Any changes in ED utilization hinge on delivery system reform
Should ED administrators be prepared for a spike in volume, or perhaps reduced volume, now that health care reform has made insurance coverage accessible to many more Americans? Not necessarily, according to Jesse Pines, MD, MBA, MSCE, director of the Office of Clinical Practice Innovation and professor of emergency medicine at George Washington University School of Medicine and Health Sciences in Washington, DC. "There are a number of competing effects," he says. "I don’t think health insurance reform is going to have a big impact on ED utilization. However, delivery system reform might."
The impact of delivery system reform really depends on how it is implemented and who it is available to, explains Pines. "If delivery system reform is available to everyone, including patients with Medicaid insurance, then I think we will probably see a reduction to some degree on low-acuity ED visits, but I think it is likely that a lot of these delivery system reforms will not be offered to everyone," he says.
For example, Pines offers that while there are lot of medical home models being implemented around the country, very few of these models are being tested in Medicaid populations, which is a critical population to consider when looking at ED utilization. "Over the last ten years the rise in ED visits has been primarily [due to] an increase in Medicaid patients coming to the ED," says Pines.