According to recent data on 22 hospitals in Maryland, visits to the emergency room saw a year over year decline of 10.72 percent last December, reflecting a downward trend doctors say is continuing into 2014. The data indicates that Maryland is reversing years of increases in emergency room use and challenges the conclusions of the Oregon Medicaid Study, which recently suggested ER use would increase in states that expanded Medicaid.
While it’s tempting for some to attribute the drop in ER volume to provisions in the affordable care act, ER doctors say that the trend is actually the result of a convergence of several long-term trends, including the growth of managed care organizations, the rise of urgent care centers, and insurance plans that ask patients to shoulder a greater share of healthcare costs, particularly for outpatient services such as emergency room visits.
The trend also flies in the face of what has until recently been taken as a given, that the number of patients coming to the emergency room will only keep going up. For years, physicians groups and hospitals have predicted increasing volume in their Emergency Departments and have planned accordingly, often with large facilities expansions.
But data on ER volume at hospitals in Maryland and Washington DC suggest otherwise. All but one of 22 hospitals who submitted data on ER volume last year reported a decrease, many of them in the double digits. In Washington DC, eight hospitals reported a collective drop of 1.8 percent in the last 12 months compared to the year before. In the last three months that drop accelerated to 5.3 percent.
Analysis of Maryland and DC data reveals that, even as overall volume is decreasing, the number of ER patients being admitted to the hospital is either holding steady or in some cases increasing slightly. Though it is difficult to assign a direct causation, the data indicate that a major goal of the Affordable Care Act is being achieved. That is, Emergency Departments are being used more by people who actually need them, and less by people who don’t.
According to Dr. Bill Frohna, Chairman at MedStar Emergency Physicians, the trends represent a successful push on multiple fronts to reduce utilization in healthcare, which has come at least partly in response to public outcry over the high cost of healthcare.
“Emergency medicine has sort of done some of this to ourselves,” Frohna said. “We’ve benefited to some extent by fee for service. But at the same time the public becomes aware of this, and managed care organizations become aware of this, and they say, boy, we can work out a better deal [that saves money].”
In Maryland, hospitals operating under the so-called Total Patient Revenue (TPR) system have an added incentive to reduce costs, sometimes by moving patients out of the ER. But Frohna said he doesn’t think TPR – or similar capitated systems around the country – is necessarily responsible for the drop in volume.
He said recent comments from active members of the Emergency Department Benchmarking Alliance suggest similar trends are occurring in Arizona, Kansas, and other states. “It’s happening all over the country,” he said.