The ACA effect

The Affordable Care Act (ACA) and its ramifications loomed large in headlines this week, with the Obama administration crowing about the money the reform bill will save. Meanwhile, one radiologist published an editorial pointing out that one of the promised side benefits of the ACA may not actually materialize.

First the good news: the ACA will lead to $5.7 billion in savings in uncompensated hospital care costs in 2014, according to Department of Health and Human Services Secretary Sylvia Burwell. The bulk of these savings will be seen in states that expanded Medicaid to allow more low-income residents to have coverage, thus resulting in hospitals being reimbursed by Medicaid for treating patients who previously couldn’t or wouldn’t pay their medical bills.

While this is certainly good news for the bottom line at a lot of institutions, the ACA was also supposed to trim emergency department (ED) volumes, though this probably won’t be the case, according to Rakesh A. Shah, MD, of Winthrop-University Hospital in Mineola, N.Y., who published an editorial in the Journal of the American College of Radiology.

Shah said the rationale behind the projected decrease in ED volumes was that newly covered patients would turn to standard primary care services rather than rely on the safety net of the ED. He noted that expanded coverage has its benefits, but similar state-level reforms have not cut ED use—in fact, it’s been just the opposite. Massachusetts and Oregon expanded coverage through healthcare reforms in 2006 and 2008, respectively, and in both cases ED volumes increased.

A lack of primary care physicians could be to blame, wrote Shah. There is a projected shortfall of 45,000 primary care physicians by 2020, and the combo of increased coverage and decreasing accessibility to primary care services could push up ED utilization.

In radiology, this has big ramifications for imaging volume. CT imaging in the fast-paced, high-stakes environment of the ED has been closely monitored in recent years, but even if appropriateness guidelines for CT imaging are followed, a rising absolute number of patients could continue to drive ED imaging volumes.

“Radiology departments should be prepared in the years to come for an increased volume of imaging from emergency departments and the manpower and equipment necessary to meet this potential surge,” wrote Shah.

-Evan Godt
Editor – Health Imaging