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  • Emergency Department Usage Remains High Despite ACA

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, December 2022

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    Has the Affordable Care Act (ACA) boosted access to outpatient care and decreased reliance on emergency departments (EDs)? Mir et al. explored this topic and found that, for ophthal­mic care, reliance on EDs for nonur­gent eye conditions is still high.

    For this cross-sectional study, the authors searched the U.S. Nationwide Emergency Department Sample to identify all patients who visited an ED to address an eye-related primary disorder. The database includes clinical, demographic, and socioeconomic char­acteristics, as well as ED and hospital costs. Each ED visit was classified as emergent, nonemergent, or indetermi­nate. The authors analyzed data for the pre-ACA period (2010-2013) and post-ACA period (2014-2017). The main objective was to compare national and regional incidences of ED visits per 100,000 people during the two time frames.

    Altogether, there were 16,808,343 eye-related ED visits from 2010 to 2017. Of these, 8,088,203 occurred prior to the passage of the ACA, and 8,720,766 occurred after that point. Although the incidence of eye-related ED visits declined when the ACA was introduced, from 652.4 per 100,000 in 2013 to 593.0 in 2014, it climbed rapidly thereafter, to 658.5 in 2015 and to 746.6 in 2016. Patients in the lowest income quartile had the highest ED usage (964.0 per 100,000 in 2017). The percentage of uninsured patients decreased from 19% (2010-2013) to 14.3% (2014-2017). Overall, 38.3% of ED visits during the entire study period were for emergency conditions, and 44.8% were for nonemergent issues. The degree of urgency could not be determined for the remaining 16.9%.

    Even though the ACA led to signifi­cantly more people being insured, the Act has not decreased reliance on EDs for ophthalmic care, as evidenced by this study. The authors acknowledged that “additional measures beyond expanding insurance coverage may be necessary to provide high-quality, efficient, and equitable outpatient oph­thalmic care to all Americans.

    The original article can be found here.