Most doctors surveyed expect the volume of patients to continue to rise under the Patient Protection and Affordable Care Act. Nearly 90% of respondents reported that they anticipate a higher volume of emergency room clients in the next three years. In addition, more than three quarters of emergency room doctors indicated that they don't believe their facilities are adequately prepared to handle the anticipated influx of customers, while just over half of respondents reported that they expect payments for emergency medical coverage to be reduced under the ACA.
Emergency room doctors also reported seeing more Medicaid enrollees, but fewer individuals with private coverage since the start of the year. Just 3% reported an uptick in private coverage patients, while 35% noted an increase in Medicaid beneficiaries at their facilities. That's despite 8 million enrollments in private plans through the state and federal exchanges during the recently completed open enrollment period.
The snapshot is consistent with a study published last year observing an increase in emergency room visits for routine care by residents who gained Medicaid coverage in 2008.
Dr. Jay Kaplan, a member of ACEP's board of directors, said he wasn't surprised by the findings given the large influx or Medicaid enrollees and the difficulty in locating primary-care doctors who will see those patients. “When people get insurance, they feel like they deserve healthcare,” Kaplan said. “When they deserve healthcare, and there's nobody else they can see, they come to us.”
Survey respondents indicated that the best way to improve emergency medical care would be to place restrictions on lawsuits stemming from such treatment. Liability reform was the top choice for improving emergency care of 32% of those surveyed, while 18% of respondents cited providing adequate reimbursements and 17% cited boosting the number of primary-care providers.
ACEP is backing legislation that would restrict medical malpractice lawsuits for emergency medical treatment that is legally required under federal law. Kaplan points out that employees of the U.S. Public Health Service already enjoy liability protection. “This is not reinventing the wheel,” he said. “It's just extending it a little bit.”
The survey was conducted by Marketing General between April 4 and 14. The survey was sent out to 21,925 members of the American College of Emergency Physicians. Of those, 8% completed the questionnaire. The survey had a margin of error of plus or minus 2.3 percentage points.
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