The Future for Overcrowded EDs

At Western Maryland Health System, our daily census of emergency department patients has risen from an average of 150 to 166 over the past 1-2 months. Many people openly acknowledge they can’t get an appointment with their primary care doctor or that no doctor in the area is taking new patients. As health care reform attempts to treat patients not in the hospital, but in outpatient settings, the pressure on the already weak primary care network could cause the entire system to collapse.

In rural and other underserved areas, the lack of primary care physicians will be felt sooner rather than later. As emergency physicians, we struggle to get patients the appropriate follow up they need for their chronic illnesses like congestive heart failure, diabetes and hypertension. As the safety net to the American health care system, the emergency department welcomes and cares for all those that can’t get help elsewhere. It looks like for the foreseeable future that we had better make more room at the Inn.

In continuing coverage, the NPR (Rovner, 4/28) “Shots” blog reported that “hospital emergency rooms, the theory goes, get overcrowded because people without health insurance have no place else to go.” However, “the real problem, according to a new survey from the American College of Emergency Physicians, isn’t caused by people who don’t have insurance — it’s caused by people who do, but still can’t find a doctor to treat them.” ACEP President Sandra Schneider said that the findings “confirm what we are witnessing in Massachusetts — that visits to emergency rooms are going to increase across the country, despite the advent of healthcare reform, and that health insurance coverage does not guarantee access to medical care.”

Medscape (4/28, Brooks) reported that “nearly all of the emergency physicians polled (97%)…report that they treat Medicaid patients on a daily basis who could not find any other physician to accept their health insurance.” According to Dr. Schneider, “Medicaid patients, the uninsured, the underinsured, often can’t get in to see their physician. In many cities, you call up, and if you’re a Medicaid patient, they might see you in a month.”

Modern Physician (4/29, Subscription Publication) reports that the ACEP survey “found that 89% of emergency-medicine physicians believe ER visits will rise following the implementation of insurance reforms contained in the Patient Protection and Affordable Care Act, despite the law’s stated goal of broadly expanding access to primary care.” More than half of the physicians “said they expected a ‘significant’ increase in ER care following the law’s implementation in the coming years.” Dr. Schneider “said emergency-department visits have increased at twice the rate of the US population’s growth and that two-thirds of all ER treatment takes place outside of normal business hours for primary-care doctors.”