ACA may lead to jump in ED utilization

Recent history indicates that the Affordable Care Act (ACA) may lead to a significant increase in emergency department utilization, according to research published in the Journal of the American College of Radiology.

Rakesh A. Shah, MD, of the department of radiology at Winthrop-University Hospital in Mineola, N.Y., wrote about this potential increase. She wrote that there are numerous benefits to the ACA, but it may have unexpected consequences as well.

“This expansion of coverage may not decompress patient volume in emergency departments, as many of its advocates had hoped, but in fact potentially increase emergency department utilization,” Shah wrote. “Radiology departments should be prepared in the years to come for an increased volume of imaging from emergency departments and the manpower and equipment necessary to meet this potential surge.”

Shah came to this conclusion partly by looking back at what happened previously in the U.S. when healthcare reform was enacted on the state level.

In 2006, Shah explained, reform similar to the ACA was signed into law in Massachusetts, and it has been associated with a “small but consistent increase in the use of emergency departments across the state from 2004 to 2009.”

And in 2008, Oregon expanded its Medicaid program for low-income adults without insurance, leading to overall emergency department use to increase by 40 percent.

“These findings are consistent with several additional recent studies demonstrating increased relative utilization of emergency departments by the Medicaid population and increased utilization of emergency departments by newly insured individuals relative to continuously insured adults,” Shah wrote.

Shah also looked at some of the specific factors that may have led to these increases in emergency department utilization, which had nothing specifically to do with the ACA. For instance, citing recent data from the U.S. Department of Health and Human Services, Shah said the country will be down approximately 45,000 primary care physicians by 2020. This could lead to more patients going straight to the emergency department instead of waiting to be seen.

“The combination of increased insurance coverage and decreasing accessibility to primary care physicians may serve as a driver of the utilization of emergency departments, which are required to see patients at any time,” Shah wrote.

The country’s aging population is also impacting emergency departments, according to Shah. Projections based on U.S. census data show that the population aged 65 years and older could jump from 43.1 million in 2012 to 83.7 million in 2050. Patients 65 years and older, and especially those 75 years and older, utilize the emergency department at higher rates than those who are 18-64 years old.