By Victoria Colliver
San Fransisco Chronicle
SAN FRANSISCO — Emergency room visits to U.S. hospitals increased more than 23 percent from 1997 to 2007 — double what researchers expected the rise would be based on population growth, according to a UCSF study released today.
Total annual visits to the country’s emergency departments rose from 94.9 million in 1997 to an estimated 116.8 million over the next decade, the study found. Visit rates for adults on Medicaid accounted for the jump, while rates for adults with private insurance and those on Medicare showed no significant change.
Relatively low reimbursements to physicians who care for patients on Medicaid, the federal-state health program for the poor who meet certain criteria, were believed to be a key factor behind the increase.
“There are many physicians who refuse to accept new patients with Medicaid,” said Dr. Ning Tang, assistant clinical professor at UCSF and lead author of the study. “This doubling in emergency department visits by adults with Medicaid suggests they might not have adequate access to outpatient care.”
According to the study, which appears in the Journal of the American Medical Association, adults enrolled in Medicaid, known as Medi-Cal in California, visited emergency rooms at the rate of just over 947 per 1,000 in 2007, up from 694 visits per 1,000 in 1999. The number of visits by Medicaid recipients nearly doubled from 9.6 million in 1997 to 17.7 million in 2007.
The emergency room study, which comes on the heels of similar emergency department numbers released last week by the National Center for Health Statistics, underscores concerns about the growing strain on America’s safety-net services, particularly in light of the recession and the impact of the national health care overhaul law.
The law will increase coverage to an estimated 16 million Americans by expanding the Medicaid program in 2014, raising questions about whether there will be enough physicians and services to accommodate them.
Because the emergency room statistics in the reports cover the years through 2007, they don’t capture the impact of the recession. Millions of workers lost their jobs and employer-sponsored health insurance, which may have caused an even further increase in visits to emergency rooms by newly uninsured people.
A report released last year by the California Hospital Association, a trade group representing the state’s hospitals, showed the economic downturn was starting to take a toll. In the survey of hospital chief financial officers conducted in the second quarter of 2009, 57 percent of hospitals reported an increase in visits to their emergency rooms over the previous year.
The federal health law increases Medicaid reimbursement rates to encourage more primary-care physicians to accept Medicaid, but those federally funded increases could last just two years. Meanwhile, hospitals are concerned about lower payments in the law, such as reduced reimbursements for care of the uninsured when more patients have coverage in 2014.
“Over next 10 years, California hospitals are facing $17 billion in new payment reductions as a direct result of the reform measures,” said Jan Emerson, spokeswoman for the California Hospital Association.
The UCSF study also noted the number of U.S. emergency departments decreased by 5 percent from 1997 to 2007.
Dr. Angela Gardner, president of the American College of Emergency Physicians, said it’s not fair to blame the increase in emergency room visits on Medicaid recipients or any other particular population.
“The fact of the matter is people are sicker than they used to be, they’re older than they used to be and have more illnesses than they used to have,” Gardner said.
Copyright 2010 San Francisco Chronicle