Emergency room visits soar in Sonoma County under Obamacare
Hospital emergency departments in Sonoma County are seeing a dramatic surge in Medi-Cal patients, the result of a provision in former President Barack Obama’s landmark health care law that greatly expanded coverage for tens of thousands of poor local residents.
New state data shows Medi-Cal patients made 150 visits each day to area emergency rooms last year, up from 90 visits a day in 2013, the year before the Affordable Care Act lowered eligibility requirements for California’s insurance program for low-income residents.
The 67 percent jump in ER visits by Medi-Cal patients over the past three years is troubling to medical professionals because historically a large share of ER visits are for nonemergency medical conditions, such as coughs, headaches, back pain and the flu. More nonemergency patients in the ER means longer waits for those who suffer a real emergency, said Dr. Omar Ferrari, chairman of Memorial Hospital’s emergency department.
“There’s a serious disconnect between what society believes the function of the emergency department should be and what a large subset of our patients actually use it for,” Ferrari said.
A visit to the nearest ER is also much more costly than seeking care at an urgent care center. One often cited study, funded in 2013 by the National Institutes of Health, put the average cost of an ER visit at $1,233.
In contrast, the cost of a visit to one of St. Joseph Health’s local urgent care centers is $50, while the new Sutter Health-affiliated walk-in clinic in Petaluma charges uninsured patients a $129 “all-inclusive” fee for each office visit.
Whether it’s leading to emergency department overcrowding or adding to the overall cost of health care, medical professionals say the overuse of emergency departments affects everyone.
But county and state officials say aggressive measures taken to beef up the local primary care network and divert Medi-Cal patients toward less expensive modes of treatment are succeeding. In fact, they say, the rate of ER visits per Medi-Cal patient has actually declined after an initial spike the year Obamacare expanded public insurance for the working poor.
Overall, Medi-Cal patients made 54,873 visits to local emergency rooms last year, up from 32,792 in 2013, according to data from the Office of Statewide Health Planning and Development.
Memorial Hospital has borne the brunt of the influx. Last year, the Santa Rosa hospital’s emergency department logged 16,921 visits from Medi-Cal patients - or 46 visits a day - up from 7,461 visits in 2013, according to state data. The number of emergency visits from uninsured patients remained virtually unchanged at about 4,000 during that period.
Ferrari said there have always been patients who use the emergency department “inappropriately” for conditions that could be treated in an urgent care or primary care setting. But he said there has been a significant uptick in recent years.
Countywide, emergency department visits by patients with private insurance and Medicare also increased between 2014 and 2016, but not nearly as significantly as it did for Medi-Cal patients.
Last year, Medi-Cal patients made 34 percent of all emergency room visits in Sonoma County, up from a quarter of ER visits in 2013. The increase was even sharper at Memorial Hospital, where emergency visits by Medi-Cal patients jumped from 26 percent of all ER visits to 45 percent during the three-year period.
Ferrari said emergency doctors, nurses and other staff pay no attention to a patient’s type of insurance - they must care for anyone brought in, whether they walk through the doors or are brought in by ambulance on a gurney.
But Ferrari said such significant spikes in usage are a serious problem for everyone who relies on emergency beds, which he views as a “precious resource.”
“The emergence of emergency department ‘superusers’ and people using the emergency department for minor complaints puts that resource at risk,” he said.
Hospital officials said many of the newly insured under Obamacare are still not connected with a “medical home.”
“We work on several fronts to get these individuals connected with a physician for their care needs and to encourage preventive care,” said Memorial Hospital spokeswoman Vanessa DeGier.
Jan Shea, a spokeswoman for the California Hospital Association, said there was no significant increase in physicians willing to see Medi-Cal patients following the expansion of Medi-Cal eligibility.
“It is our belief that many newly enrolled Medi-Cal patients are continuing to seek care in (hospital emergency departments) because they cannot access primary care in physician offices and clinics,” she said.
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