As part of its reform, Massachusetts assigned to the Division of Health Care Finance and Policy the responsibility to analyze and report on key issues related to the intended and unintended effects of the reform. The Division has published a number of useful and informative reports, including three recent ones on avoidable emergency room use, avoidable hospitalizations and use of primary care. (Mass. Reports) (All available from links on this home page.)
The emergency room report suggests that nearly one-half of ER visits in 2008 were avoidable/preventable, at a potential savings of $514 million. Most could have been avoided because the conditions for which help was sought weren’t really emergencies. A few patients, 4%, account for 20% of visits, and these people, many of whom are covered by Medicaid, are primarily responsible for the continuing growth in ER use. The uninsured are not really significant contributors. The clear message of the report is that there are patients who routinely use the ER when they don’t need to and the just as obvious solution is to force these patients to pay substantial copays to deter this utilization.
The hospitalization report found about 13% of adult hospitalizations to be preventable, with a potential savings of $639 million. Congestive heart failure, bacterial pneumonia, COPD and asthma were some of the major conditions leading to preventable hospitalizations. Medicare has the highest rate of preventable hospital stays. In most cases, hospitalization is deemed preventable if the patient had been receiving better outpatient care. Unlike ER visits, the rate of preventable hospitalization is actually declining.
The third report is on primary care and finds that while Massachusetts has a high physician to population ratio, it has a shortage of primary care physicians. Fewer primary care doctors are accepting new patients, especially those covered by Medicaid, which may partly account for the ER statistics. All these reports may give us a glimpse into possible effects of the national reform, which is similar to Massachusetts’, although the state is not similar to many other states demographically or in the nature of its health system.