Adequate Primary Care through eConsult Platforms Reduces Uncompensated Hospital Services
Medicaid expansion effects a reduction of both avoidable and unnecessary emergency setting care while adequate primary care can prevent much of the uncompensated care that needs to be provided by the hospitals.
FREMONT, CA: Uncompensated care is dragging hospitals into debt when they incur costs while providing services to a diverse set of patients. Often hospitals end up providing services to the patients for whom payments are not received as they are unable or unwilling to pay the bills, and neither have they applied for financial assistance. Thus it adds up to the sum of the hospital’s bad debt on top of the financial aid provided to the patients, which is also referred to as charity care. Financial assistance involves services for which hospitals do not expect to be reimbursed and the services provided at a reduced cost for the needy.
Since the 2014 Medicaid expansion and the passage of the Affordable Care Act, 37 states have adopted Medicaid expansion programs. Rural areas have a larger share of low-income populations that are taking advantage of Medicaid expansion. As a result, among these 37 expansion states, especially vulnerable people, have benefitted from increased coverage and have got magnified access to affordable care. Further, the uninsured rate reduced to a record low across the states after expansion, though the highest reductions were observed in the expanded states. In some rural areas, in states that have expanded Medicaid, there was an offset of more than 20 percent in uninsured populations.
Medicaid expansion effects a reduction of both avoidable and unnecessary emergency setting care. Unnecessary refers to the emergency department visits that should have been dealt as lower-acuity cases. Avoidable visits qualify as the cases that involve worsening of chronic conditions which could have been avoided at first hand in the lower-acuity setting.
Adequate primary care can prevent much of the uncompensated care that has to be provided by the hospitals. As per a report by Premier, in 2017, six common chronic conditions comprised 60 percent of 24 million emergency department (ED) visits. Out of that, almost one-third of the visits could have been avoided and dealt in a less costly outpatient setting. A retrospective study of a primary care intervention established a significant correlation between ED visits and primary care intervention. It reinforced that ED visit rates of new high-users after primary care intervention were relatively lower.
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