A recent analysis of 75 hospitals by the Los Angeles Times found that visits to Los Angeles County ERs slowed in the first three months of ACA implementation. Between January and March of 2014, ER visits by patients who didn’t require hospitalization increased 1.7% at county facilities, a slowed increase compared to 3% and 5% growths in the two years prior.
One benefit from this is that the use of high-cost emergency care for basic medical care may be declining. By emphasizing primary and preventive care, and redirecting patients to appropriate sites of care, the intent of the health reform law is to generate system savings while improving health. While it is premature to see what the lasting effects of the ACA are on ER use, particularly considering many did not fully enroll in coverage until March and April of this year, preliminary data hints at optimistic findings.
What could this data mean?
Fewer uninsured are seeking care at emergency departments
For the most part, the uninsured seek hospital/emergency services at county facilities, so this slowing rate of ER use could be indicative of the uninsured population’s health care seeking patterns. The Times did indeed find that the number of ER patients without coverage dropped from 18% to 16% in the last year. The proportion of those with Medi-Cal coverage increased from 32% to 38% in the same period.
Many of the newly insured are choosing private hospitals over county ones
This analysis also found that thousands of patients sought care at private hospital ERs, with Long Beach Memorial Medical Center seeing one of the largest increases at 16% from a year ago (285 patients per day). Fewer patients at county ERs could ease the long waits and overcrowding that is endemic to many public hospitals.
The county is doing a better job of preventing ER use by connecting patients with primary care doctors.
Los Angeles County health officials believe part of the decline in ER use is due to the fact that Medi-Cal patients are better connected to their primary care doctors, and preventing the need for the ER in the first place. In an ideal world, this should be the largest driver of declined ER use.
We don’t really know what it means.
The first three months of data are helpful, but in light of the fact that many did not enroll in coverage until close to the deadline, this effect may not necessarily be due to coverage expansions. In addition, the state suffered under the weight of a 900,000 Medi-Cal application backlog for much of the year, delaying hundreds of thousands from receiving coverage
We still need to help our communities understand health care and how to best use it.
These results seem to contradict an earlier Oregon health study, which found that increased Medicaid coverage correlated to increased ER use. In both instances, the data are yet inconclusive, but provide clues to how our communities seek care. According to a California Hospital Medical Center official, one in five ER patients doesn’t need emergency care; it has become the only open door for the uninsured, underinsured, and those who don’t have choices when it comes to their health care.
Increased health coverage is a solid first step, but altering healthcare-seeking patterns and weaning individuals off of ER reliance will take years. Not only are continued education and awareness needed, but there are greater structural changes required to allow constrained working families seek affordable, timely and culturally competent care. These preliminary findings bode well, but continued work on optimal utilization, as well as ensuring access and affordability to health care, will be critical.