ACEP: Supreme Court verdict may not stem the rising tide of visits to emergency departments

The decision today by the Supreme Court will prevent millions of people from losing their health insurance, but does not stem the rising tide of visits to the nation's emergency departments or solve other problems emerging in the post-Affordable Care Act health care system, according to a statement from Dr. Michael Gerardi, president of the American College of Emergency Physicians (ACEP).

"Emergency physicians support universal health coverage, although the challenges that Medicaid patients have faced in getting timely appointments with doctors demonstrate that health insurance does not guarantee a person's access to medical care. Furthermore, certain practices that have emerged within the insurance industry, in which the true cost of medical care is shifted from the insurance industry to the patients and providers, are troubling.

High-deductible plans with high co-pays for emergency department visits may dangerously discourage patients from seeking urgently needed care. In addition, recent drastic and precipitous reductions in reimbursement for out-of-network emergency care end up shifting costs to underinsured patients and the physicians who treat them at unreasonably discounted rates. This cost-shifting has allowed insurance companies to reap large profits at the expense of patient care.

The reliance on emergency care remains stronger than ever. As emergency physicians, we are dedicated to caring for all our patients, regardless of whether they have health insurance coverage. This is the law and also our moral responsibility.

Emergency departments provide incredible value to America. We care for 136 million patients each year with only 4 percent of the nation's health care dollar, according to the CDC. Even primary care physicians depend on emergency departments to perform complex diagnostic workshops and facilitate admissions of acutely ill patients, or simply to handle the overflow resulting from workforce shortages throughout the health care system.

And emergency visits will continue to increase for many reasons, including our aging population and primary care physician shortages. Emergency departments are facing soaring demands, and we must have adequate resources. The nation's focus must be on supporting this critical service that everyone needs."

Visits to emergency departments increased by nearly 50-percent from 1993-2013, while there was an 11-percent decrease in the number of emergency departments in America during that same time period, according to the American Hospital Association Trendbook. There were 4,440 emergency departments in the United States in 2013.

According to "The Evolving Role of Emergency Departments in the United State," published by RAND in 2013, the

4 percent of America's doctors who staff hospital emergency departments manage:

• 11 percent of all outpatient care in the United States
• 28 percent of all acute care visits
• Half of the acute care visits by Medicaid and CHIP beneficiaries
• Two-thirds of all acute care for the uninsured