Copyright © 2018 Albuquerque Journal
In a shift from the early years of the Affordable Care Act, emergency room visits appear to have fallen or increased only slightly in Albuquerque’s major hospitals.
From 2016 to 2017, both the Presbyterian and Lovelace health systems had small increases in the number of emergency room visits – 1.1 percent and 1.9 percent, respectively – according to data compiled by the Journal. The University of New Mexico Hospital had a 7.2 percent drop in the same period.
In comparison, Presbyterian and Lovelace reported a 10 percent increase in emergency room visits from 2014 to 2015. The UNM Hospital reported no significant change in the same period.
Still, the total number of patients visiting the emergency rooms of Albuquerque’s major medical providers has increased over the past few years. In 2015, the number was about 352,000; last year, the number was about 366,000. Presbyterian was the largest, with 172,908 visits.
Dr. Darren Shafer, Presbyterian’s medical director for urgent and emergency services, attributed the smaller increase in ER visits to both Presbyterian’s expanded care options – online visits, urgent care clinics and same-day primary care appointments among them – as well as to behavioral changes in those insured under the Affordable Care Act.
“What we’re seeing now is that previously uninsured or underinsured patients have access to different avenues of care,” Shafer said. “That initial increase (in ER visits) … a lot of that was unmet need when people were just starting to access our services.”
Shafer said he expected Presbyterian’s ER visits to remain fairly flat or increase slightly over the coming years, particularly as the organization focuses on opening additional urgent care clinics.
In an email, UNM Hospital interim CEO Michael Chicarelli also pointed to the hospital’s on-site urgent care offerings as one contributor to its 7.2 percent drop in ER visits. Additionally, he said, the hospital has had an increase in observation status patients – individuals admitted to the emergency department who “require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge,” according to the Centers for Medicare and Medicaid Services. Such patients are not counted in ER visit statistics. Chicarelli noted the statistics can be affected by hospital capacity (some transfer patients are rerouted to other facilities if the hospital is full, leading to fewer visits) and year-to-year variation (a particularly bad flu season, for example, would lead to more visits). He said he did not think it was likely that emergency room visits at the hospital would continue to decrease so steeply. The department this year has had a 5 percent increase in volume compared with the same time last year.
Lovelace declined a request for an interview for this story.
When New Mexico began its Medicaid expansion in 2014, uncompensated care – the costs incurred when patients or insurers don’t pay for services, or when a hospital forgoes or reduces the cost of care – dropped for all of Albuquerque’s major health systems. Such costs are a significant contributor to hospital operating expenses.
A 2015 Legislative Finance Committee report asserted that because more New Mexicans were covered under some kind of health insurance, “all indications are that uncompensated care costs will continue to decline.”
With ER visits down or up only slightly, one might expect that claim to be proved true, as unpaid emergency care is a contributor to uncompensated care costs. But in recent years, that hasn’t been the case.
From 2016 to 2017, uncompensated care costs increased 3.2 percent at Lovelace and 15 percent at UNMH, though the sums were lower than what they had been prior to the Affordable Care Act. The most recent uncompensated care data for Presbyterian was unavailable, but from 2015 to 2016, uncompensated care costs jumped 67 percent to a level more than double what they had been in 2014.
UNMH’s Chicarelli said in an email that he believes the year-over-year increase is partly the result of fewer people able to afford out-of-pocket costs associated with high-deductible insurance plans. He said he expects uncompensated care to continue to rise with the end of the Affordable Care Act’s individual mandate, which required people to pay for health insurance or incur a fine.
Presbyterian and Lovelace directed questions about uncompensated care to Jeff Dye, president and CEO of the New Mexico Hospital Association, who echoed Chicarelli’s comments on out-of-pocket costs.
“Interestingly, the information I’ve seen shows that (New Mexico’s) health plan premiums are not too bad compared to other states,” Dye said. “The problem is that our average family income and ability to pay premiums and deductibles is lower.”
Another factor cited by both Chicarelli and Dye: a decline in Medicaid enrollment. In February, there were 855,032 adults and children enrolled in Medicaid in the state, a 5.4 percent decrease from a year earlier, according to data from the New Mexico Human Services Department. The department has attributed that decrease largely to improvement in the state’s economy, while advocates for low-income New Mexicans have accused the state of a faulty application process.
A spokeswoman for the Human Services Department disputed the characterization of the Medicaid application process, saying in an email that the department approves “a vast majority of applications timely and well above federal standards.” She also said it is unlikely the rise in uncompensated care is related to a drop in Medicaid enrollment, because the department has instituted programs that allow hospitals to assist eligible patients in enrolling in Medicaid, and hospitals are given incentives to do so.
Dye said he was not sure why Medicaid enrollment has decreased, though he was more certain about its impact: “Less enrollment means less coverage,” and when uninsured individuals can’t pay for medical services, the costs are transferred to health systems in the form of uncompensated care, he said.