Thread: A Crowding Crisis In The E.R.- Courtesy of Vincente Fox Inc.

A Crowding Crisis
In The E.R.
By Kristen Gerencher
MARKETWATCH
5-30-5

SAN FRANCISCO - Despite years of warnings that hospital emergency rooms had reached capacity, visits to this vital part of the health-care system hit a record high in 2003, according to a new report.

The number of visits to emergency departments (EDs) grew 26 percent to 114 million in 2003 from 90.3 million visits in 1993, according to a report from the Centers for Disease Control and Prevention (CDC).

The U.S. population grew at less than half that rate - 12.3 percent - during the same period, and the 65-and-over population rose 9.6 percent. Meanwhile, the number of EDs fell 12 percent in that decade.

The figures reflect rising demand and strained capacity amid an aging population with chronic health problems. The report also raises questions about the readiness of the nation's first responders should a pandemic flu or other public-health disaster strike.

To be sure, business of a more mundane nature hasn't let up. The number of ED visits has increased every year for eight out of 10 years since 1992, said Linda McCaig, a health scientist for the CDC.

"For many years they've been saying there's a crisis in the ED, but it's still continuing," she said. "Although people have tried to find ways to reduce crowding, it's still a problem and could have implications for patient care."

Patients waited about 47 minutes on average to be seen, and spent a total of 3.2 hours in emergency care, the study said.

Wait times vary widely depending on geography, McCaig said. "In some rural hospitals, you probably don't have to wait at all. But in urban hospitals the length of time in the ED could be 12 hours."

Usage was highest among infants and seniors. There were 97 visits per 100 infants per year, the highest rate of any age group. Some infants likely had multiple visits, McCaig said.

Instead of turning to EDs as a first resort, some low-income people may use them often because a third of primary-care doctors won't accept new Medicaid patients, McCaig said. "They sometimes have nowhere else to go."

About 64 percent of urban hospitals reported in April 2004 that their EDs were at or above capacity, said Caroline Steinberg, vice president for trends analysis at the American Hospital Association. Another 69 percent said they had to put their ambulances on diversion at some point during the past year because there weren't enough beds at the closest ED to accommodate new patients.

"Interestingly, it wasn't really the overcrowding in the ED that was the problem," she said. "It was capacity constraints further down the line."

About 36 percent of ED visits were expected to be paid by private insurers compared with 21 percent paid by Medicaid, the study said. But Medicaid beneficiaries used EDs four times more often.

Despite some claims that people seek EDs as a substitute for primary care or because those doctors aren't managing their patients' conditions well, there is little frivolous use or abuse of emergency departments, said Robert Suter, president of the American College of Emergency Physicians, which represents 23,500 mostly board-certified emergency doctors.

Even people with good access to primary care through Medicaid or Medicare still are increasingly using the emergency room because they have chronic conditions, he said.

"What that means is there are no simple solutions to the crisis of crowding in emergency departments and the demands being placed on the emergency-care system."

What's more, about 30 percent of hospitals are losing money and many are struggling with Medicare and Medicaid payments that don't cover the costs, Steinberg said.

Medicare has been paying below the cost of patient care since 2000, amounting to a loss of 1.5 percent on average for payments, she said, adding that Medicaid paid about 92 cents on the dollar in 2003.

The constraints come as the CDC and other world health officials are concerned about the possibility of a pandemic occurring if the bird flu virus were to mutate and become transmissible between humans.

"There's no question that we have the ingredients for a perfect storm in health care if we had a bird-flu pandemic" hit a crowded ER system, Suter said.

© 2005 Philadelphia Inquirer and wire service sources. All Rights Reserved.

http://www.philly.com/mld/inquirer/livi ... 771404.htm

Yes and I without health insurance have to pay full price for my healthcare or go without.

This is obscene. Just visit any emergency room in most parts of the country. It's not just in the Southwest or the sanctuary cities. We are being overrun.

Just hope and pray you don't need serious emergency care. You may have to wait while some illegal has a boil lanced on his rear end.

No, Perhaps I should speak very little English if I go to the ER and and act as though I dont understand what they are saying.

That's right. Chances are good you might get a Pakistani or Chinese doctor and he couldn't tell if you were faking or not.