Medicaid Patients Are Users not Abusers of the ER

Aug 11, 2014, 10:05 ET from American College of Emergency Physicians (ACEP)

WASHINGTON, Aug. 11, 2014 /PRNewswire-USNewswire/ -- A new report from the Medicaid and CHIP Payment and Access Commission (MACPAC) finds that Medicaid enrollees visit the emergency department appropriately like most patients, but they have generally more complex health needs and less access to primary care than their privately insured counterparts (  The following is a statement from Alex Rosenau, DO, FACEP, president of the American College of Emergency Physicians (ACEP).

"This report from MACPAC confirms that Medicaid patients, like all emergency patients, depend on the emergency department to diagnose and treat what is wrong with them or to reassure them that what they feared could be very dangerous is not.  MACPAC found that non-urgent visits accounted for just 10 percent of Medicaid visits to the ER, which is very close to that of the general population: about 8 percent. A report from the Centers for Studying Health System Change in 2012 also found that most emergency visits by Medicaid patients are for urgent or serious symptoms.  In short, the mounting research shows that most of these patients have serious and complex medical problems that can only be addressed in the emergency department. 

"What is distinct about this population is their increased difficulty accessing primary care, either because the physician isn't available or because they can't find a physician who will accept their insurance.  Given Medicaid's historically low reimbursement rates, the shortage of primary care physicians accepting these patients isn't surprising.  This lack of access to primary care is even more acute for Medicaid patients with disabilities, who are disproportionately represented on Medicaid rolls. The lack of access to primary care certainly contributes to Medicaid patients' use of the ER, but for Medicaid patients with serious mental illness, multiple illnesses and homelessness, even having a primary care physician is no bar against appropriate emergency department use.  In general, the combination of poverty and illness present challenges with few genuinely simple solutions, despite misplaced beliefs that significant health care costs could be saved by keeping patients out of the ER.

"Efforts by various states to deny payment for Medicaid visits to emergency departments are dangerous and wrong.  As MACPAC found in its report, 'Many ED reduction programs also have faced difficulty sustaining funding and stakeholder buy-in over the long term. … To the extent that ED visit reduction programs focused on frequent users can generate savings, the money will most likely come from their larger impact on inpatient hospital care, which represents a far greater proportion of spending in Medicaid than non-emergency ED care.'"

"In the meantime, for all of our patients, the ER is the home in our medical neighborhood where the lights are always on."

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 

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SOURCE American College of Emergency Physicians (ACEP)