And Memorial isn’t alone — hospitals across the nation are also trying to prepare for the onslaught, which some experts say could mean longer waiting times and an increased use of ambulance services.
The National Center for Policy Analysts, a Dallas-based think tank, estimates that the nation’s hospitals will see an annual increase between 848,000 and 901,000 additional visits once health care reform takes effect.
The health care overhaul plan adds millions of people to the health care rolls, but doesn’t provide more primary care doctors. Experts believe that those patients who will then be able to pay for their treatment, will use the emergency room.
Memorial’s emergency room doctors already see 132,000 patients a year, said John Suits, associate administrator for government affairs. About 20 percent of those visits are from Medicaid patients — the funding platform for the Affordable Care Act.
The hospital isn’t waiting until 2014 to begin to move some of those people to other means of hospital care.
The hospital has partnered with Peak Vista Community Health Clinics to move people to a more permanent medical home, a cheaper way of accessing health care. Peak Vista keeps a staff member in the ER to help channel eligible patients to their clinics.
“It’s worked very well,” Suits said. “It started with a federal grant, and when they money ran out, Peak Vista saw the value in it so much, they agreed to keep doing it.”
Now Peak Vista also has a staff member at Penrose’s emergency department, keeping numbers down at that hospital as well.
The point is to provide a primary care doctor for patients who might not already have a relationship with one, Suits said. It not only keeps patient wait times lower, it saves money.
“The emergency department is the most expensive way to access care,” Suits said. “And we already have very long wait times, we’re always so busy.”
The Affordable Care Act doesn’t bring all bad news — many of those people using Memorial’s emergency room don’t have health insurance or any means of paying for treatment. That leads the hospital to spend up to $100 million a year for bad debt and charity care.
While Medicaid won’t cover all the expenses, “some is better than none,” Suits said.
Steve Berkshire, professor of health care administration at Central Michigan University, said Memorial’s decision is only one step in the right direction. Other hospitals are staffing triage with nurse practitioners and physicians’ assistants to deal with patients who show up and don’t truly need emergency services.
But Suits is hoping that Memorial doesn’t have to add staff to its ER.
“It might come to that,” he said. “But we’re working to keep it from happening.”
Berkshire said that the anticipated increase in ER visits could be a blip — and then decrease to regular numbers. However, he believes hospitals shouldn’t wait to begin preparing for the deluge.
“The problem is that more people will be insured,” he said. “But will they be able to find a doctor?”
Hospitals are responding by redesigning the emergency room — creating a new treatment area for patients who don’t really need emergency care. And others are doing what Memorial and Penrose are doing — working with a federally qualified community health center.
That’s important, Berkshire said, because those clinics get reimbursed at the actual cost of care, while hospitals do not.
The solution to the problem, however, might lie outside hospitals and in the nation’s medical schools. Berkshire points out that most medical schools groom doctors for research posts or specialty practices.
“But there are about six opening in the nation that focus on primary care doctors,” he said. “That’s an excellent way of getting more doctors into family medicine — and getting people out of the emergency department.”
This isn’t the first time emergency departments saw an increase in patients, thanks to federal health care legislation. When Medicare was first created by Congress, emergency departments saw many more seniors.
“People who didn’t have money suddenly had a way to pay for treatment,” Berkshire said. “They didn’t have a relationship with a doctor, so they went to the emergency room.”
In the case of Medicare, the increase was temporary, and ER visits dropped as more doctors started accepting Medicare, he said.
In the meantime, however, hospitals have to be ready to respond to the increase in patients. There are several ways of doing that, Berkshire said. Not all of them involve doctors.
Greater use of nurse practitioners, which can prescribe medicine in many states, is also another way to triage patients away from the emergency room.
The lack of primary care doctors — and the resulting surge in emergency room patients — is one of the basic criticisms of the Affordable Care act.
“But the act does address some of the primary care doctors’ concerns,” he said. “It changes payment levels, so primary doctors’ incomes increase, while incomes for specialty doctors are decreasing. There are also incentives to becoming a primary care doctor.”