Study finds that ACA Medi-Cal expansion could fuel ER use September 20, 2013 Medi-Cal Emergency Physicians, Emergency Rooms, Insurance/Reimbursement, Medi-Cal, Medi-Cal Cuts, Access to Care 0 A retrospective study conducted by researchers at the University of California, San Francisco (UCSF) found that the number of visits to California emergency rooms (ERs) rose by 13.2 percent between 2005 and 2010, from 5.4 million to 6.1 million annually, with a significant 35 percent increase in the number of ER patients insured through Medi-Cal. The authors suggest that the Medi-Cal expansion under the Affordable Care Act (ACA) could further increase these numbers, as millions of additional patients become eligible for Medi-Cal in 2014. Researchers also found that Medi-Cal patients had the highest ER usage burden for ambulatory-care-sensitive conditions (54.76 per 1,000 patients on average) compared with those who had private insurance (10.93 per 1,000 patients) or no insurance at all (16.6 per 1,000 patients). This study comes on top of the announcement this month that the California Department of Health Services intends to begin to implement a 10 percent Medi-Cal physician payment rate reduction on October 1, 2013, for Medi-Cal managed care and on January 9, 2014, for fee for service. This reduction is the result of legislation that was passed in March of 2011, when California’s budget was in dire straits. Even though California's fiscal outlook is much brighter now than it was in 2011 when the legislature first passed the 10 percent cut, the state has moved forward with the cuts and will retroactively collect payment back to July 2011. The cuts had been held up in court while the California Medical Association (CMA) pursued legal action to stop the state from decimating California's already tattered safety net. Unfortunately, the Ninth Circuit Court of Appeals recently overturned the injunction, clearing the way for the state to begin implementation. CMA has submitted a petition to the U.S. Supreme Court, asking them to review the case. (See, "CMA files a petition with the Supreme Court to block the 10 percent physician reimbursement cut" for more information.) These cuts will assuredly force physicians out the Medi-Cal program, which is expected to assume care for more than 2 million new patients in 2014 under the ACA Medicaid expansion. Even before the cuts, California's Medi-Cal provider payment rates were the lowest in the nation. Low reimbursement rates have driven many of California’s providers from the program. As a result, 56 percent of Medi-Cal patients report difficulty finding a doctor. When they are unable to find a provider, many Medi-Cal patients seek preventive and other non-urgent care in hospital ERs. Others may simply go without preventive and primary care altogether and end up in the ER only after their condition has become severe. The inability to find a provider adds to pervasive ER overcrowding, which increases wait times, decreases quality and threatens access to emergency care for everyone. If these cuts are not stopped, Medi-Cal will become nothing more than a broken promise of access to care. The UCSF study was supported by the California HealthCare Foundation, the National Center for Advancing Translational Sciences, the National Institutes of Health and the Robert Wood Johnson Foundation Physician Faculty Scholars Program. View the research letter, recently published in the Journal of the American Medical Association. Comments are closed.
