Real health care reform starts with looking at real evidence
After last month’s Supreme Court ruling on the Affordable Care Act (ACA), a number of studies were released analyzing the decision’s potential effects on Medicaid. One eye-opening study by the Center for Studying Health System Change (HSC) debunked the conventional wisdom about Medicaid patients and their “inappropriate” use of emergency departments. By using methodology based on presenting symptoms rather than final diagnoses, the report found Medicaid patients seek care at EDs for legitimate, potentially urgent medical issues at a rate comparable to privately-insured patients.
However, the study also indicated that Medicaid patients use EDs at a rate more than double that of the privately insured. This is because patients are often unable to find physicians that accept Medicaid and, as a result, forego routine preventive care and neglect solvable health issues until they become emergencies.
Also released last month was an important CDC study on access to primary care for Medicaid beneficiaries. According to the Washington Post, the study estimates that 31 percent of the nation’s doctors wouldn't accept new Medicaid patients.
This spells trouble for the ACA’s expansion of Medicaid.
If Medicaid’s expansion isn’t accompanied by a proportionate growth in the number of doctors willing to accept Medicaid, we will continue to see patients with increasingly complicated and costly health problems stream into already-overcrowded emergency departments.
The studies by HSC and the CDC highlight an important point: access to coverage is not the same as access to care. Acknowledging this basic fact will be crucial to bridging the holes in our health care delivery system, providing our most vulnerable citizens with appropriate care, and repairing an already-strained health infrastructure.
Real health care reform will begin only when policy makers begin looking at actual evidence rather than assumptions unsupported by the facts.
I have always taught residents that being a good emergency physician is a mixture of Boy Scout preparedness and simple paranoia. The astute EP always thinks a few steps ahead to prepare for potential surprises. Regardless of your political persuasion, we should be prepared for implementation of the ACA and how it could affect the care we give our patients.
Mike Smith, MD, FACEP
Limiting Non-Urgent ED Visits Won’t Curb Health Care Spending
According to a study published recently in Annals of Emergency Medicine, reducing non-urgent visits to emergency departments will generate little or no cost savings for the nation’s health care system. The study, entitled “A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department,” suggests the focus on eliminating “non-urgent” ED visits by insurance programs—both public and private—distracts from more promising ways to save money in hospital admissions.
Host an Emergency Department Visit for your Member of Congress
As an emergency physician, your perspective is important to the national discussion on effective health care. Hosting your Member of Congress for a “white coat” visit is a great way to show your legislators how health care works—or doesn’t work—in the real world. ACEP has written a helpful guide on how to arrange an ED visit for your legislators.
On October 6 and 7, at the ACEP Council meeting prior to Scientific Assembly in Denver, the ACEP Council will hold its annual meeting to debate and vote on a series of resolutions to determine ACEP policy.
Mike Smith, MD, FACEP, for his promotion to Associate Professor at Case Western Reserve University
Greg Fermann, MD, FACEP, for being named Executive Vice Chairman for the University of Cincinnati’s Department of Emergency Medicine
David F. Baehren, MD, FACEP, for his article, "A Gift from My Brother," in the July issue of ACEP News
Paul Rega, MD, FACEP, for being quoted in the Toledo Blade article, “UT honors providers of emergency medical care”
Ryan Squier, MD, for presenting at ICEM’s 2012 meeting in Dublin, Ireland; his abstract, “A ‘trichy’ area: should positive ED visit testing for trichimonas vaginalis warrant treatment for chlamydia or neiserria gonorrhea?” was voted one of the Top 100 abstracts at the conference and published in Academic Emergency Medicine
Tom Lloyd, DO, for presenting his poster, “Door to balloon times for primary percutaneous coronary intervention: how do freestanding ED's perform?” at ICEM’s 2012 meeting in Dublin, Ireland
Erin Simon, DO, for presenting her poster, “Publicly posted ED Wait Times: how accurate are they?” at ICEM’s 2012 meeting in Dublin, Ireland
Thanks to Dr. Nick Jouriles for pointing out the accomplishments of Drs. Squier, Lloyd and Simon for inclusion in our eNews
Stephanie Hunter, MD (pictured above left); Joseph Stone, MD (pictured above center); and Justin Yax, DO (pictured above right) for graduating and taking a faculty positions at University Hospitals Case Medical Center
Amy Pound, MD, on receiving an award from the Andrews Foundation which will fund her proposal to integrate palliative care into emergency medicine education
Thanks to Dr. Vicken Totten for pointing out the accomplishments of Drs. Hunter, Stone, Yax and Pound for inclusion in our eNews
Richard N. Nelson, MD, FACEP; Catherine A. Marco, MD, FACEP; Robert W. Strauss, MD, FACEP; Carol A. Cunningham, MD, FACEP; Rita K. Cydulka, MD, FACEP; Michael S. Beeson, MD, FACEP; Curtis P. Snook, MD, FACEP; Gary T. Giorgio, MD, FACEP; Eric A. Anderson, MD, FACEP, David Cheng, MD; Gary R. Katz, MD, MBA, FACEP; David H. Smile, MD, FACEP; and Thomas A. Tallman, DO, FACEP, were each recognized in the American Board of Emergency Medicine’s 2011-2012 Annual Report for their service to ABEM. Read the full listing of members and their ABEM involvement.
If you know of a member that deserves to be congratulated, let us know!
Premier Physician Services Celebrates 25th Anniversary!
Congratulations to our friends at Premier Physician Services on their 25th Anniversary! Premier’s physicians have played an active role in Ohio ACEP’s boards and committees, and we thank them for their leadership and commitment to our shared goal: advancing emergency medicine.
Recent News and Opinion
ACEP corrects statistic used by Texas Medicaid Director about emergency care
In a press release, ACEP reported that “[a] statement by the Texas state Medicaid Director incorrectly attributed a statistic that applies to all of hospital care by Texas Medicaid patients to emergency care.”
UT Medical Center dedicates EM Wall of Honor
On July 14, the Toledo Blade published an article on the unveiling of the University of Toledo Medical Center’s new Emergency Medicine Wall of Honor. The wall was created to recognize and celebrate the outstanding prehospital care providers, emergency nurses and emergency physicians of northwest Ohio.
Photo credit: Dave Zapotsky, Toledo Blade
ED physician, ACEP member, describes treating victims of Colorado mass shooting
During the July 20 mass shooting in a crowded Colorado movie theater, Dr. Comilla Sasson was one of two attending physicians at the nearby University of Colorado Hospital at Aurora. She saw each of the patients that arrived in her ED that night and shared her story with NBC Nightly News.
Aurora Shootings: Well-Orchestrated Emergency Response Saved Lives
As reported by ACEP News, many gravely wounded victims of the Aurora shooting are alive thanks to the outstanding emergency response from first responders and area EDs.
ACA cuts emergency care funds for illegal immigrants; Hospitals brace for financial impact
As reported by The New York Times on July 26, a provision the Affordable Care Act will cut federal aid to hospitals used to pay for emergency care for illegal immigrants.
NIH creates new Office of Emergency Care Research
On July 31, the National Institutes of Health announced they have established a new Office of Emergency Care Research with the goal of improving health outcomes for patients. In a press release, ACEP’s President, Dr. David Seaberg, welcomed the news, calling the event a “landmark” for emergency care research.