Payment review of emergency department eye care in Florida
A substantial proportion of emergency department eye care in Florida is reimbursed through Medicaid or paid for out of pocket by patients, and those findings may help in strategic planning as the debate over how best to implement the nation's new health care reform law progresses, according to a study published in the Archives of Ophthalmology, one of the JAMA/Archives journals.
The Patient Protection and Affordable Care Act (PPACA) will increase insurance coverage in large part by expanding eligibility for Medicaid, "an already stressed and underfunded system in many states," the authors explain in study background.
"Planning for such change in ophthalmology requires knowledge of what role Medicaid currently plays in the delivery of eye care," the authors suggest.
Matthew T. Witmer, M.D., the University of South Florida, Tampa, Fla., (now at New York- Presbyterian/Weill Cornell Medical Center) and colleagues analyzed Florida Agency for Health Care Administration emergency department data sets for outpatient visits and admissions for eye care from 2005 through 2009. A total of 587,227 emergency department visits were identified with a primary diagnosis in need of eye care and, of those visits, 12,105 resulted in hospital admission. Researchers reviewed the types of insurance coverage reported and separated patients according to age as older or younger than 18 years.
During the five year study period, commercial insurance was the most frequent payer of emergency department outpatient services (31.1.percent), followed by self-pay (26.2 percent) and Medicaid (22 percent).
The results indicate that for patients under 18, Medicaid and self-payment accounted for 67.7 percent of principal payers. For outpatient emergency department visits, the percentage of change in Medicaid increased 5.9 percent for each calendar year and commercial coverage declined 4.5 percent.
The authors suggest that while their study cannot be "indiscriminately generalized" to other states, they believe the data are applicable to other states.
"Emergency department eye care will assume a larger safety-net function if more patients move into categories of Medicaid or self-pay. Already stressed EDs (emergency departments) and hospital staff need to be prepared to navigate change brought on by health care reform and the delayed economic recovery without compromising quality of care. Data within this study although sobering should be used for strategic planning as the debate on how to best implement PPACA moves forward," the authors conclude.
In an accompanying editorial, Paul Lee, M.D., J.D., and Jacqueline Dzau, M.D., M.P.H, of the Duke Eye Center, Duke University Medical Center, Durham, N.C., write, "The long-term growth in Medicaid, Medicare, and other public payor sources will only accelerate over the next 10 years, creating additional pressures and constraints on how we deliver eye care."
"To the extent that ED (emergency department) payments are linked to an increasing proportion of Medicaid patients, traditionally among the lowest paying of all payors for adult care, the economic incentive for ophthalmologists not employed by hospitals to provide coverage will decrease, further exacerbating challenges in obtaining call coverage of eye conditions," they write.
"If 'necessity is the mother of invention,' the findings described in the study by Witmer et al may be a harbinger of fundamental changes in the financing of ED provision of eye care and in the resulting care delivery models in Florida as well as the United States," Lee and Dzau conclude.
More information: Arch Ophthalmol. 2012;130:25-32.
Arch Ophthalmol. 2012;130:106-107.
Journal reference: JAMA Ophthalmology
Provided by JAMA and Archives Journals
- Pediatric emergency department visits for psychiatric care on the rise Oct 14, 2011 | not rated yet | 0
- Visits to emergency departments increases in recent years Aug 10, 2010 | not rated yet | 0
- Study examines impact of Massachusetts health law on emergency department visits Jun 06, 2011 | not rated yet | 0
- Massachusetts health-care reform associated with increased demand for medical safety-net facilities Aug 09, 2011 | not rated yet | 0
- Rising barriers to primary care send many Americans to the emergency department Aug 09, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(AP)—A woman who lost both hands, her left leg and right foot after contracting a flesh-eating disease has been fitted with prosthetic hands.
Other May 18, 2013 | not rated yet | 0
(AP)—Medical marijuana use in Illinois is now in Gov. Pat Quinn's hands after the state Senate approved legislation.
Other May 17, 2013 | 5 / 5 (1) | 0
A Nigerian court on Friday sentenced two officials from a pharmaceutical company to seven years in prison over the sale of an adulterated teething drug which killed 84 babies in 2008.
Other May 17, 2013 | not rated yet | 0
(HealthDay)—Many Americans feel that keeping out-of-pocket health care costs is more important than staying with the same primary care physician.
Other May 17, 2013 | not rated yet | 0
(AP)—China is phasing out its reliance on executed prisoners for donated organs, but an architect of the country's transplant system said Friday that ingrained cultural attitudes are impeding the rise of ...
Other May 17, 2013 | not rated yet | 0
The devastating effect of Alzheimer's disease on bilingual people has been thrown into focus in Canada, where the sudden loss of a second language can leave sufferers feeling like strangers in their own country.
55 minutes ago | not rated yet | 0
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
2 hours ago | not rated yet | 0
Regular consumption of coffee is associated with a reduced risk of primary sclerosing cholangitis (PSC), an autoimmune liver disease, Mayo Clinic research shows. The findings were being presented at the Digestive Disease ...
10 hours ago | not rated yet | 0 |
Patients with treatment-resistant major depression saw dramatic improvement in their illness after treatment with ketamine, an anesthetic, according to the largest ketamine clinical trial to-date led by researchers from the ...
10 hours ago | 4.7 / 5 (3) | 0 |
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
10 hours ago | not rated yet | 1
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
9 hours ago | not rated yet | 0