John, as I have said before, these kinds of calculations don’t take into account the possibility that newly insured Medicaid patients may use the ED more frequently than these enrollees did prior to having insurance coverage. The data is still a bit conflicting on this https://www.macpac.gov/wp-content/uploads/2015/01/MACFacts-EDuse_2014-07.pdf
but it is likely to be driven by local conditions, such as the availability of primary care services for these new Medicaid enrollees. It is likely that in many areas where Medicaid expansion ensues, EDs and ED physician groups will find themselves having to staff up (and thus increase their overhead) to meet this demand, and since Medicaid almost always fails to cover the costs of providing these ED and emergency physician services: the net effect of Medicaid expansion for certain EDs may actually be a reduction in net revenues, rather than a gain. Arguments to the contrary just feed into the notion that the solution to ensuring the financial wellbeing of the emergency care safety net is to expand Medicaid. This may help some EDs and EP groups, or it may sink them, depending on circumstances often beyond their control (unless it forces them to skate around the thin ice of EMTALA violations by aggressively ‘deferring’ ED care of Medicaid patients).
One Response to “Emergency Department Patients’ Demographics, Disposition, Composition Affect How They Pay for Services”
September 25, 2016
Myles Riner, MDJohn, as I have said before, these kinds of calculations don’t take into account the possibility that newly insured Medicaid patients may use the ED more frequently than these enrollees did prior to having insurance coverage. The data is still a bit conflicting on this
https://www.macpac.gov/wp-content/uploads/2015/01/MACFacts-EDuse_2014-07.pdf
but it is likely to be driven by local conditions, such as the availability of primary care services for these new Medicaid enrollees. It is likely that in many areas where Medicaid expansion ensues, EDs and ED physician groups will find themselves having to staff up (and thus increase their overhead) to meet this demand, and since Medicaid almost always fails to cover the costs of providing these ED and emergency physician services: the net effect of Medicaid expansion for certain EDs may actually be a reduction in net revenues, rather than a gain. Arguments to the contrary just feed into the notion that the solution to ensuring the financial wellbeing of the emergency care safety net is to expand Medicaid. This may help some EDs and EP groups, or it may sink them, depending on circumstances often beyond their control (unless it forces them to skate around the thin ice of EMTALA violations by aggressively ‘deferring’ ED care of Medicaid patients).