Wednesday, May 6, 2015

ER Visits Climb Under ObamaCare

The best laid schmes o’ mice and men

Gang aft a’gley

Robert Burns 1759-1796, To a Mouse

It wasn’t supposed to be this way. Under ObamaCare, more people would be insured, and they would no longer have to go to the ER. They could go to their primary care physician and skip those notoriously overcrowded ERs.

It hasn’t worked out that way. According to a report of The American College of Emergency Physicians, 2,099 of the doctors said ER visits are at an all time high: 28% reported visits have greatly increased, 47% slightly increased, 17% the same, 5% slightly decreased, and 0% no change.

Federal policy makers overlooked a number of crucial factors, as seen through the eyes of patients.

· 1. A growing shortage of primary care physicians with overloading practices in those who remain.

· 2. Delays, sometimes for weeks or months, in scheduling a primary care or specialist visit.

· 3. A tendency among medical practices to being open only during working hours and closed on weekends.

· 4. Public knowledge that hospitals were legally obligated to be open 24 hours a day and to receive and treat all comers.

· 5. An understanding among patients that ERs had the equipment and the spectrum of specialists to handle almost any contingency.

· 6. The trend among primary care physicians to not accept or to see fewer Medicare, Medicaid, and uninsured patients.

· 7. The historical pattern of uninsured or under-insured patients to go the ER first because that is what they had always done.

· 8. The insensitivity of insured patients to costs because they believe their insurance will pay no matter what the cost.

· 9. The belief that when it comes to one’s health or one’s illness or complaint, money is no object.

· 10. The reality that were no financial or economic penalties for not going to the ER.

· 11. The false promise of ObamaCare – that if you had a Medicare, Medicaid, or health exchange plan that if you went in these programs, you had access to primary care physicians.

The spikes in ER visits ran counter to one of the goals of the health reform law. The law was designed to reduce pressure on ERs by getting more people insured through Medicaid or subsidized private coverage and providing better access to primary care (Laura Ungar and Jayne O’Donnell, “Contrary to Goals, ER Visits Rise Under ObamaCare,” USA Today, May 4, 2015)

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