In the study, Excellus said 10 common medical conditions are responsible for more than 2 million annual visits to hospital emergency rooms in the state of New York. The study claimed about 90 percent of those visits could be better treated at other care locations, such as primary care offices, which would free up resources for hospital ERs to tend to more serious cases.
The ACEP released a statement April 11 in response to the study, in which it called Excellus’ report “seriously flawed and misleading,” and accused the study of being “self-serving” and potentially dangerous to patients.
Below are four things to know about the ACEP’s response.
1. The ACEP fears insurance companies will use the report to justify denying legitimate medical claims when their members visit hospital emergency departments for services. This means in certain cases payers could hold patients wholly responsible for ER costs if the payer determined a patient’s diagnosis didn’t qualify a trip to the ER.
2. The ACEP said this direct violation of provisions in the Affordable Care Act, which protect patients from being denied coverage if their diagnosis does not match their initial symptoms.
3. Jay Kaplan, MD, president of the ACEP, said this is serious because it “may discourage some people from visiting the emergency department who really should be there. The consequences of that could be tragic.”
4. For instance, Excellus claims in its study that abdominal pain caused 271,570 unnecessary visits to New York EDs in 2013. In some cases, abdominal pain indicates something simple like indigestion. But, Dr. Kaplan says, it could also indicate a life-threatening condition such as a heart attack, an abdominal aortic aneurysm or an eptopic pregnancy.
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