News: Outpatient emergency department use increases, study finds

Outpatient treatment following emergency department (ED) visits increased sharply among all payer types, but particularly Medicare patients, according to a recent study published by JAMA Health Forum. Visits resulting in inpatient treatment declined or remained the same over the course of the study, which examined all ED visits from 2008 to 2023 from licensed, acute care hospitals in California.

In theory, privately insured and Medicare populations rely less on the ED due to greater access to primary and specialist care. On the other hand, Medicaid populations rely on the ED as a “first and last resort of care” due to less, or lack of, outpatient access, the study explains. While the Affordable Care Act expanded coverage through Medicaid and marketplace plans, ED visits continued to rise. The study differentiates outpatient from inpatient ED use across all payer groups to understand whether shifts are related to coverage alone or broader systemic forces.

Research results found that ED visits increased by 38%, from 10.8 million to 14.8 million visits overall. Visits made by Medicaid patients increased the most, by 33.3%. Medicare visits increased by 12.5%, less than half of Medicaid visits. The study also found a 5.2% increase in privately insured visits and a 2.2% increase in uninsured visits. Inpatient visits remained relatively stable across all payers.

Discharge visits—i.e., follow-up visits with a primary care or specialty provider following an inpatient admission—per 1,000 enrollees increased across all payers. Medicaid saw the largest relative increase at 38%, and Medicare saw a 28% increase. Privately insured patients saw an 8% increase, and uninsured patients saw a 6.7% increase. In contrast, admitted visit rates decreased dramatically by 45% for uninsured patients, 16.5% for privately insured patients, 12.8% for Medicare patients and 3.3% for Medicaid patients.

These findings indicate that coverage alone is not the only reason for reduced reliance on EDs. The rise occurred over a period that saw major coverage changes, including Medicare enrollment doubling and uninsurance falling by 50%. However, per capita ED use among Medicaid enrollees rose by only 38%, which suggests that expanded coverage for Medicaid patients reduced barriers to non-ED care. Additionally, system-level factors including regional clinician shortages, rural hospital closures, and higher admission thresholds likely shaped the patterns the study identified.

Editor’s note: To access JustCoding’s coverage of this story, click here. To read the full study, click here.