Pondering the Affordable Care Act: Care in the ER will change!

While the law has always said that anyone can go into an ER and be seen/screened, the payment for doing so will likely change. Now that the ACA pays for primary care, coverage for care that is able to managed in a clinic or MD/mid-level provider office will likely not be reimbursed. Many administrators are very happy because patients newly insured with ACA are now flocking to ERs. The challenge is that many facilities are not prepared for the volume increase. And in turn, public hospitals are seeing fewer patients in the ER. Their volume is dropping, which spells trouble for public health agencies. Ultimately, reduction of cost will result in proper arenas for care. Therefore, expect that in the future, care in an ER that can be performed elsewhere will result in lack of reimbursement for the patient, and possibly the hospitals. While anyone can be screened in the ER, more patients will be referred to lower level of care prior to treatment, but after the triage assessment. This will change the staffing model for both ERs and outpatient clinics.

Posted by Susan Odegaard Turner- MentorRN