Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA: Evidence From a Rural Georgia Hospital

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. Data and Methods: We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. Results: During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. Conclusions: Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.

Original languageEnglish (US)
Pages (from-to)407-409
Number of pages3
JournalMedical Care
Volume57
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Patient Protection and Affordable Care Act
Rural Hospitals
Hospital Emergency Service
Costs and Cost Analysis
Primary Health Care
Insurance
Linear Models
Economic Inflation
Demography

Keywords

  • ACA
  • cost of care
  • emergency department
  • health services research
  • rural hospital

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA : Evidence From a Rural Georgia Hospital. / Vernon, Marlo; Goggans, Steven; De Leo, Gianluca; Heboyan, Vahé.

In: Medical Care, Vol. 57, No. 6, 01.06.2019, p. 407-409.

Research output: Contribution to journalArticle

@article{5f29e07686014669afb3f1523a2a4878,
title = "Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA: Evidence From a Rural Georgia Hospital",
abstract = "Background: A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. Data and Methods: We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. Results: During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. Conclusions: Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.",
keywords = "ACA, cost of care, emergency department, health services research, rural hospital",
author = "Marlo Vernon and Steven Goggans and {De Leo}, Gianluca and Vah{\'e} Heboyan",
year = "2019",
month = "6",
day = "1",
doi = "10.1097/MLR.0000000000001114",
language = "English (US)",
volume = "57",
pages = "407--409",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA

T2 - Evidence From a Rural Georgia Hospital

AU - Vernon, Marlo

AU - Goggans, Steven

AU - De Leo, Gianluca

AU - Heboyan, Vahé

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background: A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. Data and Methods: We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. Results: During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. Conclusions: Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.

AB - Background: A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. Data and Methods: We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. Results: During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. Conclusions: Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.

KW - ACA

KW - cost of care

KW - emergency department

KW - health services research

KW - rural hospital

UR - http://www.scopus.com/inward/record.url?scp=85065961029&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065961029&partnerID=8YFLogxK

U2 - 10.1097/MLR.0000000000001114

DO - 10.1097/MLR.0000000000001114

M3 - Article

C2 - 30994524

AN - SCOPUS:85065961029

VL - 57

SP - 407

EP - 409

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 6

ER -