In Massachusetts, visits to the emergency department increased from 2005 to 2014. In the same time period, the availability of on-call specialists in the ED declined. In Illinois, despite flat population growth, the amount of average monthly ED visits since the implementation of ACA increased by 5.7 percent.
These findings were reported in two state-specific studies published in the Annals of Emergency Medicine.
For the Massachusetts study, researchers surveyed more than 60 ED directors about department characteristics regarding the previous year in 2006, 2009 and 2015. Survey analysis revealed ED consultations with general surgeons declined from 98 percent to 83 percent throughout the course of the survey period. Also, the availability of round-the-clock psychiatry care declined from 56 percent to 33 percent. The availability of orthopedic surgeons, pediatricians and plastic surgeons also saw declines.
"That is far from ideal and is indicative of an increasingly taxed emergency medical care system," said the study's lead author Jason L. Sanders, MD, of the department of emergency medicine at Massachusetts General Hospital in Boston.
For the Illinois study, researchers examined statewide hospital administrative data from 2011 through 2015 on 201 nonfederal Illinois hospitals. Analysis revealed an increase from 32,025 annual ED visits to 42,000 during the study period, marking a 5.7 percent ED visit increase post-ACA implementation.
The authors of the Illinois study concluded that the changes in ED use across the state are too significant to be attributed to population changes alone and noted ED trends shifted considerably after the ACA came into play.
"Emergency departments continue to be squeezed by pressures inside and outside the hospital," said lead author Scott Dresden, MD, of Northwestern University Feinberg School of Medicine in Chicago. "We still don't know if these results represent longer-term changes in health services use or a temporary spike in ED use due to pent-up demand."
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