In 2014, under the Medicaid Expansion provision of the Patient Protection and Affordable Care Act (PPACA) approximately 20 million uninsured Americans will qualify for coverage under the state-run program.
This should be good news. Some coverage is better than no coverage, and many industry experts believe Medicaid will actually lower the pressure on Emergency Departments (EDs) nationwide. However, the devil is in the details.
As has been observed with Medicare, many primary care physicians may simply not accept low reimbursement from Medicaid enrollees, thus driving patients to the ED for primary care anyway.
As evidence, researchers recently examined the results from the Commonwealth Health Connector, the coverage program conceived by the Massachusetts healthcare reform bill, which served as a model for national reform legislation. The Massachusetts legislation effectively lowered the percentage of uncovered individuals in the state to 5.5% in 2008, down from an average of 10.7%.
The inverse was true when it came to ED visits, however. Between 2004 and 2008 ED visits in Massachusetts actually increased between 1.5% and 2.4% annually, according to a report by the Massachusetts Division of Health Care Finance and Policy.
National research shines some light on a possible cause for the Commonwealth Health Connector’s results. According to a study by the National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC), 32% of Medicaid enrollees used the ED at least once during a 12-month period in 2007.
However, only 17% of individuals with private health coverage -- and nearly the same percentage of the uninsured -- visited an ED in the same period.
Even more revealing are the NCHS/CDC findings that Medicaid enrollees were three times as likely as the privately insured to have visited the ED twice within the same year. Compared to the uninsured, Medicaid enrollees were twice as likely to have made a second ED visit within the same time period.
In a recent industry survey conducted by CSC, a Falls Church, Va.-based provider of technology-based business solutions, nearly 25% of healthcare executives interviewed predict a significant strain on their organization to provide care when Medicaid Expansion takes effect. An additional 43% anticipate some additional capacity strain on their organizations, and predict that the greatest stress will be placed on outpatient primary care, followed not far behind by ED visits.
With this realization in mind, hospitals are wise to ready themselves for Medicaid Expansion. Clinical staff may be overwhelmed, and patients might not understand the new laws taking effect. But as always, regardless of a patient’s ability to pay, hospitals will still provide needed care. Helping an uninsured individual realize their coverage options, and working to help secure reimbursement, however small, is in an organization’s best interest.
Kirk Reid is the Executive Vice President and Chief Marketing Officer of Chamberlin Edmonds, an Atlanta-based firm serving as patient advocates and providing custom-tailored eligibility services to hospitals nationwide.