News & Events

ER visits, costs in Mass. climb (MS)

More people are seeking care in hospital emergency rooms, and the cost of caring for ER patients has soared 17 percent over two years, despite efforts to direct patients with nonurgent problems to primary care doctors instead, according to new state data.

Visits to Massachusetts emergency rooms grew 7 percent between 2005 and 2007, to 2,469,295 visits. The estimated cost of treating those patients – including salaries for caregivers, tests such as X-rays and CT scans, and medicines – jumped from $826 million to $973 million, according data provided to the Globe.

The large portion of visits in which the patient didn’t require immediate treatment, or could have been treated in a doctors’ office, remained essentially unchanged over those years at 47 percent.

Massachusetts officials yesterday cautioned against drawing conclusions about whether the state’s new insurance mandate has failed to ease overuse of the emergency room, saying more years of data are needed to measure the law’s impact. But the numbers may provide an early view of how difficult it will be to meet the high expectations for the law.

The 2006 mandate requires nearly everyone to have health insurance, coverage the law’s framers hoped would encourage the insured to visit primary care doctors for minor illnesses.

Several physicians and policy makers said the state information, along with other new data from Harvard researchers, suggests that emergency room crowding and rising costs will not be solved by providing people with health insurance alone, despite optimistic talk by politicians who advocated for the law.

What is needed, they said, are more primary care doctors and nurses, and a new payment system that encourages intense monitoring of patients with diabetes, asthma, and other chronic illnesses.

"Just because you have insurance doesn’t mean there’s a [primary care] physician who can see you," said Dr. Sandra Schneider, vice president of the American College of Emergency Physicians, which, like other national groups, is closely watching the Massachusetts experiment. "I am not surprised at all that visits went up."

During the college’s annual conference in Washington, D.C., this week, Dr. Peter Smulowitz, an emergency room physician at Beth Israel Deaconess Medical Center, presented preliminary, but more recent, data showing that ER visits at six Boston-area hospitals grew between 2006 and 2008, despite a steep drop in the number of uninsured residents. As a result, Smulowitz said, he is convinced that the uninsured are not causing emergency room crowding and overuse and that the solutions are far more complicated than simply providing health insurance coverage.

"We have to pay primary care doctors what they’re worth and increase the network for primary care from doctors and other providers," he said. "It’s going to take a lot of money up front to change this. But do we have any other choice?"