I believe the impact will be two fold: initially positive, yet progressively negative as time progresses. Currently, federal law (i.e., EMTALA) requires the emergency department to provide care to everyone, regardless of insurance. So it only begs to reason that if this bill is going to provide insurance coverage to 35 million additional Americans, less patients will present as self pay ( aka: good luck getting reimbursed). Using elementary math, more patients in the ED with insurance equates to more payouts.
One could argue that there are numerous negatives to this plan. I'm going to argue that this bill does nothing to address the shortage of primary care physicians which I believe is one of the largest problems with our current healthcare system. As an ED doc, why do I care you ask? As the shortage of primary care docs in this country grows, so does the amount of primary care I have to put up with in the emergency department.
The common cold.
Lost medications.
Poor glycemic control.
Depression.
Those are just a handful of daily complaints I have in the emergency department. None of which are emergencies. I predict that as more and more people receive insurance, intuitively there will be an increase in people seeking care. Instead of waiting three, four or even five weeks to see a primary care physician, they'll just jump in the car and come to the ED. "Why not, I have insurance now," they'll say.
Technically according to my first paragraph this wouldn't necessarily be a bad thing; however it would inevitably worsen ED overcrowding. About once every couple of years I here about a patient dying in the lobby of an emergency department as he or she was waiting to be seen. Incidences like that, albeit rare, do represent consequences to ED overcrowding, and the prevalance of these negative consequences under this new system I believe are destined to rise.
Then again, I'm just an intern, and this is a very simplistic view of a very complicated matter. Time will tell how it all plays out.
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ReplyDeleteWhere I live there are a bunch of urgent care clinics staffed by PAs and NPs opening up. I would think that a lot of the non-urgent cases would go to these clinics rather than wait 6 or more hours in the ED. Since nearly everyone will have insurance, I don't see the benefit of going to the ED for minor complaints. I could be totally wrong though, I don't have any experience in the ED.
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