Emergency Department Costs Increase Despite Massachusetts Health Insurance Law

Main Category: Health Insurance / Medical Insurance
Also Included In: Public Health
Article Date: 28 Apr 2009 - 7:00 PDT

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The total cost of treating emergency department patients in Massachusetts increased by 17% over two years, despite efforts included in the state's health insurance law to direct patients with non-urgent problems to primary care physicians instead of EDs, according to state data, the Boston Globe reports. The data are for fiscal years 2006 and 2007 and include numbers on ED visits for patients discharged, rather than for patients admitted. Visits to EDs in the state increased by 7% during the two years to 2,469,295, which caused treatment costs to rise from $826 million to $973 million, according to the data. The portion of patients who did not require immediate treatment or who could have been treated in a doctor's office remained steady at 47% throughout the two years.

Some physicians and policymakers said the numbers suggest that ED overcrowding cannot be solved simply by enrolling people in insurance plans, as the 2006 law sought to do. They say that more primary care doctors and nurses are needed, as well as a new payment system that creates incentives for monitoring patients with chronic conditions such as diabetes.

"Just because you have insurance doesn't mean there's a (primary care) physician who can see you," American College of Emergency Physicians Vice President Sandra Schneider said. Peter Smulowitz, an ED physician at Beth Israel Deaconess Medical Center, said, "We have to pay primary care doctors what they're worth and increase the network for primary care from doctors and other providers," adding, "It's going to take a lot of money up front to change this. But do we have any other choice?" Blue Cross and Blue Shield of Massachusetts Senior Vice President Andrew Dreyfus said, "The most important way to change patterns of care is to change payments and encourage primary care physicians and the health system to treat conditions early and actively to prevent patients from going to the ER in the first place. That's the next important reform we need in Massachusetts" and "should be part of the legacy of the health insurance law."

Massachusetts officials urged critics not to draw conclusions about whether the insurance mandate has succeeded in decreasing stress on EDs, saying that more years of data are needed to properly gauge the law's effect. Kate Nordahl, assistant commissioner for policy and research at the state Division of Health Care Finance and Policy, said, "These are very early results," adding, "I would caution you not to make any conclusions until we have 2008 data available" (Kowalczyk, Boston Globe, 4/24).

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