RICHMOND, Va. (WRIC) — New data has shed light on an emerging crisis in Virginia hospitals. The cost of an emergency room visit has risen dramatically since the start of the COVID-19 pandemic, even as the emergency room increasingly becomes a place of last resort for those struggling with serious mental illnesses.

A new comprehensive report from the General Assembly tracked trends in emergency room care from 2016-2020, finding that the total number of emergency room visits actually declined from 2016-2020, largely due to the COVID-19 pandemic — but visits for Mental Health and Substance Abuse (MHSA) increased steadily, then jumped at the outset of the pandemic.

The cost of a visit, however, spiked by over 20% — an extra burden on patients who are already more likely to be low-income recipients of Medicare and Medicaid. The average emergency room visit now costs just over $800 in Virginia — a 33% jump since 2016.

Medicaid Woes

There have been an increasing number of Medicaid participants in Virginia since former Governor Ralph Northam signed a bill into law in 2018 that has, so far, added over 500,000 additional Virginians to the program.

Although the expansion granted them access to insurance, it does not guarantee them access to medical care. That’s because primary care physicians — those that perform routine check-ups and other largely preventative care — can refuse Medicare and Medicaid patients altogether.

“Medicaid enrollees use the ED more frequently than commercially insured patients in part because they have difficulty accessing other sources of care,” the report reads.

The study found that as of 2019, just 58% of primary care practices were accepting new Medicaid patients.

“Even for providers that do accept Medicaid patients, there is no guarantee that a person can get an appointment to see a doctor in a timely manner,” the report reads. “Physicians, clinical practices and other health care providers can, and often do, limit the number of Medicaid patients they see.”

That leaves many with the emergency room as the only option readily available. That’s because federal law requires that emergency departments provide care to everyone who comes in their doors, regardless of their ability to pay.

“I don’t think anyone enjoys going to the emergency room,” said Delegate Patrick Hope (D-Arlington). “So they go there because they don’t have another option.”

That sentiment was backed up by the report, which suggested that in many places, people go the emergency room for non-emergencies because the proper care facilities either do not exist in their area or are not accessible for another reason, such as cost.

The Supports That Aren’t There

Mental health patients place an extra burden on emergency departments, with their visits costing about $200 more on average than others.

“A person with an MHSA diagnosis requires more staff resources and time than
one with a medical diagnosis,” the report reads. “In many cases a staff person has to stay with the patient until they are either properly transferred or discharged.”

That lack of proper care facilities is especially prominent for those suffering form mental health and substance abuse disorders, who now make up over 8% of all emergency room visits. The study found that in 2020, 16,022 patients across the commonwealth, many suffering from chronic mental health conditions, accounted for 256,395 visits, an average of 16 visits per year.

The average person, by comparison, visits the emergency room about once a year.

In 2021, Virginia State Police called on the General Assembly to take action and expand mental health services, saying many suffering from mental health crises were ending up in local jails, which were totally unequipped to treat them.

That same year, mental health hospitals across Virginia were forced to close their doors to new patients amid rising admissions and chronic under-staffing.

Emergency departments have tried to make do, with two large hospitals in Virginia reportedly outfitting special “safe rooms” — rooms “stripped of anything a person can use to harm themselves with” that resemble “small one-car garages” — to house patients in the midst of metal health crises.

Senator David Suetterlein (R-Salem) spoke to the committee about one case in his district that highlighted the strain placed on emergency services by mental health patients who lack other key supports.

“The other day I was with a policeman in Roanoke County who got a call telling him where to go, which was a place that houses more than a hundred people. He correctly guessed exactly who it was going to be, and then, when the ambulance came, they also correctly guessed who it was going to be. They were all aware of him because this is something they do every week. Roanoke Memorial would no longer accept him, so he was now going to go over to Louis Gale. These four public servants, each of them spent over two hours of their shift just for this one individual.”

Senator David Suetterlein, Testifying to the General Assembly’s Joint Commission on Healthcare

In Search of Solutions

The report made several recommendations, many of which would require action by the General Assembly. One such option was to create a system of “care management programs” in hospitals to follow up with patients and make sure they get adequate care once they’re discharged form emergency rooms.

The cost would range from $85,000 to $190,000 per hospital — a total of $4.1 million a year in grants across the state.

Other recommendations included better data collection by emergency departments to connect patients with services and measures to encourage primary care physicians to accept more Medicaid patients.

One thing all of the solutions have in common? They’re likely to cost the state some money. But as one state official noted, the time for action has long since passed.

“In total, mostly it just seems like we keep studying this and talking about it and reporting on what’s happening,” he said. “So hopefully this will help you think about ways to focus on — fortunately or unfortunately, depending on where you sit — it’s gonna require some funds to do.”