According to a national study released Wednesday by the Center for Studying Health System Change (HSC), contrary to popular belief, the majority of emergency department (ED) visits by nonelderly Medicaid patients are actually for signs and symptoms of urgent or more serious medical conditions or emergencies rather than routine care.
The study, which was funded by the Robert Wood Johnson Foundation, showed that while nonelderly Medicaid patients do use EDs at higher rates total than nonelderly privately insured patients, their numbers for nonurgent or routine care and urgent ED visits were closer than many may have expected.
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The study based on the most recent available data from the National Hospital Ambulatory Medical Care Survey conducted by the Centers for Disease Control and Prevention.
About 10 percent of nonelderly Medicaid patient ED visits were for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people in 2008, according to the study. In contrast, around half of Medicaid and private insurance visits were categorized as emergent (needing immediate attention) or urgent (needing attention within an hour).
According to the study, two kinds of information from emergency department visits generally are used to explain ED use – patients' symptoms as assessed by ED triage staff to determine how quickly patients need evaluation and patients' diagnoses after evaluation by a physician.
In 2008, people up to age 64 covered by Medicaid had 45.8 ED visits per 100 enrollees compared with 24.0 visits per 100 nonelderly privately insured people, the study found.
"Most of the difference in emergency department use between nonelderly Medicaid and privately insured patients results from more ED use by Medicaid patients for urgent and semi-urgent symptoms that need prompt medical attention," said Emily Carrier, HSC senior researcher and co-author of the study. "The data is surprising in that if you look at the amount of Medicaid policy attention paid to addressing this question of how much Medicaid patients use the ED for routine visits, you would think those types of visits would form a much bigger section of ED use for them. So the numbers were closer than expected. Having worked in EDs with a lot of Medicaid users and EDs with mainly private insurance holders, you realize people are similar in a lot of ways."
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Nonelderly Medicaid patients were seen in EDs for emergent visits (needing immediate attention) at the rate of 5.6 visits per 100 enrollees compared to 3.6 visits per 100 privately insured people, according to the study. For urgent visits (needing attention within an hour), the rate for nonelderly people covered by Medicaid was 18.1 visits per 100 enrollees compared to 9.6 visits per 100 privately insured people. For semi-urgent visits (evaluation needed in one to two hours), the Medicaid rate was 10.4 visits per 100 nonelderly enrollees compared to 5.5 visits for privately insured people.
Carrier and her fellow study authors, Anna Sommers and Ellyn Boukus, used the study to also offer thoughts and suggestions on how to decrease the use of the ED for nonurgent cases overall.
"It's an issue that a lot of people are thinking about and there's a lot of great work being done with medical homes and alternative locations for outpatients to go. A number of needs have to be met outside of the ED, so communities need to offer alternative sites that would offer the care for patients with a broad range of symptoms or injuries," Carrier said. "The solution to the problem will require a pretty significant effort on the outpatient side – a system that would meet their needs on the outpatient side and help them avoid the ED. Right now in many states the resources are spread thin and it would require a lot of significant investments."
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