Affordable Care Act
The American Journal of Emergency Medicine, 2014
Context: Americans who received public insurance under the Affordable Care Act use the emergency department (ED) more frequently than before they were insured. If newly enrolled patients cannot access primary care and instead rely on the ED, they may not enjoy the full benefits of health care services. Objective: The objective of the study is to characterize reasons for ED utilization among American adults by insurance status and usual source of care. Design, setting, and participants: Cross-sectional analysis of adult sample respondents to the 2013 National Health Interview Survey reporting 1 or more ED visits in the preceding 12 months. Main outcomes and measures: Among American ED users that reported no usual source of care and who reported relying on the ED, 27.7% (95% confidence interval [CI], 23.6%-32.2%) and 35.1% (95% CI, 28.0%-43.0%) noted at least 1 issue of access and none of acuity as a reason for their last ED visit, as compared to 17.7% (95% CI, 16.3%-19.2%) among those with a stable usual source of care. Conclusions and relevance: Although past research has shown that those who lack a stable usual source of care use the ED more often, this is the first population-level study to demonstrate their propensity for lack of access-based utilization. In the wake of the Affordable Care Act, EDs will need to evolve into outlets that service a wider range of health care needs rather than function in their current capacity, which is largely to address acute issues in isolation.
Care Intervention and Reduction of Emergency Department Utilization in Medicaid Populations
2019
Care Intervention and Reduction of Emergency Department Utilization in Medicaid Populations by Eno J. Rouse Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University February 2019 Abstract Expansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences in utilization patterns that exist among the Medicaid population that participated in an optimal level ofExpansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences i...