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ED Visits at Record High Since Affordable Care Act Implementation

After implementation of the Affordable Care Act (ACA) visits to emergency departments (EDs) shot up, climbing to a record high of 141.4 million patient visits in 2014, the most recent data available.

That’s according to the national Centers for Disease Control and Prevention (CDC), which points out that the statistic represents a 10-million-visit increase compared with 2013, when 130.4 million visits were posted.

The data also suggest that ED visits are increasingly severe and complex, which the CDC posits might be related to the growth of retail clinics, urgent care centers, and other facilities that accept patients with nonurgent medical problems. In fact, the report said that only 4.3% of emergency patients had nonurgent medical symptoms.

“Clearly emergency departments are providing a valuable service that most patients can’t get anywhere else,” noted Becky Parker, MD, FACEP, president of the American College of Emergency Physicians. “What other doctor will see you at 2 a.m. — no appointment necessary? Nearly two-thirds of visits occurred after business hours. The highest users of emergency care include patients over age 75, infants, and nursing home residents.”

Parker mentioned that emergency visits are expected to soar past 150 million annually in the 2016 statistics, based on the 2.1% average increase over the past 20 years.

Current estimates of the number of ED visits are based on data collected in the 2014 National Hospital Ambulatory Medical Care Survey (NHAMCS). The survey, which was conducted from December 2013, through December 2014, used 23,844 patient record forms (PRF) from 319 emergency service areas.

The analysis found that the top reasons for emergency visits were chest pain, stomach pain, shortness of breath, injury, and general pain.

In terms of chronic disease, those most often playing a role in ED visits included the following:

  • hypertension (21.1%)
  • diabetes (9.8%)
  • asthma (8%)
  • depression (8%)
  • substance abuse (5.6%)
  • coronary artery disease (5%)
  • COPD (4.9%)

About 40 million visits were related to injuries, with the highest rate among patients 75 and older. The number dropped 5 million from 2009, when there were 45 million visits, the CDC pointed out, crediting injury prevention programs.

“A growing number of patients also are coming to emergency departments with mental health problems and opiate overdoses,” Parker said. “While overall admission rates to the hospital have fallen, it's a different story for mental health patients, with more than a million of them needing admission to the hospital in 2014.”

At the same time, wait times lessened, with 68% of patients being seen in less than an hour. Nearly a third, 32%, saw a medical provider within 15 minutes, and only about 10% spent more than six hours in the ED, according to the report.

The expected source of payment for about a third of the visits was Medicaid and the Children’s Health Insurance Program, 34.9%, followed by private insurance at 34.6% and Medicare at 17.5%. Fewer than 12% of visitors seeking emergency care were uninsured.

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