Posted on 07/02/2010 2:56:38 PM PDT by LouAvul
Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more crowded with longer wait times under the nation's new health law. That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER crowding. It would seem these patients would be able to get routine health care by visiting a doctor's office, as most of the insured do.
But it's not that simple. Consider:
_There's already a shortage of front-line family physicians in some places and experts think that will get worse.
_People without insurance aren't the ones filling up the nation's emergency rooms. Far from it. The uninsured are no more likely to use ERs than people with private insurance, perhaps because they're wary of huge bills.
_The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million. Medicaid is the state and federal program for low-income families and the disabled. And many family doctors limit the number of Medicaid patients they take because of low government reimbursements.
_ERs are already crowded and hospitals are just now finding solutions.
Rand Corp. researcher Dr. Arthur L. Kellermann predicts this from the new law: "More people will have coverage and will be less afraid to go to the emergency department if they're sick or hurt and have nowhere else to go.... We just don't have other places in the system for these folks to go."
Kellermann and other experts point to Massachusetts, the model for federal health overhaul where a 2006 law requires insurance for almost everyone. Reports from the state find ER visits continuing to rise since the law passed - contrary to hopes of its backers who reasoned that expanding coverage would give many people access to doctors offices.
Massachusetts reported a 7 percent increase in ER visits between 2005 and 2007. A more recent estimate drawn from Boston area hospitals showed an ER visit increase of 4 percent from 2006 to 2008 - not dramatic, but still a bit ahead of national trends.
"Just because we've insured people doesn't mean they now have access," said Dr. Elijah Berg, a Boston area ER doctor. "They're coming to the emergency department because they don't have access to alternatives."
Crowding and long waits have plagued U.S. emergency departments for years. A 2009 report by the Government Accountability Office, Congress' investigative arm, found ER patients who should have been seen immediately waited nearly a half-hour.
"We're starting out with crowded conditions and anticipating things will only get worse," said American College of Emergency Physicians president Dr. Angela Gardner.
Federal stimulus money and the new health law address the primary care shortage with training for 16,000 more providers, said Health and Human Services Department spokeswoman Jessica Santillo.
But many experts say solving ER crowding is more complicated.
What's causing crowding? Imagine an emergency department with a front door and a back door.
There's crowding at both ends.
At the front door, ERs are strained by an aging population and more people with chronic illnesses like diabetes. Many ERs closed during the 1990s, leaving fewer to handle the load. The American Hospital Association's annual survey shows a 10 percent decline in emergency departments from 1991 to 2008. Meanwhile, emergency visits rose dramatically.
At the back door, ER patients ready to be admitted - in hospital lingo, ready to "go upstairs" - must compete for beds with patients scheduled for elective surgeries, which bring in more money. "If you've got 10 ER patients and 10 elective surgeries," Kellermann asked rhetorically, "which are you going to give the beds to?"
That's why easing crowding will take more than just access to primary care. It also will take hospitals that run more efficiently, moving patients through the system and getting ER patients upstairs more quickly, Kellermann said.
Ideas that work include bedside admitting, where a staffer takes a patient's insurance information as treatment starts.
That and other strategies are being tried at St. Francis Hospital and Health Centers in Indianapolis. There, the performance of nurse managers is measured by how long admitted patients wait in the emergency department for a bed upstairs.
And to stave off inappropriate ER visits, the hospitals have opened after-hours clinics staffed by primary care doctors to handle patients who can't leave work to see a doctor, said Indianapolis hospital executive Keith Jewell. ER wait times have fallen.
A Chicago hospital, too, is readying for the onslaught of ER patients. On the city's South Side, Advocate Trinity Hospital handles 40,000 emergency visits a year and is expecting more because of the new law.
Greeter Stephanie Bailey makes sure patients don't get frustrated while they're waiting. She can take their vital signs and inform staff if the patient is about to leave without treatment.
Inside the emergency department, a giant sheet of paper hangs on a wall. It's hand-lettered in orange and purple, and tracks daily progress on hospital goals: How many patients left before they were treated? How many minutes did patients stay in the ER?
On a recent day, the note said "0.0 percent" of the patients left without treatment. Someone had added a smiley face. But there was no smiley face next to the average ER length of stay for the same day - nearly four hours. The hospital's goal is three.
Is this the hope and change the Rats kept talking about?
Yes it is. Hope and Change meant Stalinization - the complete takeover of the US by government.
Look how well USSR turned out. Labor camps, eternal depression, horrid pollution, government directed reallocation of wealth, etc.
Yup, this IS what the Democrats and Obama want. Pure control.
This is so unexpected.
Seriously, a friend of mine underwent some surgery and was conciouslly awake. She didn’t feel anything, but remembered every word the doctors said.
All they talking about was Obamacare, how it was going to ruin American medicine, and what an idiot Obama was.
Sorry, all they were talking about WAS Obamacare.
There is a word for the people that thought that - morons.
They're going to add 32 million to our health care system, yet there are just under 5,000 hospitals in the country, as of 2008 Census fugues. That's 6,400 extra people per hospital. Is that a lot? I think so.
Of course, the practical reality is that there aren't anywhere near 5,000 large metropolitan hospitals around. Most of these people are concentrated in the top 50 cities. In those cities, you're going to find a real burden placed on hospitals and hospital staff, because while we're increasing the demand, there certainly won't be any increase in supply.
I, for one, am, SHOCKED, SHOCKED, I tell ya!
Not to mention a sieve-like border, large swaths of Arizona and many of our national parks under foreign occupation, a disastrous foreign policy, Iran heading to nuke status, Afghanistan on the fast track to a defeat for America, 4.4 million people jobless in the past year, a takeover of and massive damage to the health care system, etc. What a F*****G train wreck!!!!
“UNEXPECTED”
The democrat party media is always finding “unexpected” consequences to their party’s endless evil deeds and lies.
Throw in amnesty for 15-20 million illegal aliens and you can forget seeing any doctor at all.
Emergency rooms are filled with illegal aliens.
as obama probably says to himself in the mirror every morning ... “ It’s good to be King “
My niece just took her MSAT’s as she wants to be a brain surgeon. She lives in California and agreed there are a lot of potential lobotomy patients right there in Claremont. She laughed when I suggested the procedure will become more commonly used for crowd control.
you know ... we’re all b*tching and complaining about how obama and congress is destroying this country , but , there’s not a damn thing we can do about it . So , i guess , let’s continue complaining .
My advice for your niece? Don’t go into medicine unless you love it. If you want to be paid what you’re worth for the work you do, go into some other profession.
I’d ask you what your plan is but you admitted there is nothing we can do about it.
Can’t even discuss it with her! Class of 2010 from Claremont McKenna with her B.A. in neuroscience. She honestly believes that the government should set her salary or in the alternative tax her at a 90% rate. I have a nephew coming out of the University of Alabama with the same mindset. Their generation has been so damaged by their “educations” that I fear for them, don’t understand them, and have little hope for them.
hmm ... we can “vote” but, that’ll take us back to complaining again . The possible solution : maybe what Good ol George Washington did back in 1776 ... George tried the peaceful way but it didn’t seem to work .
That solution is always available to us. The most likely outcome of it would be someone else’s tyranny over the rubble. If you think of anything else let me know.
“She honestly believes that the government should set her salary or in the alternative tax her at a 90% rate.”
That’ll wear off.
“Health overhaul may mean longer ER waits, crowding...”
No, what it will really mean is more deaths. Anything that interferes with timely, first-rate care costs lives.
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