A weak tie to a regular physician was seen in Medicaid patients who were high users of emergency departments, according to a recent analysis by the Medicaid and CHIP Payment and Access Commission.
"Expanding the availability of primary care could lead to more efficient use of the ED," a new report by MACPAC states. "However, ED use is likely to remain relatively high in Medicaid until new delivery models are in place to address the needs of frequent users."
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Medicaid patients will likely continue high usage of ED care until delivery models are changed, says a new report.
The report, released July 31, estimates that nonurgent care accounts for 10% of all Medicaid-covered ED visits for nonelderly patients, a rate that is comparable with the one seen among privately insured patients.
Nearly all Medicaid enrollees report having a usual place of care other than the ED. Approximately one-third of adult and 13% of child enrollees have reported barriers to finding a doctor or delays in getting needed care, MACPAC’s research found. "Medicaid enrollees who report more primary care barriers are more likely to report ED use."
The analysis suggests that frequent ED use could be avoided with better access to primary care. "Some frequent ED users appear to receive inadequate primary or specialty care (while others use those services frequently). Among Medicaid enrollees with 10 or more ED visits in 1 year (who accounted for 12% of all ED visits), about half had weak ties to a regular physician."
Another factor is primary care physicians referring their patients to emergency departments because of the ability to rapidly utilize diagnostics. There has been "a sharp decline in direct admissions to the hospital by office-based physicians and an even sharper increase in the number of submissions through the ED: now, almost one-half of all nonelective admissions go through the ED," the report states
States have pursued a variety of paths to reduce ED visits, including diverting patients with complaints deemed to be nonemergencies to lower-cost settings, charging copayments for so-called nonemergency ED use, and focusing those considered "super utilizers" to other settings. The results of those initiatives have been mixed.
"Given Medicaid’s historically low reimbursement rates, the shortage of primary care physicians accepting these patients isn't surprising," Dr. Alex Rosenau, president of the American College of Emergency Physicians, said in a statement, adding that "efforts to deny payment for Medicaid visits to emergency departments are dangerous and wrong."