PHP370 - AMBULATORY CARE TRENDS IN THE EMERGENCY DEPARTMENT

Abstract

Ambulatory Care Sensitive Conditions (ACSCs) are illnesses where management should be achieved by regular consultation with a primary care physician. ACSCs are often a metric for access to primary care. The Patient Protection and Affordable Care Act(ACA) of 2010 offered significant regulatory changes expanding access to low income insurance (Medicaid). By evaluating the rate of ACSCs in the Emergency Department(ED) over time, we aimed to evaluate the impact of ACA Medicaid expansion. The US National Emergency Department Sample—a representative 20 percent sample of ED visits-- offering a sample of 25 million in 2006 and 31 million by 2014. ACSCs were adapted from the Agency for Healthcare Quality and Research(AHRQ) prevention quality indicators guidebook. Dental insurance was not impacted by ACA and therefore Dental ACSCs were evaluated as a baseline comparison. The rates of ACSCs remained largely unchanged at 7.68% of observations with a decrease of 0.33% over the study period. Dental specific ACSC rates were consistent as well starting at 1.63% and ending at 1.66%. Age, gender, and income bracket characteristics were consistent throughout the 9 year period. Congestive Heart Failure had the largest decrease of 0.55%. Urinary Tract Infections was the highest at 2.15% and grew the most by 0.32%. Evaluation of primary payer amongst ACSC specific events revealed the rate of privately insured patients decreased by 5.02% and Medicaid recipients increased by 9.63%. The rate of self-pay and Medicare offered slight decreases of 1.49% and 2.65% each. Payer changes indicate a significant shift in healthcare costs. Stable income bracket frequency juxtaposed to primary payer changes may reveal poorer citizens dropping low quality private plans upon Medicaid qualification. Despite payer shifts and payment access, there has not been a reduction in ACSC’s. Study extension is needed for further evaluation as States continue with ACA implementation.