villa6 Posted September 20, 2012 Share Posted September 20, 2012 I want to get your opinion. Since expanded healthcare coverage should allow many of the individuals who are presently using the ER as their primary care outlet to shift to primary care providers, there should be a reduction in ER patient numbers. Do you feel this will lead to reduced staffing in ER departments and less PA job openings in the ER? Link to comment Share on other sites More sharing options...
Gaijyn Posted September 20, 2012 Share Posted September 20, 2012 At a guess I would say that it is entirely possible that there would be less PA spots available. However, it is just as likely (perhaps more so in some locations) that there would be more PA spots/openings as the cost effectiveness of the profession is shown to be higher. This of course depends largely on the hospital and how the ED is set up to operate but you in my experience the cost per MD/DO is roughly the equivalent of 2-3 PAs. So I suppose it could be a toss up. It seems a couple of the hospitals I know of now are going towards having a PA in triage to start orders and labs and early evals to streamline the process and because they do not generate RVUs (or whatever the bonus per time per patient unit is) they pay them straight hourly pay. Not to get overmuch into the politics but it seems that one of the rallying cries of the Republican party is that they will repeal/revoke/not fund the ACA (otherwise known to some as Obamacare) and will place their own legislation that will keep some of the benefits...whatever that will really mean... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 20, 2012 Moderator Share Posted September 20, 2012 MOST of the newly insured will get medicaid. many pcp's don't take this therefore those folks will go where they have a guarantee that their coverage will be accepted, the ER Link to comment Share on other sites More sharing options...
physasst Posted September 20, 2012 Share Posted September 20, 2012 No....In fact, there will likely be a surge in ED visits, and an increase in the need for ED providers. All the current modeling predicts this. Link to comment Share on other sites More sharing options...
Doc Savage Posted September 20, 2012 Share Posted September 20, 2012 I have already seen a trend where most providers I have encountered will not take any new medicaid patients under the system. They take the minimum required. There will be more PA positions in ER. ER docs already complain that they are seeing too many lower acuity PCP problems. Just saying... Link to comment Share on other sites More sharing options...
MedicinePower Posted September 20, 2012 Share Posted September 20, 2012 Medicaid patients are always welcome at walk-in clinics, urgent care centers, etc that are operated by hospital systems. I suspect that there will be more hiring of PAs due to the increased number of paying patients. Link to comment Share on other sites More sharing options...
villa6 Posted September 21, 2012 Author Share Posted September 21, 2012 Thanks EMEDPA for pointing out the Medicaid angle on that. I had never thought about how exactly they would be covered. This is why I ask questions. Link to comment Share on other sites More sharing options...
villa6 Posted September 21, 2012 Author Share Posted September 21, 2012 All the current modeling predicts this. I believe your statement physasst, but where could I look to find out more about trends predicted by these models? Link to comment Share on other sites More sharing options...
physasst Posted September 21, 2012 Share Posted September 21, 2012 I believe your statement physasst, but where could I look to find out more about trends predicted by these models? Well, there's a couple of schools of thought. One is that ED visit trends will curb slightly, another view would be that they will go up....The truth is both. The best paper on this is Sarah Miller's out of Illinois. She examined what happened in Mass. after reform, and found (on whole) a 2.4-3.6 visit per 100 patient reduction in ER visits after reform. http://www.economics.illinois.edu/seminars/labor/documents/Miller%20ER%20Paper.pdf John Goodman wrote about this a while back in Health Affairs, but Goodman is being overly critical, and I don't think visits will reach what he says, as he is also using somewhat faulty assumptions. (Partly cause he works for a Conservative think tank that is solely focused on free market solutions to everything). http://healthaffairs.org/blog/2010/07/12/what-will-happen-to-emergency-room-traffic/ The real truth is that ED visits will continue to increase, although the increase will likely be slowed slightly by reform. The reason being that ED visit trends suggest an annual increase of between 9 and 14% since 1996. I think what we will see, is a slight reduction with ED trends being 6-10% per year. That's still not sustainable without adding workforce. When you factor in decreasing reimbursements and a possible decreasing number of residents (very possible, but separate issue), the future for PAs in ED looks bright. (Right now, the budget sequestration will not only reduce Medicare spending, but will decrease GME spending. Right now it would decrease indirect GME reimbursement from 5.5% to 2.2%, and would also cut direct expenses, but no one knows how much right now).... Link to comment Share on other sites More sharing options...
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