Medicaid beneficiaries aren’t clogging up emergency departments with routine health complaints, according to a new analysis from the Center for Studying Health System Change.
More than 60% of ED visits made by Medicaid beneficiaries under age 65 years are for symptoms that are considered urgent or semiurgent and that should be evaluated in 2 hours or less, the analysis found. Visits for nonurgent complaints – symptoms that should be addressed within 2-24 hours – accounted for only about 10% of ED visits by nonelderly Medicaid beneficiaries in 2008. This compares with 7% among those under age 65 years with private insurance.
The findings come from an analysis of ED visits and insurance enrollment conducted by the Center for Studying Health System Change and funded by the Robert Wood Johnson Foundation.
Nonelderly Medicaid beneficiaries do use EDs at a higher rate than their counterparts with private insurance do. In 2008, nonelderly Medicaid beneficiaries made 46 visits/100 enrollees, compared with 24 visits/100 nonelderly individuals with private insurance. In fact, Medicaid beneficiaries made more visits to the ED than did privately insured individuals across all ages from birth to 64 years. However, the increased usage was not because they are seeking primary care in the ED.
But the higher ED use by Medicaid beneficiaries for nonurgent medical issues accounted for only 13% of the total difference in ED visit rates, according to the researchers. Most of the gap is because of greater use by Medicaid patients for urgent and semiurgent symptoms.
For example, Medicaid beneficiaries visited the ED for urgent symptoms at a rate of 18/100 enrollees vs. privately insurance patients who were seen at a rate of 9.6/100. Similarly, for semiurgent symptoms, Medicaid beneficiaries were treated in the ED at a rate of 10/100, compared with 5.5/100 for those with private insurance.
The findings, which come as states are considering ways to curb excessive ED use by Medicaid beneficiaries, suggest that while inappropriate ED visits may not be as high as previously thought, there are ways steer some care into less costly settings.
Lower-cost care sites, such as retail clinics and urgent-care centers, could provide an alternative for some of the relatively minor, but urgent conditions, such as acute infections in children and minor injuries among all ages, according to the researchers. But, in order to be effective, these settings need to offer certain critical services, ranging from urinalysis and intravenous fluid administration to X-rays and suturing.
Although the increased availability of primary care physicians for extended hours could help to some degree, primary care practices likely wouldn’t be able to handle all these patients, according to the researchers. The hurdle with moving more care into retail clinics and urgent care centers is that it is unknown whether most of these sites will accept Medicaid payment, which provides lower reimbursement than other payers do.
"Ultimately, broader payment reform toward policies that emphasize provider accountability for populations rather than fee-for-service payment may encourage providers to invest in alternative settings where patients can get timely care for urgent problems without resorting to emergency departments," the researchers wrote.