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Lack of Primary Care Under the ACA Increases ED Visits

October 9th, 2016

DETROIT – Despite hopes that the Patient Protection and Affordable Care Act would ease the demand on emergency departments by allowing more patients to seek care with primary physicians, it hasn’t worked out that way.

In fact, the opposite may be true, according to a recent study published in the American Journal of Emergency Medicine. EDs are used more frequently than before the ACA because of the lack of primary health providers in many urban and rural areas, according to the researchers.

Instead of just calling for more efforts to increase primary care providers, however, the study suggests that EDs should remake themselves to provide for more healthcare needs.

The study, “Access to care issues and the role of EDs in the wake of the Affordable Care Act,” was led by Alexander Janke, a second-year medical student at the Wayne State University School of Medicine. It reviewed data from the 2013 National Health Interview Survey, focusing on 7,233 respondents who reported at least one ED visit in the preceding 12 months.

Results indicate that the ED users – 27.7% who reported no usual source of care and another 35.1% who said they relied on EDs for care – reported that lack of primary care access was the reason. Others said an ED was their “closest provider.” None of those respondents said the issues sending them to the ED were true emergencies.

The overcrowding of EDs for non-emergency issues will remain a problem, according to the study authors, unless EDs “evolve into outlets that service a wider range of healthcare needs rather than function in their current capacity, which is largely to address acute issues in isolation.”

“We found that insurance status is a far less significant predictor of lack of access-based emergency department utilization than usual source of care,” Janke said. “As healthcare services utilization increases in the era of the Affordable Care Act, the shortcomings of primary care accessibility will become increasingly salient. Many patients will simply present to our nation’s emergency departments. Policymakers should consider providing resources for emergency departments in under-resourced communities to address the full range of healthcare needs for patients lacking a stable usual source of care.”

Newly insured patients who cannot access primary care and use EDs instead may not reap the full benefits of healthcare services provided under the ACA, study authors point out, noting that Americans with an established usual source of care are more likely to follow recommended preventive care measures, and demonstrate better rates of awareness, treatment and control of chronic conditions such as hypertension and elevated cholesterol levels.

Yet, EDs offer accessibility, diagnostic testing, procedures and a full range of provider expertise, according to Janke, who adds, “In the paper we say ‘policymakers should provide emergency departments with resources and incentives to better address the full range of their patients' health care needs, especially as utilization picks up under the Affordable Care Act.’ Emergency departments can coordinate better referral and follow-up, and address health issues not related to patients' acute or emergent conditions, for example, as a checkpoint in long-term hypertension management.”

That cannot be done without substantial financial investment, however.

“Emergency department staff already has plenty to do,” Janke pointed out.