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Under the Affordable Care Act, millions have gained heath coverage [1]. However, UW Hospital is still seeing an increase of emergency room visits this year compared to previous years, mostly from insured patients not using primary care. Emergency room visits are a burden for hospitals if in large volumes and the increase in insurance has not solved the issue.
This spike in visitors has caused hospitals like Aurora Sinai Medical Center of Milwaukee to change their tactics. Aurora Sinai is targeting frequent ER visitors and connecting them with social workers to help them build relationships with doctors.
The social workers developed plans with these low-income visitors to ensure transportation and child-care when booking primary care appointments. In the first four months of the implementation, ER visits among these visitors dropped by more than 68 percent. This helped the hospital downgrade costs from $1.5 million to $440,000, according to an article [2] by National Public Radio.
[3]The UW Hospital has seen an increase of emergency room visits this year compared to previous years. (UW Photo Library)Policymakers thought that once low-income citizens were insured under the Affordable Care Act, they would not use ERs for everyday health care needs. However, the opposite has happened as these low-income citizens are reliant on emergency rooms because they don’t know how to use primary care.
“We’ve seen a volume increase among our well-insured population as well,” UW Hospital Department Chair of Emergency Medicine Azita Hamedani said.
While many who previously lacked insurance are now covered, Hamedani said inappropriate uses of health insurance, such as using the ER in place of primary care appointments, have become another issue. An increase in inappropriate visits increases the amount that ER doctors are asked to do and reduces their ability to serve patients experiencing true emergencies.
After seeing Aurora Sinai’s success, UW Hospital has started to increase social work services to address the underlying problems. Most of the time these repeat patients suffer mental illnesses.
“A chronic alcoholic comes into the ER 20 times; we shouldn’t be seeing this,” Hamedani said. “But while primary care can sometimes be difficult to find for those that are unfamiliar with it, emergency rooms cannot turn anyone away.”
Research by Shreya Kangovi, a Robert Wood Johnson Foundation scholar, showed that when asked, poverty-stricken Philadelphia residents preferred the ER to primary care due to better convenience, cost and quality.
Kangovi is using this research to shine light on vulnerable patients.
“They are telling us that we are creating a maze of hoops and hurdles that are driving them out of primary care and into the hospital,” Kangovi said.
Hamedani said UW Hospital ER staff members try to educate patients about when it is appropriate to come in for emergency visits, when it’s better to visit primary care and how they can connect with primary care offices. The hoops and hurdles are referring to the advanced planning and processes that scheduling primary care visits requires.
Educating patients is an important step to solve the problem, but hospitals like UW and Aurora Sinai also need to restructure their services. A reconstruction would continue to service low-income patients in the emergency room, but only for emergencies.
“It’s a myth that ER visits from low-income residents are a failure,” Hamedani said. “But our scope is expanding to service them.”
This story was originally published on The Arc [4]. The website is the result of a collective effort to examine justice in Madison by students in a reporting course at the University of Wisconsin-Madison taught by Professor Michael Wagner.
