Hospitals say too many of the newly insured are using emergency rooms for primary care; state says it’s working on the problem

By Melissa Patrick
Kentucky Health News

More people with health insurance, a shortage of primary-care physicians and a steep learning curve for the newly insured all add up to more patients than ever using emergency rooms for non-emergency purposes.

More than 413,000 Kentuckians are newly enrolled in health care coverage under the Patient Protection and Affordable Care Act, and nearly three out of four of those enrolled under the Medicaid expansion, which covers residents earning up to 138 percent of the federal poverty line.

Because many of these newly insured are using the emergency room for non-emergency reasons, emergency rooms are feeling the strain, Don Weber reports for cn|2‘s “Pure Politics,” a service of TimeWarner Cable.

“In the past three months, we are seeing about a 12 percent increase per month in our emergency room visits,” Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, told Weber in a broadcast.

“Many of the patients that come have multiple chronic conditions that have been undeserved,” Currans said in the broadcast. “Diabetic. Obesity. Vascular disease. And so they come with chronic conditions and they don’t really have a primary-care physician. And so the ability to get them into a primary-care setting, into specialty-care settings, becomes more difficult without that primary-care person to refer and to kind of coordinate and manage that care.”

Currans added, “Primary-care physicians have got to lead this transformation in health care, because  … they can take care of the whole patient. We have to reform the payment system so that the primary-care physician can spend 30 minutes with you and/or can spend 15 minutes with you, but can hand you off to a professional within their office that can help educate, continue to educate, re-mediate.”

Norton Hospital in Louisville has also seen a 12 percent spike in the number of patients, many for non-emergency reasons, Laura Ungar reported in The Courier-Journal. Weber reports that the 12 percent increase in emergency room visits is “pretty consistent with the state average.”

This is not a new problem, according to Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.

“Kentuckians suffer poorer health than many other Americans, and have traditionally utilized emergency rooms at a higher rate. This is not a new phenomenon,” Midkiff said in an e-mail. She said Kentucky is working on the problem, focusing on so-called “super-utilizers” who use ERs at least 10 times in a year.

“Last summer, Kentucky was one of seven states chosen to participate in the National Governors Association Policy Academy on emergency-room utilization, with particular focus on managing super-utilizers,” Midkiff said.

People who have never had insurance often don’t know how to use their benefits, which also adds to the number of people using the emergency room instead of seeking a primary care physician, Midkiff said. “There is a steep learning curve to navigating the healthcare system and all providers and the insurance companies must help educate the newly insured,” she said.

Part of that effort is being handled by the companies that manage the care of Medicaid patients under contracts with the state that reward them when expenses are less than expected.

The Kentucky Health Benefits Exchange, branded as Kynect, “is developing some very basic ‘Insurance 101’ materials to help educate the newly insured about how to find a primary care physician, when to seek health care services, when to visit the ER, how to use pharmacy benefits, as well as providing a glossary of commonly used insurance terms,” Midkiff said. “We think this fills a real need and will help consumers more appropriately and efficiently use their health-care coverage.”

Midkiff said emergency rooms have long been considered the “de facto primary care center,” with some hospitals even advertising the average wait times on websites and remote-controlled billboards. “This provides a confusing message to those who are newly covered,” she said. “Many hospitals across the country have revised their health-care delivery model to include both emergency services and immediate care to adapt to the increased and changing demand for services.”

Many hospitals around the country have done that, and are profiting. “Hospital chains and insurers are making more money, more patients using ERs are paying for their
care, and the country as a whole is enjoying slower growth in its
health-care spending,” Alex Wayne and Shannon Pettypiece of Bloomberg News report, on the basis of public filings by hospital chains.

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