Sacramento hospitals see rise in emergency patients

Sacramento Bee
By Phillip Reese and Bobby Caina Calvan
preese@sacbee.com
Monday, Sep. 28, 2009 - 12:00 am | Page 1A

Local emergency rooms are seeing a big spike in patients without health insurance, increasing waiting times and costs for everyone, according to a Bee analysis of state and national health data.

Among those patients is Shannon Zeitler, who lost her medical insurance when she lost her marriage. She recently went to UC Davis Medical Center for help controlling her seizures. There was no urgency for her visit, she conceded, but she had little choice.

"I was so under stress. I knew I needed to get some medicine in me," she said "I had no doctor. ? I'm $7,000 in the hole now."

Emergency room visits by uninsured patients like Zeitler have surged more than 25 percent across the capital region since the recession began, The Bee found, based on its review of forms hospitals file with the Office of Statewide Health Planning and Development.

During the first six months of 2008, about 35,000 ER patients in the four-county region told their hospital they would try to pay the bills themselves. During the same time frame this year, that number rose to 44,000.

Total ER visits ? by the insured and uninsured ? also have risen, but not as sharply.

The increase locally is "reflective of what's happening statewide," said Jan Emerson, spokeswoman for the California Hospital Association.

In a survey released this spring, the association found that 57 percent of hospitals statewide registered an increase in the number of uninsured patients seeking care in their emergency rooms.

Economic problems blamed

Local hospitals cite two economy-related factors: job loss and government budget cuts.

"On a daily basis, the status of the economy is probably on the forefront of our minds," said Dr. John Wiesenfarth, emergency services chief for Kaiser's Sacramento Medical Center.

The closure of government clinics leads more to use the ER as a substitute for a family physician, Wiesenfarth said. In the past year, Kaiser has reported a 30 percent increase in local ER patients and a 40 percent increase in patients paying out of pocket.

"Working on the front line, we see more and more people using it for their primary care or their only source of care," Wiesenfarth said.

Nobody benefits from these trends, said Rosemary Younts, director of community benefits for the Sacramento region of Catholic Healthcare West.

The uninsured can get stuck with a larger bill, causing them stress and damaging their credit. And everyone has to wait longer to see a doctor.

"Of course, if a person comes in, we treat them," Younts said, adding that hospital officials try to get patients with milder problems to use Mercy's lower-cost primary care clinics.

The extra traffic "extends the waiting time for all patients," Younts said. "It crowds the ERs and puts pressure on medical staffs."

Group gives state an 'F'

The American College of Emergency Physicians recently cited overcrowding as a factor in awarding California an "F" for access to emergency care. It blamed much of the crowding on a lack of emergency facilities in its "National Report Card on the State of Emergency Medicine," but said "contributing to the problems are high rates of uninsured adults and children."

Hospitals end up absorbing many of the unpaid bills. Last year, hospitals across California wrote off nearly $1.2 billion in bad debts. And they wrote off $973.4 million in free care ? an 89 percent increase from four years earlier.

"In the big picture, it's raising the cost of health care," Younts said of the rise in ER use by the uninsured.

Cost shifting because of the uninsured is expected to add about $1,100 this year to insurance premiums for the typical American family, according to the Center for American Progress Action Fund, headed by John Podesta, former chief of staff for then-President Bill Clinton. In California, that shift now adds $1,400 to insurance premiums.

While many patients come in with minor issues, ERs also see more patients with conditions that should have been treated sooner, Younts said, like Lisa Martinez of North Sacramento, who put off treatment as long as possible.

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