An Evaluation of Statewide Emergency Department Utilization Following Tennessee Medicaid Disenrollment

Abstract

The proportion and rate of ED visits resulting in hospital admission, again assessed separately by payer type, were compared across the same disenrollment periods in a similar way. We fitted a series of linear models for the total number of ED visits and each proportion and rate, with various degrees of adjustment for seasonality and time trend.Results: The mean number of ED visits was 45,662 per week during the predisenrollment period and 44,463 per week during the postdisenrollment period (mean difference = )1,199; 95% confidence interval [CI] )1,722 to )676). By payer category, there was a decrease of 3,119 visits per week by TennCare beneficiaries and an increase of 2,203 per week by the uninsured. After disenrollment, the absolute proportion of ED visits by TennCare beneficiaries significantly decreased by 6.2% (95% CI = )6.6% to )5.8%), and the absolute proportion of uninsured ED visits increased by 5.3% (95% CI = 4.9% to 5.7%). The rate of ED visits by TennCare beneficiaries decreased by )0.091 ED visits ⁄ person ⁄ year (95% CI = )0.136 to )0.046) in the disenrollment period when controlling for time and seasonality. The rate of ED visits among the uninsured increased by 0.038 ED visits ⁄ person ⁄ year (95% CI = 0.011 to 0.065) in the postdisenrollment period when controlling for cubic time trend. The proportion of all TennCare ED visits that resulted in hospital admission did not change significantly between the two periods after adjusting for time trend and seasonality. The proportion of uninsured ED visits resulting in hospital admission, however, significantly increased after disenrollment by 2.0% (95% CI = 1.8% to 2.2%) and by 0.6% (95% CI = 0.0% to 1.2%) after adjusting for time and seasonality.Conclusions: The TennCare disenrollment of 2005 was associated with a modest decrease in the number of total ED visits in Tennessee. However, the payer mix among the Tennessee ED population shifted abruptly. The increased rate of ED visits by Tennessee's uninsured and the increased proportion of uninsured ED visits leading to hospital admission suggest an increased burden of illness in this highly vulnerable population.

Losing Medicaid: What happens to hospitalizations?

“…This finding is consistent with a scenario in which cost-related barriers to care lead the uninsured to seek care through emergency rooms. This result is comparable in direction to Heavrin et al (2011), who find an increase in uninsured ED visits resulting in inpatient admission after the Medicaid contraction in Tennessee. Likewise, Garthwaite, Gross and Notowidigdo (2015) find that…”

Medicaid Disenrollment and Disparities in Access to Care: Evidence from Tennessee

“…While a few studies have documented the association between losing Medicaid and an increase in emergency room visits in Tennessee (Heavrin et al. ; Emerson et al. ) and other states (Rimsza, Butler, and Johnson ; Lowe et al.…”

Updating the Emergency Department Algorithm: One Patch Is Not Enough

“…The simplest approach is to study overall ED visit rates. Overall ED utilization rates vary with differences in access in different populations and in different geographic regions, and ED utilization rates change with temporal changes in access (Lowe et al 2005(Lowe et al , 2009Lowe, Fu, and Gallia 2010;Heavrin et al 2011;Cheung et al 2012). Policy makers can easily understand that-as long as reduction in ED utilization is not achieved through denying access to ED carereduction in overall ED utilization reflects improved access to primary care.…”