Why are ERs so busy? It’s really no surprise.

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If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee.  But, I don’t think you would mind paying this premium if you were having a stroke causing half of your body to be paralyzed.  The truth is the emergency room is an essential service to our community, but you should try to avoid unnecessary trips to the emergency room, especially if you are not in the super rich category.   One of the overall goals of the Affordable Care Act (ACA) or Obamacare was to decrease unnecessary visits to the emergency room by providing insurance to millions, but interestingly the opposite has actually happened.

To give you a little background, I am a clinical instructor for the USC and Western University Physician Assistant (PA) programs.  In the last three years, I have noticed that one of the hottest jobs for a newly graduated PA students is a job in the emergency room.  This might not seem too shocking to most.  The ER is an exciting place to learn and practice medicine.  The shocking part is these newly graduated students with very little experience are being scooped up by emergency rooms across Southern California, and they are getting paid almost as much as primary care providers with ten years of experience.  Why is this happening?  It’s because the number of patients that visit an emergency room continues to increase.

So, why are so many people going to the ER when our uninsured rates are historically low?  It helps to understand that health care expansion has really been Medi-Cal expansion.  Medi-Cal is federally funded insurance for the poor, which is free for those who qualify.  The state of California has added 4 million new Medi-Cal enrollees since the rollout of Obamacare.  There are now over 12.7 million covered by Medi-Cal, which is a whopping 1 in 3 Californians.  The simple fact is that Medi-Cal does not have enough doctors in its network.  Primary care doctors and specialists are paid so little that most will refuse to see Medi-Cal patients.  Also, under the new guidelines of Obamacare, Medi-Cal patients have essential services that are guaranteed to them which include ER visits, These ER visits most of the time are completely covered without any copay or co-insurance payments.  So it is no wonder that emergency rooms are expanding to meet the needs of this new Obamacare landscape.

It seems to me that everyone loses in this situation.  Medi-Cal patients don’t have enough access to physicians and all too often will use the ER as a source of primary care.  Doctors in the community are being left out of the health care process, and many are resorting to Botox injections, and cosmetics to pay the bills.  Many hospitals are struggling to make ends meet and are expanding primary care type, fast-track services, in the ER by hiring a lot of new PAs.  Insured patients with high deductible insurance plans have to now wait longer in the ER and are shouldering most of the cost of the emergency room.  Critically ill patients that need rapid attention in the ER are more likely to be lost in the shuffle, or they might need to wait longer for that important CT scan.

So, the emergency rooms post-Obamacare are still overcrowded and getting busier.  The public can accept this broken insurance based system and wait their turn in the emergency room.  Uninsured patients and those with high deductible insurance can continue to pay thousands and thousands for unnecessary emergency room visits.  The other option is for providers in the community to innovate new payment models and make commitments to take safely care of sicker patients.  By paying the doctor directly, there is a substantial savings to the patient and providers can charge based on the value of their services.  Expect to see direct pay primary care, urgent care, and specialty clinics popping up in your neighborhood.

Manuel Momjian is a family physician.  This article originally appeared in the Urgent 9 blog.

Image credit: Shutterstock.com

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