Austin-Area Health Officials Hope to Avoid ER Strain

Jan. 04--Austin-area health officials said Friday they are hopeful that efforts underway will discourage newly insured people from seeking more costly care in the emergency room, a consequence seen in a study of ER use in Oregon.

The much-anticipated study in the journal Science came out this week as more Americans began receiving health care coverage under the Affordable Care Act, also called Obamacare. The law's supporters had hoped to see ER visits drop as more people get access to less-expensive visits with primary care doctors. But the study found that, over an 18-month period, new Medicaid patients in Portland made 40 percent more ER trips for care than uninsured people.

The results differed from a study spanning 2006 to 2009 in Massachusetts, whose reforms became the model for the federal health care law. There, researchers found no evidence that ER use rose in comparison to states that didn't reform their health systems.

Local health care providers don't know yet how many people have signed up for coverage under Obamacare or what the impact will be. But officials with Central Health, which oversees care to needy Travis County residents, said they expect their efforts at transforming the health care delivery system to produce a different result than seen in Portland. They have formed a partnership with the Seton Healthcare Family called the Community Care Collaborative to better coordinate where and when patients receive health care services.

Included in that partnership are a variety of taxpayer-funded projects that seek to keep people healthier and out of the hospital. Those projects include efforts to channel people into "medical homes" with primary care doctors; more intensive help provided to patients with chronic conditions, including calls to patients to remind them to take their medicine; and extended hours at community clinics, where care is cheaper than at an ER.

"The exciting part for me is, we're not just talking about expanding coverage here," said Patricia Young Brown, president and CEO of Central Health, the public hospital district in Travis County. "What we have been really undertaking, with the CCC and the new medical school is all about transforming the system. ... That's the thing that distinguishes us from the Oregon study the most."

That study, with researchers from Harvard, Columbia University and Providence Portland Medical Center, examined what happened in 2008 when Medicaid was expanded to thousands of uninsured, low-income adults.

Texas, however, won't see any immediate influx of new Medicaid patients under Obamacare. It is one of 25 states that have decided not to expand Medicaid, a key part of the federal law that the U.S. Supreme Court made optional. Without that expansion, there won't be as many newly covered patients as there would have been otherwise.

"No one's happy Texas did not expand Medicaid, but it does give us more time to change the delivery system," Young Brown said.

An estimated 1.4 million Texans will remain uninsured and will continue to receive care in ERs and elsewhere, said Dr. James Rohack, director of the Center for Healthcare Policy at Scott & White Healthcare, which has a hospital in Round Rock and clinics across Central Texas. "For those newly insured who are wanting to access care, same-day access appointments are available in most of our Central Texas facilities," he said in an email.

Also, newly insured patients through the Scott & White Health Plan can get help from staff whose role it is to expedite appointments with primary care and specialty care doctors, said Rohack, the plan's medical director for system improvement. Those patients also will have 24-hour access to a nurse advice line and other resources, Rohack said.

St. David's HealthCare also offers a 24-hour nurse line, appointment assistance and help finding a physician, said Denise Bradley, director of corporate communications and public affairs.

"St. David's HealthCare is prepared for growth, whether that growth is due to changes in health care coverage or because of population growth," she said in an email.

Greg Hartman, president of external affairs for Seton, said that newly covered patients have a pent-up demand for the care that could, at least initially, result in more ER visits.

"Basically, people have become conditioned to go to the emergency room for care, so not only does the system need to change, but people need to change," Hartman said.

Seton is involved with the University of Texas in a study that seeks to understand why people bypass clinics and doctors for an ER, he said. Because the Oregon study examined just 18 months, results could change over time as people become accustomed to going elsewhere for care, he added.

"We have a lot to learn from watching the Oregon study and doing our own research," Hartman said. "We're going to have to take steps to make sure this isn't a problem in Central Texas."

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