Emergency Department Visits Grow, Specialist Availability Drops

The impact of the Affordable Care Act on emergency department visits.

While emergency department visits have been increasing, a recent study found that the availability of specialists has declined.

Findings from 2 studies, both published in Annals of Emergency Medicine, found that visits to the emergency department have grown since the implementation of the Affordable Care Act (ACA). Although previous studies have found that Medicaid expansion under the ACA has not increased hospitalization, this is not the case for states such as Illinois and Massachusetts.

In the first study, researchers specifically examined emergency department visits in Illinois. They found that emergency department visits increased from 2.9 million in 2011 to 3.2 million in 2015, an 8.1% increase, according to the study.

Comparing before and after the implementation of the Affordable Care Act, emergency department visits increased 5.7%. This increase was not explained by the population size or aspects of hospitalizations, the researchers concluded.

“Emergency departments continue to be squeezed by pressures inside and outside the hospital,” said lead author of the first study Scott Dresden, MD, MS. “A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in emergency department visits by uninsured patients. We still don't know if these results represent longer-term changes in health services use or a temporary spike in emergency department use due to pent up demand.”

In the second study, researchers found that emergency department visits in Massachusetts increased from 32,025 to 42,000 from 2005 to 2015. They also discovered a significant decrease in clinicians with specialties in the areas of surgery, neurology, obstetrics-gynecology, orthopedics, pediatrics, plastic surgery, and psychiatry during this time, according to the study.

The availability of general surgeons also dropped from 98% to 83%, while psychiatric availability decreased from 56% to 33% during this time.

“During the studied period, the burden of increasing patient volume was clear,” said author of the second study Jason Sanders, MD, PhD. “The proportion of emergency departments reporting any patients primarily cared for in the hallway climbed from 70% to 89%. That is obviously far from ideal and is indicative of an increasingly taxed emergency medical care system.”