Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act

Dresden, Scott M.; Powell, Emilie S.; Kang, Raymond; McHugh, Megan; Cooper, Andrew; Feinglass, Joseph

doi:10.1016/j.annemergmed.2016.06.026

Cited by 60 publications

(54 citation statements)

References 19 publications

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“…A large study of EDs across the United States found no increase in ED utilization after ACA implementation, 19 while a study of all EDs in Illinois found a modest increase in ED visits attributable to insurance expansion under the ACA. 20 Understanding the effect of insurance expansion, particularly Medicaid, on ED utilization is important for policy planning at both the state and hospital levels. This is particularly relevant as a Supreme Court ruling on the ACA enabled states to choose whether or not to adopt Medicaid expansion.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments

Klein

Levin²,

Toerper³

et al. 2017

Annals of Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments

Klein

Levin²,

Toerper³

et al. 2017

Annals of Emergency Medicine

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“…1,2 Despite these efforts, studies measuring ED utilization before and after the enactment of the ACA have yielded mixed results. [3][4][5] Estimates of the effect of health insurance coverage on ED visits is a complex relationship that must be factored with out-of-pocket expenses to patients and access to alternative sources of healthcare, as well as reimbursement to primary care providers. Economic theory suggests that expanding access to health insurance could either increase or reduce ED use.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments

Probst

Walls

Cirone

et al. 2019

WestJEM

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Introduction: The emergency department (ED) has long served as a safety net for the uninsured and those with limited access to routine healthcare. This study aimed to compare the characteristics and severity of ED visits in an Illinois academic medical center (AMC) and community hospital (CH) of a single health system before and after the implementation of the Affordable Care Act (ACA). Methods: This was a retrospective record review of 357,764 ED visits from January 1, 2011-December 31, 2016, of which 74% were at the AMC and 26% at the CH. We assessed the severity of ED visits by applying the previously validated Ballard algorithm, which classifies ED visits as non-emergent, intermediate, or emergent. Descriptive analyses were conducted to compare the characteristics of ED visits before and after the implementation of the ACA. We conducted multilevel logistic regression analysis to examine the odds of non-emergent compared to intermediate/ emergent ED visits by the ACA implementation status controlling for patient demographic characteristics, insurance status, and multiple visits per patient. Results: ED visits for patients with Medicaid or other governmental coverages increased in the post-ACA compared to pre-ACA period (Pre: 33.2 % vs Post: 38.3% at the AMC, and Pre: 29.7% vs Post: 35.1% at the CH). A statistically significant decrease in ED visits for uninsured patients was observed at the AMC and CH in the post-ACA period compared to the pre-ACA period (Pre: 12.1% vs Post: 6.4%, and Pre: 13.9% vs Post: 9.8%, respectively). Results from the regression analysis showed a significant decreased odds of non-emergent vs intermediate/emergent ED visits during the post-ACA period compared to the pre-ACA period at the AMC (odds ratio [OR] 0.68; confidence interval [CI], 0.66-0.70). However, an increased odds of non-emergent vs. intermediate/emergent ED visits was observed at the CH (OR 1.09; CI, 1.04-1.14). Conclusion: Similar to other Medicaid expansion states, ED utilization for uninsured patients decreased at both the AMC and the CH in the post-ACA period. While Medicaid visits for children < 18 years declined in the post-ACA period, it increased for ages 21 to 65 years of age. Contrary to our hypothesis, the severity of emergent ED visits increased in the post-ACA period but not at the CH.

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“…While improved primary care access and broader health insurance coverage are appealing solutions, early reports suggest enhanced insurance coverage may be associated with greater ED utilization by all patients, including those with AHF. 5,6 Therefore, differentiating patients with AHF who require admission versus direct ED discharge or a brief period of observation, may help improve outcomes while reducing costs.…”

Section: Accepted Manuscript Backgroundmentioning

confidence: 99%

Design and rationale of a randomized trial: Using short stay units instead of routine admission to improve patient centered health outcomes for acute heart failure patients (SSU-AHF)

Fish-Trotter

Collins

Danagoulian

et al. 2018

Contemporary Clinical Trials

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Nearly 85% of acute heart failure (AHF) patients who present to the emergency department (ED) with acute heart failure are hospitalized. Once hospitalized, within 30 days post-discharge, 27% of patients are re-hospitalized or die. Attempts to improve outcomes with novel therapies have all failed. The evidence for existing AHF therapies are poor: No currently used AHF treatment is known to improve long-term outcomes. ED treatment is largely the same today as 40 years ago. Admitting patients who could have avoided hospitalization may contribute to adverse outcomes. Hospitalization is not benign; patients enter a vulnerable phase post-discharge, at increased risk for morbidity and mortality. When hospitalization is able to be shortened or avoid completely, certain risks can be mitigated, including risk of medication errors, in-hospital falls, delirium, nosocomial infections, and other iatrogenic complications. Additionally, patients would prefer to be home, not hospitalized. Furthermore, hospitalization and re-hospitalization for AHF predominantly affects patients of lower socioeconomic status (SES). Avoiding hospitalization in patients who do not require admission may improve outcomes and quality of life, while reducing costs. Short stay unit (SSU: <24 h, also referred to as an 'observation unit') management of AHF may be effective for lower risk patients. However, to date there have only been small studies or retrospective analyses on the SSU management for AHF patients. In addition, SSU management has been considered 'cheating' for hospitals trying to avoid 30-day readmission penalties, as SSUs or observation units do not count as an admission. However, more recent analyses demonstrate differential use of observation status has not led to decreases in re-admission, suggesting this concern may be misplaced. Thus, we propose a robust clinical effectiveness trial to demonstrate the effectiveness of this patient-centered strategy.

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Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act

Cited by 60 publications

References 19 publications

The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments

The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments

Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments

Design and rationale of a randomized trial: Using short stay units instead of routine admission to improve patient centered health outcomes for acute heart failure patients (SSU-AHF)

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