Las Vegas Faced a Massacre. Did It Have Enough Trauma Centers?
Medi-Cal Patients Flocking to ERs More Than Before ACA
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Did It Have Enough Trauma Centers?","publishDate":1507161814,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Las Vegas is not only a glittering strip of casinos and hotels but a fast-growing region with more than 2 million residents — and one hospital designated as a highest-level trauma center.\u003c/p>\n\u003cp>The deadly shooting Sunday that killed at least 59 and sent more than 500 people to area hospitals raised questions about whether that’s enough.\u003c/p>\n\u003cp>Las Vegas is not the only big city with just one such trauma center. Seattle and Nashville, among others, also are in \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenter\" target=\"_blank\" rel=\"noopener\">this category\u003c/a>, according to the American Trauma Society, a professional and advocacy organization focused on improving trauma care.\u003c/p>\n\u003cp>Casey Nolan, a hospital consultant and managing director of Navigant Consulting in Washington, D.C., said what matters most is not the number of high-level centers, but the degrees of coordination across the area’s medical network, including the first responders.\u003c/p>\n\u003cp>“It’s how well integrated the care is and whether there is a triage system to get patients to the right place in the right time,” he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What Makes Up The Network\u003c/strong>\u003c/p>\n\u003cp>The highest-level trauma centers are equipped and staffed around-the-clock to provide care for patients who suffer from traumatic injuries such as gunshot wounds, falls and car accidents.\u003c/p>\n\u003cp>The designation “trauma center” is the result of a validation process at the state or local level. Centers are categorized by Level I, II or III, for instance, in keeping with nationally accepted standards. Centers can also seek additional approval from the American College of Surgeons.\u003c/p>\n\u003cp>Across the country, there are \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenters.\" target=\"_blank\" rel=\"noopener\">217 Level I trauma centers\u003c/a>, up from 198 in 2012, according to the trauma society. These centers must see at least 1,200 trauma patients a year and have general surgeons and other specialists immediately available at the facility.\u003c/p>\n\u003cp>There are another 310 Level II centers that face similar staffing rules, but with fewer education and training requirements. Level III centers have emergency medical staff, but will stabilize severely injured patients and often transport them to higher-level trauma centers.\u003c/p>\n\u003cp>For decades, the hospital industry viewed trauma care as a money-losing proposition because of the high costs of keeping doctors and nurses on standby 24 hours a day. Trauma centers, particularly those in inner cities, tended to attract more patients without health insurance.\u003c/p>\n\u003cp>But in recent years, hospitals have been competing to get the designation as a way to increase profits, in part because trauma centers enhance demand for surgery and ancillary services like CT scans. In addition, a trauma designation can boost a facility’s overall reputation, Nolan added.\u003c/p>\n\u003cp>“Trauma had gotten a bad rap,” explained Nolan. “But in suburban locations, where more people have insurance, you can do pretty well on trauma.”\u003c/p>\n\u003cp>Some hospitals also began charging a fee — known as a “trauma activation” fee — to help pay for the extra staffing and equipment trauma units require.\u003c/p>\n\u003cp>Those fees could range from a few hundred dollars to several thousand dollars on patients’ bills, Nolan said.\u003c/p>\n\u003cp>\u003cstrong>Trauma Care In Las Vegas\u003c/strong>\u003c/p>\n\u003cp>Despite the burgeoning population of Las Vegas and surrounding Clark County, which more than doubled to 2.2 million in the past 25 years, University Medical Center has been Las Vegas’ only Level I trauma center since 1992.\u003c/p>\n\u003cp>The metro area includes two other lower-level trauma centers. Sunrise Hospital & Medical Center in Las Vegas is a Level II facility and St. Rose Dominican Hospital in nearby Henderson, Nev., is a Level III.\u003c/p>\n\u003cp>Even the idea of expanding Las Vegas’ trauma network has stirred controversy.\u003c/p>\n\u003cp>Last year, a state agency rejected applications by three hospitals in the Las Vegas area to be designated as Level III trauma centers.\u003c/p>\n\u003cp>HCA, the national, for-profit chain that owned two of these facilities, said adding trauma centers would help ensure quicker care to patients in the growing region. The company has made adding trauma centers a strategy across the country and has met resistance from existing centers.\u003c/p>\n\u003cp>But opponents argued HCA was motivated by the opportunity to boost profits. The \u003ca href=\"http://www.tampabay.com/news/health/how-hca-turned-trauma-into-a-money-maker/2169280\" target=\"_blank\" rel=\"noopener\">Tampa Bay Times\u003c/a> reported last year that the hospital chain charged significantly higher “activation fees” than other hospitals.\u003c/p>\n\u003cp>Opponents also countered that adding trauma centers would affect University Medical Center’s ability to provide quality care and train doctors. Some experts say it could diminish the number of patients seen at each center.\u003c/p>\n\u003cp>That’s because the more trauma patients a center deals with annually, the better the results, studies show.\u003c/p>\n\u003cp>“If you can bring all the patients to one place, then those surgeons become really good at dealing with trauma, instead of spreading it out [around a number of facilities],” said Bill Bullard, senior vice president with the Abaris Group, a California-based consulting firm that advises hospitals on emergency care.\u003c/p>\n\u003cp>Ian Weston, executive director of the American Trauma Society, said the trauma system worked well in Las Vegas, which is a credit to ambulances and other first responders and their ability to triage patients to hospitals across the city.\u003c/p>\n\u003cp>Seriously ill patients have the best outcomes when treated at a Level I trauma center, said David Callaway, a professor of emergency medicine at the Carolinas Medical Center in Charlotte, N.C. But “when you have 500-plus casualties and 58 dead … if all the patients went to a Level I, mortality would not be improved, because they would be completely overwhelmed,” Callaway added.\u003c/p>\n\u003cp>Bullard agreed.\u003c/p>\n\u003cp>“In theory, the more centers you have the more people you have to deal with injuries. However, no trauma system is able to handle a tragedy of this magnitude.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Hospitals view adding trauma care as a potential profit tool, but experts say more centers don't necessarily improve the system’s ability to respond to a mass casualty event.","status":"publish","parent":0,"modified":1507161814,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":978},"headData":{"title":"Las Vegas Faced a Massacre. Did It Have Enough Trauma Centers? | KQED","description":"Hospitals view adding trauma care as a potential profit tool, but experts say more centers don't necessarily improve the system’s ability to respond to a mass casualty event.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Las Vegas Faced a Massacre. Did It Have Enough Trauma Centers?","datePublished":"2017-10-05T00:03:34.000Z","dateModified":"2017-10-05T00:03:34.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"361338 https://ww2.kqed.org/stateofhealth/?p=361338","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/04/las-vegas-faced-a-massacre-did-it-have-enough-trauma-centers/","disqusTitle":"Las Vegas Faced a Massacre. Did It Have Enough Trauma Centers?","nprByline":"\u003ca href=\"https://khn.org/news/author/julie-appleby/\">Julie Appleby\u003c/a> and \u003ca href=\"https://khn.org/news/author/phil-galewitz/\">Phil Galewitz\u003c/a>","path":"/stateofhealth/361338/las-vegas-faced-a-massacre-did-it-have-enough-trauma-centers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Las Vegas is not only a glittering strip of casinos and hotels but a fast-growing region with more than 2 million residents — and one hospital designated as a highest-level trauma center.\u003c/p>\n\u003cp>The deadly shooting Sunday that killed at least 59 and sent more than 500 people to area hospitals raised questions about whether that’s enough.\u003c/p>\n\u003cp>Las Vegas is not the only big city with just one such trauma center. Seattle and Nashville, among others, also are in \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenter\" target=\"_blank\" rel=\"noopener\">this category\u003c/a>, according to the American Trauma Society, a professional and advocacy organization focused on improving trauma care.\u003c/p>\n\u003cp>Casey Nolan, a hospital consultant and managing director of Navigant Consulting in Washington, D.C., said what matters most is not the number of high-level centers, but the degrees of coordination across the area’s medical network, including the first responders.\u003c/p>\n\u003cp>“It’s how well integrated the care is and whether there is a triage system to get patients to the right place in the right time,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Makes Up The Network\u003c/strong>\u003c/p>\n\u003cp>The highest-level trauma centers are equipped and staffed around-the-clock to provide care for patients who suffer from traumatic injuries such as gunshot wounds, falls and car accidents.\u003c/p>\n\u003cp>The designation “trauma center” is the result of a validation process at the state or local level. Centers are categorized by Level I, II or III, for instance, in keeping with nationally accepted standards. Centers can also seek additional approval from the American College of Surgeons.\u003c/p>\n\u003cp>Across the country, there are \u003ca href=\"http://www.amtrauma.org/?page=FindTraumaCenters.\" target=\"_blank\" rel=\"noopener\">217 Level I trauma centers\u003c/a>, up from 198 in 2012, according to the trauma society. These centers must see at least 1,200 trauma patients a year and have general surgeons and other specialists immediately available at the facility.\u003c/p>\n\u003cp>There are another 310 Level II centers that face similar staffing rules, but with fewer education and training requirements. Level III centers have emergency medical staff, but will stabilize severely injured patients and often transport them to higher-level trauma centers.\u003c/p>\n\u003cp>For decades, the hospital industry viewed trauma care as a money-losing proposition because of the high costs of keeping doctors and nurses on standby 24 hours a day. Trauma centers, particularly those in inner cities, tended to attract more patients without health insurance.\u003c/p>\n\u003cp>But in recent years, hospitals have been competing to get the designation as a way to increase profits, in part because trauma centers enhance demand for surgery and ancillary services like CT scans. In addition, a trauma designation can boost a facility’s overall reputation, Nolan added.\u003c/p>\n\u003cp>“Trauma had gotten a bad rap,” explained Nolan. “But in suburban locations, where more people have insurance, you can do pretty well on trauma.”\u003c/p>\n\u003cp>Some hospitals also began charging a fee — known as a “trauma activation” fee — to help pay for the extra staffing and equipment trauma units require.\u003c/p>\n\u003cp>Those fees could range from a few hundred dollars to several thousand dollars on patients’ bills, Nolan said.\u003c/p>\n\u003cp>\u003cstrong>Trauma Care In Las Vegas\u003c/strong>\u003c/p>\n\u003cp>Despite the burgeoning population of Las Vegas and surrounding Clark County, which more than doubled to 2.2 million in the past 25 years, University Medical Center has been Las Vegas’ only Level I trauma center since 1992.\u003c/p>\n\u003cp>The metro area includes two other lower-level trauma centers. Sunrise Hospital & Medical Center in Las Vegas is a Level II facility and St. Rose Dominican Hospital in nearby Henderson, Nev., is a Level III.\u003c/p>\n\u003cp>Even the idea of expanding Las Vegas’ trauma network has stirred controversy.\u003c/p>\n\u003cp>Last year, a state agency rejected applications by three hospitals in the Las Vegas area to be designated as Level III trauma centers.\u003c/p>\n\u003cp>HCA, the national, for-profit chain that owned two of these facilities, said adding trauma centers would help ensure quicker care to patients in the growing region. The company has made adding trauma centers a strategy across the country and has met resistance from existing centers.\u003c/p>\n\u003cp>But opponents argued HCA was motivated by the opportunity to boost profits. The \u003ca href=\"http://www.tampabay.com/news/health/how-hca-turned-trauma-into-a-money-maker/2169280\" target=\"_blank\" rel=\"noopener\">Tampa Bay Times\u003c/a> reported last year that the hospital chain charged significantly higher “activation fees” than other hospitals.\u003c/p>\n\u003cp>Opponents also countered that adding trauma centers would affect University Medical Center’s ability to provide quality care and train doctors. Some experts say it could diminish the number of patients seen at each center.\u003c/p>\n\u003cp>That’s because the more trauma patients a center deals with annually, the better the results, studies show.\u003c/p>\n\u003cp>“If you can bring all the patients to one place, then those surgeons become really good at dealing with trauma, instead of spreading it out [around a number of facilities],” said Bill Bullard, senior vice president with the Abaris Group, a California-based consulting firm that advises hospitals on emergency care.\u003c/p>\n\u003cp>Ian Weston, executive director of the American Trauma Society, said the trauma system worked well in Las Vegas, which is a credit to ambulances and other first responders and their ability to triage patients to hospitals across the city.\u003c/p>\n\u003cp>Seriously ill patients have the best outcomes when treated at a Level I trauma center, said David Callaway, a professor of emergency medicine at the Carolinas Medical Center in Charlotte, N.C. But “when you have 500-plus casualties and 58 dead … if all the patients went to a Level I, mortality would not be improved, because they would be completely overwhelmed,” Callaway added.\u003c/p>\n\u003cp>Bullard agreed.\u003c/p>\n\u003cp>“In theory, the more centers you have the more people you have to deal with injuries. However, no trauma system is able to handle a tragedy of this magnitude.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361338/las-vegas-faced-a-massacre-did-it-have-enough-trauma-centers","authors":["byline_stateofhealth_361338"],"categories":["stateofhealth_11","stateofhealth_2746"],"tags":["stateofhealth_3116","stateofhealth_2808","stateofhealth_392","stateofhealth_3174","stateofhealth_2519","stateofhealth_3173"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_361344","label":"stateofhealth_3007"},"stateofhealth_342500":{"type":"posts","id":"stateofhealth_342500","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"342500","score":null,"sort":[1497468710000]},"guestAuthors":[],"slug":"medi-cal-patients-flocking-to-ers-more-than-before-aca","title":"Medi-Cal Patients Flocking to ERs More Than Before ACA","publishDate":1497468710,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n","blocks":[],"excerpt":"Experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.","status":"publish","parent":0,"modified":1497472683,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["//datawrapper.dwcdn.net/5D3d9/1/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":740},"headData":{"title":"Medi-Cal Patients Flocking to ERs More Than Before ACA | KQED","description":"Experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Medi-Cal Patients Flocking to ERs More Than Before ACA","datePublished":"2017-06-14T19:31:50.000Z","dateModified":"2017-06-14T20:38:03.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"342500 https://ww2.kqed.org/stateofhealth/?p=342500","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/14/medi-cal-patients-flocking-to-ers-more-than-before-aca/","disqusTitle":"Medi-Cal Patients Flocking to ERs More Than Before ACA","nprByline":" Kellen Browning","path":"/stateofhealth/342500/medi-cal-patients-flocking-to-ers-more-than-before-aca","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/342500/medi-cal-patients-flocking-to-ers-more-than-before-aca","authors":["byline_stateofhealth_342500"],"categories":["stateofhealth_2442","stateofhealth_14","stateofhealth_2746"],"tags":["stateofhealth_294","stateofhealth_3116","stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_365"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_342585","label":"stateofhealth_3036"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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