Nearly half of emergency physicians responding to a poll are already seeing a rise in emergency visits since Jan. 1 when expanded coverage under the Affordable Care Act began to take effect. In an online poll conducted by the American College of Emergency Physicians, 86 percent expect emergency visits to increase over the next three years. More than three-fourths (77 percent) say their EDs are not adequately prepared for significant increases.

"Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care," said ACEP President Alex Rosenau, D.O. "But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low. When people can't get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care."

The data suggest that states that expanded Medicaid are more likely to see increases in the volume of Medicaid emergency patients. Rosenau said policymakers need to make sure there are adequate resources to care for growing numbers of emergency patients.

Eighty-four percent of emergency physicians report that psychiatric patients are being held — "boarded" — in their emergency department, with nine in 10 (91 percent) saying the practice has led to violent behavior by distressed psychiatric patients, distracted staff or bed shortages, all of which may harm patients.

More than half of the physicians polled add that the amount of time and effort their emergency department expends to transfer psychiatric patients who need admission has increased since January.

Providers increasingly dissatisfied with EHRs

Providers nationwide project increased investments in health care information technology and telecommunications solutions, as well as modern clinical equipment, according to Premier Inc.'s spring 2014 Economic Outlook C-suite survey.

Nearly half (49 percent) of the C-suite respondents plan to make their largest capital investments over the next year in HIT, to include electronic health records, advanced data analytics and telecommunications, according to survey results. The acquisition of clinical equipment (surgical, imaging and lab) was cited by 22 percent of executives as the area in which they are planning the largest capital investments.

The survey also suggests that 41 percent of respondents are dissatisfied or indifferent in regards to their current EHR systems.

"Hospitals are making necessary investments in infrastructure to meet the demands of this new generation of health care," said Michael J. Alkire, Premier's chief operating officer. "What we are hearing increasingly from health care leaders is dissatisfaction with their existing EHR systems, often citing cost and difficulty of use. Providers need a solution that integrates clinical, financial and operational data across their hospitals and health systems; the majority of EHR systems cannot do that."

Workers Wary of Wellness Programs that Tie Premiums to Participation, Outcomes

As many employers begin to expand their wellness programs under new guidelines set forth by the Affordable Care Act, a recent Kaiser Health Tracking Poll finds workers oppose programs that make them pay higher premiums if they fail to participate or meet specific health goals.

Overall, a large majority (76%) of the public says it is appropriate for employers to offer wellness programs to promote healthy behaviors among their workers, but most (62%) also say it is not appropriate for employers to require workers to pay more for their health insurance premiums if they don't participate in those programs. Even more (74%) say it is inappropriate for employers to require that workers pay more if they are unable to meet certain health goals.

The results are similar among working-age adults who get their insurance through an employer. A large majority (80%) is supportive of wellness programs themselves, but most oppose requiring workers to pay higher premiums if they don't participate (62%) or if they don't meet certain health-related goals (75%).

For many years, employers have offered a wide range of wellness programs to their workers, and some have recently started using financial rewards or penalties as incentives to get workers to participate and to meet specific health outcomes such as lose weight or meet a body-mass index target. The Affordable Care Act includes provisions that permit certain financial incentives and penalties related to health outcomes as part of employer wellness programs, and federal rules published last year set standards for such programs.