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(HealthNewsDigest.com) – WASHINGTON-Children on public insurance (Medicaid/CHIP) may have an easier time gaining access to outpatient specialty medical care when they are referred by the emergency department rather than by their primary care physician. The results of qualitative interviews with specialists and primary physicians published online yesterday in Annals of Emergency Medicine reveal a common “work-around” to barriers faced by publicly insured children seeking outpatient specialty care and highlight a potentially overlooked aspect of care coordination practiced in the nation’s emergency departments (“‘Patients Who Can’t Get an Appointment Go to the ER’: Access to Specialty Care for Publicly Insured Children”)http://tinyurl.com/auy6oxc.
“Many specialists will accept patients referred by the ER whom they might otherwise turn down,” said lead study author Karin Rhodes, MD, MS, Director of the Center for Emergency Care Policy Research in the Department of Emergency Medicine at the University of Pennsylvania in Philadelphia, Pa. “Concerns about poor reimbursement by Medicaid still exist, but specialists seem to be more willing to accept these lower-paying patients when they come through the ER. One reason may be that Medicaid referrals from the ER are more evenly distributed across numerous specialists, so everybody takes their fair share. The hope is that as health systems restructure as a result of the Affordable Care Act, we will be able to improve access to outpatient specialty care by understanding the strategies that already work.”
Dr. Rhodes and her team conducted a series of interviews with 40 physicians who treat children and predominantly practice in outpatient settings (26 specialists and 14 primary care physicians) in Cook County, Ill. Nearly three-quarters (72 percent) of the specialists interviewed reported rationing appointments by insurance status. Specifically, they reported limiting the number of children with Medicaid/CHIP whom they were able or willing to see. Some blamed the policies of the health systems in which they practice for these limitations. Of the primary care physicians who were interviewed, more than three-quarters (79 percent) reported difficulties in obtaining specialty appointments for their Medicaid-enrolled patients.
Many primary care physicians acknowledged using the emergency department as the “middle man” if a child cannot get into a specialist’s office in a timely fashion. Primary care physicians admitted sending patients to the ER because specialists tell them “you can always go to the ER and if they think you need to be seen by a [specialist] they’ll call one.”
“Our research suggests that certain aspects of the emergency department referral process – perhaps the EMTALA requirements in particular – increase the likelihood of connecting Medicaid patients with specialty physicians,” said Dr. Rhodes. “Given the current economic and political climate, it seems unlikely that Medicaid reimbursement for specialty care will improve substantially any time soon. Therefore, if the emergency department is expected to play a major role in care coordination between primary care physicians and specialists, that role should be explicitly recognized and supported.”
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.
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