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ACA Provisions Tied to Change in Profile of Frequent ER Users

After controlling for patient-level characteristics, odds of being frequent ER user down in Medicaid-insured

emergency room sign

THURSDAY, June 21, 2018 (HealthDay News) -- Following implementation of several major coverage expansion provisions in the Affordable Care Act (ACA), the profile of frequent emergency department users changed, according to a study published in the June issue of Health Affairs.

Using data from California's Office of Statewide Health Planning and Development, Shannon McConville, from the Public Policy Institute of California in San Francisco, and colleagues compared the characteristics of frequent emergency department users among non-elderly adults in California before and after implementation of several major coverage provisions in the ACA.

The researchers found that frequent users, with four or more annual emergency department visits, accounted for 7.9 and 8.5 percent of emergency department patients before and after implementation of those provisions, respectively; they were responsible for 30.7 and 31.6 percent of all visits before and after implementation. For Medicaid-insured patients, the odds of being a frequent emergency department user were significantly lower post-ACA, after controlling for patient-level characteristics. The likelihood of being frequent users was lower among uninsured patients post-ACA, while little change was experienced by privately-insured patients. Having a diagnosis of a mental health condition or a substance use disorder was the largest predictor of frequent emergency department use.

"Interventions to address frequent emergency department use must involve Medicaid managed care plans, given that more than two-thirds of frequent emergency department users post ACA have Medicaid as their primary coverage source," the authors write.

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