ACA Sending Patients to the ER

Leave a Comment
August 14th, 2014

Blog-Post-8.14.14The influx of newly-insured under the ACA has further added to the over-utilization of healthcare facilities across the US. With more people covered, a shortage of primary care physicians, and the difficulties in navigating healthcare, many patients are flocking to Emergency Rooms and Walk-in Clinics for non-emergency purposes. In fact, hospitals in many states are seeing an average increase of 12% in ER admissions since the ACA came into effect.

Emergency rooms are often seen as the “de facto primary care center”, encouraging many hospitals to advertise them in this manner and compete based on shorter wait times or even cleanliness. With more and more walk-in clinics popping up around the country, similar trends have been seen when patients are admitted seeking emergency care.

However, emergency rooms and walk-in care clinics are developed to serve two separate patient populations and are equipped with different capabilities ERs are designed to handle patients with life-threatening injuries or illnesses, while walk in care quickly handles minor but acute illnesses or injuries. This is where primary care physicians and providers in family practice argue that becoming established with a doctor can be essential in receiving the right treatment at the right time.

When to go to the ER

Federal regulations require ERs to provide care to all patients regardless of extent of their malady or ability to pay. For many individuals unaware of their options, the ER has become a go-to point of access for healthcare. However, visiting the ER often disrupts a regular patient care cycle. Many ER doctors recommend following up your treatment with your Primary Care Physician. Patients who do not have primary care providers are encouraged to consider becoming established with one, while post-discharge clinics can provide a way for hospitals to follow-up with patients after they are discharged to avoid readmissions.

Patients should seek ER treatment for injuries including chest pains, suspected stroke, head injuries, fractures and other urgent procedures, while those with complex illnesses such as cancer, can also be seen in the ER for emergency treatment.

When to go to a Walk-in Care Clinic

Walk-in care or urgent care units often blurs the situation when it comes to seeking treatment during an emergency. Many walk-in care units see patients that should in fact be seen in the ER, and are capable to administer many of the same procedures and treatments.

Traditionally, walk-in care clinics and facilities treat patients for respiratory illnesses, episodic ailments, strains, back injuries, acute fever with vomiting, diarrhea and rashes. Some units can often do blood draws or lab work, including x-rays, testing for illnesses such as influenza or strep throat, and even conduct diagnostic evaluation. However, walk-in care providers do not always have access to a patient’s medical history with their primary care physician.

For patients with high-level trauma, life-threatening illness, heart attacks or stokes, seeking care in the ER is a must.

When to go to your Primary Care Physician

The relationships that can grow over time between doctor and patient cannot be duplicated in the ER or in a walk-in care setting. When a patient relies to heavily on the ER or walk-in care units as a stand-in for having a primary care physician, the continuity of care can often become fragmented and drive spending higher due to increased readmissions and improper follow up. In fact, many patients are unaware that their PCP can often be contacted in the case of an emergency by calling their doctor’s nurse for assistance or an after-hours on-call physician.

This trend is more commonly seen amongst younger patients who do not have ongoing medical conditions or newly insured individuals. Many choose not to establish themselves with a PCP – while 80% of elderly patients utilize a primary care provider, only 30% of younger patients 25 and under have an elected PCP.

Regardless of age, patients should see their PCP at least once a year for a physical and address other chronic medical conditions, including prevention screenings.

Many have called for primary care to lead the shift in how patients access their health care, because they can take care of the whole patient. Calls for reform to the payment system have pushed for PCPs to see patients more frequently within their office and help educate, continue to educate, and re-mediate the health care cycle.

For hospitals and clinics, providers should consider revising their healthcare delivery model to include both emergency services and immediate care to adapt to the increased and changing demand.

PayerFusion provides it’s group members with assistance services that include setting up medical appointments and locating a preferred medical provider based on the patients condition. This can often lead to cost-savings on the follow-up portion of the care cycle, with reduced readmissions and misdiagnoses. To learn more about PayerFusion’s assistance services click here.