The Affordable Care Act and Emergency Care

McClelland, Mark; Asplin, Brent R.; Epstein, Stephen K.; Kocher, Keith E.; Pilgrim, Randy; Pines, Jesse M.; Rabin, Elaine; Rathlev, Neils Kumar

doi:10.2105/ajph.2014.302052

Cited by 21 publications

(16 citation statements)

References 25 publications

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“…This may be due to individuals with chronic conditions generally being sicker and potentially using more medical resources [ 28 ]. With EMTALA prohibiting disposition of any patient presenting at the ED until they have been medically assessed, regardless of their ability to pay, the ED is always available for patient use [ 6 , 9 , 22 , 50 , 51 , 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of EDs for non-emergent care results in overcrowding, strains limited resources [ 2 , 3 ], and can result in fragmented care [ 4 , 5 ]. Current use of EDs is shaped by the view of many people as an around-the-clock healthcare resource that is available for patients to use for healthcare needs, emergent or not [ 6 ]. Non-emergent ED use resulted in a doubling of the total United States ED expenditure between 2000 and 2008 [ 7 ] and is considered by the medical community to be ‘excess charges’ [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

McManus

Cramer

Boshier

et al. 2018

IJERPH

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Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. ‘Other’ ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal ‘need’, including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

McManus

Cramer

Boshier

et al. 2018

IJERPH

View full text Add to dashboard Cite

show abstract

“…Remote patient monitoring systems are a promising and growing area of healthcare technology, particularly for the expanding population of elderly adults. Although the Patient Protection and Affordable Care Act does not specifically highlight PRPM technologies, the general push for more‐connected and ‐continuous care, fewer ED visits, and cost savings are important features of the law . The current study data suggest that PRPM systems may be aligned with such goals through changes to patterns in monthly healthcare costs and use.…”

Section: Discussionmentioning

confidence: 85%

Reduced Healthcare Use and Apparent Savings with Passive Home Monitoring Technology: A Pilot Study

Finch

Griffin

Pacala

2017

J American Geriatrics Society

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“…In complaint-specific analyses, we further found ED hospitalization rates also reduced significantly across visits with and without advanced imaging for primary complaints of abdominal pain, chest pain, and injuries by up to 40%. While our results suggest that increased advanced imaging use may not have contributed to the decline in ED hospitalization rates, other clinical factors, such as outpatient clinical pathways [ 15 , 16 ], and policy factors, including the rising scrutiny of short-stay admissions and improved access to follow-up as a result of coverage expansion may be have driven the decline in ED hospitalizations [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

Advanced imaging and trends in hospitalizations from the emergency department

et al. 2020

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Objective The proportion of US emergency department (ED) visits that lead to hospitalization has declined over time. The degree to which advanced imaging use contributed to this trend is unknown. Our objective was to examine the association between advanced imaging use during ED visits and changes in ED hospitalization rates between 2007–2008 and 2015–2016. Methods We analyzed data from the National Hospital Ambulatory Medical Care Survey. The primary outcome was ED hospitalization, including admission to inpatient and observation units and outside transfers. The primary exposure was advanced imaging during the ED visit, including computed tomography, magnetic resonance imaging, and ultrasound. We constructed a survey-weighted multivariable logistic regression with binary outcome of ED hospitalization to examine changes in adjusted hospitalization rates from 2007–2008 to 2015–2016, comparing ED visits with and without advanced imaging. Results ED patients who received advanced imaging (versus those who did not) were more likely to be 65 years or older (25.3% vs 13.0%), non-Hispanic white (65.3% vs 58.5%), female (58.4% vs 54.1%), and have Medicare (26.5% vs 16.0%). Among ED visits with advanced imaging, adjusted annual hospitalization rate declined from 22.5% in 2007–2008 to 17.3% (adjusted risk ratio [aRR] 0.77; 95% CI 0.68, 0.86) in 2015–2016. In the same periods, among ED visits without advanced imaging, adjusted annual hospitalization rate declined from 14.3% to 11.6% (aRR 0.81; 95% CI 0.73, 0.90). The aRRs between ED visits with and without advanced imaging were not significantly different. Conclusion From 2007–2016, ED visits with advanced imaging did not have a greater reduction in admission rate compared to those without advanced imaging. Our results suggest that increasing advanced imaging use likely had a limited role in the general decline in hospital admissions from EDs. Future research is needed to further validate this finding.

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The Affordable Care Act and Emergency Care

Cited by 21 publications

References 25 publications

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Reduced Healthcare Use and Apparent Savings with Passive Home Monitoring Technology: A Pilot Study

Advanced imaging and trends in hospitalizations from the emergency department

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