Emergency physicians already are seeing a rise in emergency visits since expanded coverage under the Affordable Care Act began to take effect on Jan. 1, according to results of an online poll conducted by the American College of Emergency Physicians. What’s more, 86 percent expect emergency visits to increase over the next three years, and 77 percent say their EDs are not adequately prepared for significant increases.

The data suggest that states that expanded Medicaid are more likely to have increases in the volume of Medicaid ED patients. Slightly more than one-third of ED physicians report seeing more Medicaid patients, and 27 percent are seeing fewer privately insured patients.

An overwhelming 84 percent of ED physicians report that psychiatric patients are being boarded, or held in their ED, with 91 percent saying that this practice has led to violent behavior by distressed psychiatric patients, distracted staff or bed shortages. More than half of the physicians polled add that the amount of time and effort their ED expends to transfer psychiatric patients who need admission has increased since January.

When asked about other issues related to the implementation of health care reforms, 69 percent report challenges with the disposition of patients who require hospital admission but do not meet the two-midnight rule for hospital admission, and 25 percent call it a "significant dilemma." In regard to long-term impact, 34 percent believe the ACA will have a positive impact on access to emergency care.

For more, go to www.acep.org.