Monday, January 13, 2014

ER study only half the story

The findings of a major study published this month cast doubt on the Obama administration's claim that emergency room use would decline, and costs would drop, as previously uninsured people obtained health insurance.
Opponents of health care reform saw the study on Oregon's expansion of Medicaid, published in Science magazine, as proof that the goals of the Affordable Care Act could not be achieved.
But reports of the study failed to note that the research covered the first year of Oregon's Medicaid expansion, in 2008 - before Obamacare was even proposed. They failed to point out that in the five years since, Oregon has significantly changed the way it delivers health care to Medicaid patients. As it has moved primary care outside the emergency department, diverting patients to less costly settings if they didn't need emergency care, Oregon has seen patient behavior change.
In the past two years, ER visits by Medicaid patients have dropped by 9 percent, and emergency department spending has decreased by 18 percent. Hospital admissions for congestive heart failure dropped by 29 percent, "chronic obstructive pulmonary disease by 28 percent and adult asthma by 14 percent," the Portland Business Journal reported in November.
Oregon, which has 600,000 people on Medicaid, has as many as 130,000 new patients entering its system through the Affordable Care Act's Medicaid expansion this month. State officials are confident the new system will continue to reduce ER visits and allow the coordinated care organizations to stay within their budgets.
That's welcome news for other states expanding Medicaid to reach more of the poor and uninsured, as directed by the 2010 law.
The law, designed to provide health insurance to every American and lower spiralling medical costs, has been beset by myriad problems and has far fewer people signed up than promised. President Barack Obama delayed implementation of parts of the law, leaving only a shell of a health insurance delivery program in place this month.
But the states in the forefront of revamping health care to manage diseases and prevent problems are making strides.
Sadly, Virginia remains on the sidelines, having eschewed the federal money to expand Medicaid to cover another 400,000 Virginians.
The money the commonwealth's hospitals used to receive as reimbursement for ER visits by the uninsured will go to places like Oregon, where health experts are reducing health care spending even as they provide immunizations, prenatal care and physicals to more residents.

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