A major part of Florida’s emergency department eye care is reimbursed through Medicaid or paid for directly by the patients. According to a study published in the Archives of Ophthalmology, one of the JAMA/Archives journals, these findings may be beneficial in strategic planning as the debate over how best to implement the nation’s new health care reform law progresses.
The background information of the study reveals that the Patient Protection and Affordable Care Act (PPACA) will raise insurance coverage in large part by expanding the eligibility for Medicaid, which is “an already stressed and under-funded system in many states.”
The researchers state that:
“Planning for such change in ophthalmology requires knowledge of what role Medicaid currently plays in the delivery of eye care.”
Matthew T. Witmer, M.D. and team evaluated data sets from the Florida Agency for Health Care Administration emergency department for outpatient visits and admissions for eye care, from 2005 through 2009. They identified a total of 587,227 emergency department visits with a primary diagnosis in need of eye care. 12,105 of these visits resulted in hospitalization. The researchers categorized all patients by age, i.e. younger or older than 18 years, and reviewed the types of insurance coverage.
They established during the 5-year study period that commercial insurance was the most frequent payer of emergency department outpatient services, with 31.1%, followed by 26.2% who paid themselves, and 22% of patients with Medicaid.
According to the findings, 67.7% of patients under the age of 18 years either paid themselves, or the cost was covered through Medicaid. The researchers also discovered that for outpatient emergency department visits, the percentage of change in Medicaid increased by 5.9% for each calendar year, whilst commercial coverage declined by 4.5%.
The researchers indicate that even though the study cannot be “indiscriminately generalized” to other states, they believe the data does apply to other states.
They conclude:
“Emergency department eye care will assume a larger safety-net function if more patients move into categories of Medicaid or self-pay. Already stressed EDs (emergency departments) and hospital staff need to be prepared to navigate change brought on by health care reform and the delayed economic recovery without compromising quality of care. Data within this study – although sobering – should be used for strategic planning as the debate on how to best implement PPACA moves forward.”
Paul Lee, M.D., J.D., and Jacqueline Dzau, M.D., M.P.H, of the Duke Eye Center at Duke University Medical Center in Durham, N.C., write in an accompanying editorial that:
“The long-term growth in Medicaid, Medicare, and other public payor sources will only accelerate over the next 10 years, creating additional pressures and constraints on how we deliver eye care.
To the extent that ED (emergency department) payments are linked to an increasing proportion of Medicaid patients, traditionally among the lowest paying of all payors for adult care, the economic incentive for ophthalmologists not employed by hospitals to provide coverage will decrease, further exacerbating challenges in obtaining call coverage of eye conditions.”
They conclude that:
“If ‘necessity is the mother of invention,’ the findings described in the study by Witmer et al may be a harbinger of fundamental changes in the financing of ED provision of eye care and in the resulting care delivery models in Florida as well as the United States.”
Written by Petra Rattue