Tuesday, May 11, 2021



Medi-Cal Patients Use Emergency Rooms at Higher and Growing Rate Than Uninsured and Privately Insured Patients Serious Implications for Impending Expansion under Affordable Care Act

According to new research from UC San Francisco, Medi-Cal patients rely disproportionately on care provided in the emergency room, and do so at an increasingly high rate that far outpaces both uninsured and privately insured patients.

The study, to be published in the Journal of the American Medical Association (JAMA), looked at California emergency room (ER) data from 2005 to 2010 and found an overall 13.2% increase in ER visits. Within that increase researchers found that Medi-Cal patient use of the ER increased by 13.9% compared to increases of 3.79% and 2.89% by privately insured and uninsured patients, respectively.

“We’re not at all surprised by this dramatic increase,” said Dr. Thomas Sugarman, president of the California Chapter of the American College of Emergency Physicians (California ACEP), “The fact of the matter is that when you repeatedly slash Medi-Cal reimbursement, physicians won’t participate in the program, and patients are left with nowhere else to go but the ER where we see everyone regardless of their insurance status.”

Researchers also found that Medi-Cal patients were most likely to be in the ER for severe conditions that might have been prevented from progressing had they had better access to primary care. The data showed an increase of nearly 7% in visits for certain acute conditions by Medi-Cal patients, compared to a decline in the same type among privately insured patients.

“What’s clear from this study is that we’re not talking about runny noses here, Medi-Cal patients are coming to us in worse shape because they’ve delayed care or not gotten any at all,” Sugarman continued, “These patients need access to a complete network of physicians who can provide ongoing healthcare so they don’t end up in the ER in bad shape, but they can’t get

it because the State continues to make it almost impossible for doctors to see Medi-Cal patients. Equally as frightening for patients is that this study looks at a time period before the State made its most recent ten percent cut in Medi-Cal reimbursement rates in 2011. This problem is only escalating. ”

The UC San Francisco research raises serious questions about the impact of the full implementation of the Affordable Care Act on California’s ERs, especially in light of research from UC Berkeley in January 2013 which found that as many as 3.9 million Californians, who are not already enrolled, will be eligible for Medi-Cal in 2014. Combine that with Medi-Cal patients’ already-high ER use which continues to grow faster than other patients, and abysmally low Medi-Cal physician reimbursement which was recently cut further as part of the

State Budget, and the picture is stark. Sugarman continues, “Just as the State is expanding the Medi-Cal rolls, they are decreasing the number of doctors patients can see.”

Sugarman continued, “The authors of this study further estimate a more than 10% increase in ER visits just due to these transitions in insurance. A 10% decrease in physician reimbursement combined with a 10% increase in patients needing access to immediate high- quality care is a formula for failure. Overcrowded, underfunded emergency departments threaten patient safety and access to emergency care for everyone – Medi-Cal recipient, insured, and uninsured alike Despite this being the third recent study to point out these facts, the State continues to ignore the data and act in the best interest of patients.

“Legislators and Governor Brown need to restore emergency care funding and exempt emergency providers from any Medi-Cal cuts since we are California’s safety net. We are the only physicians available for patients no matter what.”

California ACEP is a not-for-profit association representing California’s emergency physicians, who see and treat all Californians regardless of their ability to pay, providing more than 11 million emergency care visits each year.


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