A Review of Nonemergent Emergency Room Visits within the Kentucky Medicaid Population

Date of Conferral

2021

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Lloyd Ford

Abstract

AbstractEach year Kentucky spends billions of dollars covering the cost associated with nonemergent emergency room (ER) visits paid for Medicaid recipients. Over 460,000 people gained Medicaid health coverage because Kentucky chose to expand coverage under the Affordable Care Act (ACA). The purpose of this quantitative research study was to convey awareness to managed care organizations’ administrators and lobbyists regarding the unnecessary use of the ER among Medicaid beneficiaries after the ACA commenced. The research questions focused on understanding the cost of wasteful spending and if nonemergent ER visits occurred because of inadequate access to care. The Andersen model of health care utilization served as the theoretical framework for this research. Seven districts where 11 selected nonemergent conditions presented to the ER between 2014 – 2019 were analyzed. A cost analysis was performed on the nonemergent ER visits providing the potential savings if the visits occurred in a suitable care setting. Results indicated that in 2019, the potential savings for the top seven districts totaled $114,705,394.32. A goal of the research was to determine if access to care remained the reason for the continued nonemergent visits. A primary care provider (PCP) to population ratio provided data about each county’s availability to provide adequate access to healthcare providers. The PCP to population ratio indicated Kentucky counties have inadequate access to care in most counties, which can be a reason for the continued use of the ER for nonemergent needs. The potential savings could go towards developing population health programs that could benefit the lives of those in local communities resulting in positive social change.

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