Emergency Rooms at a Crossroads: The Rising Tide of Non-Emergent Visits, Federal Shifts, and Future CHC’s as a Solution

Emergency departments (EDs) in the United States are often described as the “safety net of last resort.” Yet, mounting evidence shows that a significant portion of patients who walk through their doors are not facing true emergencies. This mismatch between patient needs and ED resources is straining hospitals, raising costs, and creating risks for patients who truly need urgent care. With new federal payment reforms accelerating, the future of the ED hinges on how well policymakers and health systems balance cost control, patient safety, and equity.

The Current Landscape: How Many ED Visits Are True Emergencies?

National studies vary, but the consensus is clear: a large share of ED visits are non-emergent.

• At least 10% of ED visits are strictly non-urgent.

• Broader analyses suggest 30%–40% could be managed in primary care, urgent care, or telehealth.

• In some systems, the figure climbs above 60% when including all low-acuity cases.

That means, conservatively, nearly 1 in 3 Americans visiting the ER today could be safely treated elsewhere (Hwang & Concato, 2004; Uscher-Pines et al., 2013).

Why Patients Use the ER for Non-Emergencies

1. Access Barriers – Primary care shortages, long wait times, and lack of after-hours options.

2. Insurance Gaps – Medicaid churn, uninsured populations, and uncertainty about coverage.

3. Perceptions of Urgency – Patients often overestimate symptoms (e.g., chest pain later found benign).

4. Convenience – EDs are open 24/7 and cannot legally refuse emergencies under EMTALA.

The Federal Policy Shift: What’s Changing

Federal reforms aim to reduce inappropriate ED use:

• Medicaid Redesign: Some states piloting denial of payment for “non-emergency” ED visits.

• Medicare Advantage: Plans tightening pre-authorization and steering to urgent care.

• Value-Based Care: Hospitals pressured to cut unnecessary utilization.

• Telehealth Expansion: Post-COVID federal waivers encouraging first-line virtual triage.

While these reforms target cost control, the consequences may disproportionately fall on safety-net hospitals and vulnerable patients.

Future Risks

1. Safety Net Strain – Reduced reimbursement could destabilize hospitals with high Medicaid/uninsured volume.

2. Delayed Care – Deterrence policies may push patients to delay seeking help, worsening outcomes.

3. Equity Concerns – Low-income, rural, and limited-English patients may bear the brunt.

4. Primary Care Bottlenecks – Without added capacity, redirection may overwhelm already strained clinics.

Solutions for the Future

1) Smarter Public Campaigns

• “Right Door, Right Now” messaging: Pair symptoms with recommended sites of care, but emphasize EMTALA protections.

• Nurse Advice Lines: 24/7 phone/text triage lines reduce ED visits by ~5–6%.

• Co-located Urgent Care Centers: EDs with adjacent urgent care absorb ~21% of low-acuity cases.

2) Addressing the Uninsured Dilemma

• Point-of-Care Enrollment: Financial counselors in EDs start Medicaid/Marketplace applications immediately.

• ED Navigators: Direct low-acuity patients to follow-up in FQHCs within 72 hours, reducing revisits.

• Community Paramedicine: Mobile crisis units and treat-in-place models for non-urgent 911 calls.

3) Health System Strategies

• Reserve same-day primary care slots linked to nurse-line referrals.

• Scale hotspotting initiatives (mobile clinics, CHWs) in high-utilization neighborhoods.

• Contract with payers for shared savings pools tied to lowering avoidable ED visits.

Projections: What the Next 5 Years Could Bring

• Scenario A (Coverage Erosion): With Medicaid unwinding and MA restrictions, expect a 5–10% rise in low-acuity ED demand, higher uncompensated care, and worsening disparities.

• Scenario B (Access Expansion): Nurse advice lines + co-located urgent care + navigation could cut 15–25% of low-acuity visits.

• Scenario C (Coverage + Access): Strong Medicaid retention + access expansion could reduce low-acuity ED use by 20–30%, especially among uninsured and Medicaid populations.

Conclusion

The numbers tell a sobering story: up to 40% of ED visits are not true emergencies. With federal reforms reshaping reimbursement, the U.S. health system stands at a crossroads. If reforms succeed alongside smart investments in access, education, and equity, EDs will return to their core role—saving lives in crises. If not, the system risks pushing vulnerable patients further into the margins while overburdening hospitals.

The next decade will determine whether emergency rooms remain a beacon of urgent medical care—or whether policy shifts leave them clogged with avoidable demand, jeopardizing timely care for those who need it most.

The Case for Community Health Centers

One of the most effective solutions lies in expanding the role of community health centers (CHCs). As Federally Qualified Health Centers (FQHCs), these clinics already serve millions of low-income and uninsured patients, offering comprehensive primary and preventive care at a fraction of the cost of an ED visit. By directing non-urgent patients to CHCs, the system can reduce overcrowding in emergency rooms, deliver culturally competent and continuous care, and lower overall health expenditures. Unlike the episodic, high-cost nature of ED care, CHCs provide ongoing management of chronic conditions, care coordination, and preventive services that reduce future emergencies. Strengthening CHC capacity—through workforce expansion, extended hours, mobile units, and integrated behavioral health—makes sense not only for hospitals and payers but also for patients, who benefit from accessible, affordable, and relationship-based care close to home.

References

Centers for Disease Control and Prevention. (2017). Emergency department visits: Percent distribution by triage level and age group. National Center for Health Statistics.

Hwang, U., & Concato, J. (2004). Care in the emergency department: How crowded is overcrowded? Academic Emergency Medicine, 11(10), 1097–1101. https://doi.org/10.1111/j.1553-2712.2004.tb00703.x

North Carolina Quality Assurance (NCQA). (2023). Emergency department utilization (EDU). Retrieved from https://www.ncqa.org

Rui, P., Kang, K., & Ashman, J. J. (2016). National Hospital Ambulatory Medical Care Survey: 2016 emergency department summary tables. National Center for Health Statistics.

Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., & Mehrotra, A. (2013). Deciding to visit the emergency department for non-urgent conditions: A systematic review of the literature. American Journal of Managed Care, 19(1), 47–59.

Yee, T., Lechner, A. E., & Boukus, E. R. (2013). The surge in urgent care centers: Emergency department alternative or costly convenience? Center for Studying Health System Change, Research Brief No. 26.