Improving access to affordable primary care cuts hospital stays, but fails to reduce ED visits in dual eligible patients

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.

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 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."