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Member Research & Reports

Member Research & Reports

Iowa Study Looks at How to Reduce Hospital Stays, Emergency Department Visits for Those Who Receive both Medicare, Medicaid

Convincing the nation’s most vulnerable citizens to avoid costly emergency department visits is proving harder than expected. A new study from the University of Iowa found improving access to affordable primary care reduced preventable hospital stays for Black and Hispanics who receive both Medicare and Medicaid but failed to reduce the number of trips to the emergency department.

[Photo: Dr. Brad Wright]

In fact, trips to the emergency department went up among all individuals who receive both Medicare and Medicaid, known as “dual eligible,” regardless of race or ethnicity.

The study, which appeared July 7 online in Health Affairs, is the first to evaluate the relationship between receiving care at federally qualified health centers, or FQHCs, and the rate of hospital stays and emergency department visits for potentially preventable conditions among individuals who receive both Medicare and Medicaid, the majority of whom are members of racial or ethnic minority groups.

“We’ve found evidence that increased FQHC use among the dual eligible population might be a very good thing among certain groups of dual eligibles,” said Dr. Brad Wright, an assistant professor in the department of health management and policy at the University of Iowa’s College of Public Health and co-author of the study. “But it should not be a strategy we pursue until we understand more about the increased use of emergency department visits we observed.”

However, a key finding suggests that federally qualified health centers can reduce disparities in preventable hospitalizations for some dual eligibles, Dr. Wright said.

FQHCs are standalone health care facilities that receive federal grants to administer care to underserved populations. According to The Kaiser Family Foundation in 2013, there were 14 FQHCs in Iowa, including Proteus Inc. (Migrant Health Center) in Des Moines and Siouxland Community Health Center in Sioux City.

Dr. Wright is not sure why the number of emergency department visits increased among those studied but speculated it might be the same reason those who are dual eligible use a FQHC.

“It’s always open and therefore more convenient, plus it offers one-stop shopping if they need services such as lab work and imaging tests,” he says. “A potentially preventable hospitalization indicates a serious lack of care earlier in the progression of the condition. A potentially preventable ED visit, on the other hand, just indicates inappropriate use of the ED for something that could be done by a primary care doctor, but it’s still care earlier in the process.

“So, in fact, the ED visits may end up preventing the hospitalizations, which is why the two results may be seen to move in different directions,” Dr. Wright explained.

Researchers analyzed Medicare data from 2008 to 2010 for elderly and nonelderly disabled dual eligibles residing in primary care service areas with nearby federally qualified health centers.

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