Emergency Room Visits Rise as Primary Care Access Drops

For most hospitals, the road to bad debt expense begins in the emergency department. Patients arrive there with dangerous or life threatening injuries, illnesses or conditions that require prompt treatment regardless of their ability to pay their medical bills.

Now, recent findings by the Centers for Studying Health System Change (HSC) show that ED visits are rising, especially for patients with non-urgent conditions.  The leading cause is the lack of access to primary care physicians and specialists, according an HSC’s May report “Safety Net Emergency Departments: Creating Safety Valves for Non-Urgent Care.”

Total emergency visits classified as non-urgent conditions, or those that should have been treated in two to 24 hours, increased from 10 percent in 1997 to 14 percent in 2005, the report said. While visits by uninsured patients increased slightly during that time, people with private insurance account for most of the increase.  But low-income uninsured, underinsured and Medicaid patients rely more on hospital emergency departments because they can’t get timely access to outpatient care, and EDs can’t turn patients away without screening them.

“The growing reluctance of physicians and dentists to service Medicaid and uninsured patients, along with shortages of primary care physicians and certain specialists, such as psychiatrists, in some communities, make obtaining clinic or physician appointments increasingly difficult,” according to the report.

Lehman Brother’s equity research predicts that bad debt and charity care expense for the for-profit hospital industry will rise 15 percent to 17 percent in 2008, reaching $14.6 billion this year. 

The HSC said community health care centers have expanded coverage in underserved areas, but still struggle with growing demand for primary care.  Likewise, hospital clinics provide primary care services, but capacity and demand can mean patients wait months for treatment. 

According to the report, a Boston emergency department director said, “We see people coming back to the ED two to three times because they can’t get an appointment with a specialist.” Meanwhile, some ED directors suggest safety net EDs accommodate low-income patients so well they have become their preferred provider.

The HSC conducts site visits to 12 nationally representative metropolitan communities as part of its Community Tracking Study to interview health care providers about the local market, how it has changed and the effect of the changes on its patients.