Newly Insured Massachusetts Residents Seek ED Care

Ruzanna Harutyunyan's picture

Massachusetts residents enrolled in the state-subsidized health insurance program Commonwealth Care continued to seek routine care at hospital emergency departments at a rate 14% higher than state residents overall, according to data compiled by the state at the request of the Boston Globe. The state data show that Commonwealth Care beneficiaries used the ED at an annual rate of 557 visits per 1,000 members between Nov. 1, 2006, and Dec. 31, 2007, compared with the statewide average of 488 visits. The data excluded ED patients whose conditions were serious enough to warrant hospital admission.

Commonwealth Care beneficiaries with the lowest incomes, who previously received no-cost ED care and now pay $3 per ED visit, used EDs at a rate 27% higher than the state average. These beneficiaries, who account for about half of the program's enrollment, have the highest rates of ED use, while Commonwealth Care beneficiaries with higher incomes, who have copayments of between $50 and $75 per visit, used EDs at a rate lower than the state average.


A 2007 report by the state Division of Health Care Finance and Policy found that the average cost of an ED visit for the treatment of a non-urgent ailment is about $976, compared with $84 to $164 to treat a common ailment at a primary care physician's office, according to Blue Cross and Blue Shield of Massachusetts. According to the Globe, it is "unclear how the new health care law has affected overall usage of" EDs because the state report on such visits comes out every two years and the report from 2007 does not account for changes created by the new law.

Emergency care physicians and counselors say that one reason for the continued use of EDs is the lack of primary care physicians in the state, which has contributed to lengthy appointment wait times for newly insured residents. Patrick Holland, CFO for the Commonwealth Health Insurance Connector Authority, said, "It's going to take some time to educate" the lowest-income beneficiaries about using primary care, adding, "They probably never had a primary care doctor before." Holland said the state expected HMOs that provide benefits for Commonwealth Care and Medicaid beneficiaries to educate their members about how and when to contact a primary care physician.

Meanwhile, a number of medical centers across the state have added telephone help lines, counselors and social workers to their EDs to help provide information about insurance, enroll uninsured patients in health care programs and find ED patients primary care physicians (Lazar, Boston Globe, 10/6).

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