NYT: The Shifting Burden of Emergency Care
CAL/AAEM News Service
pottsbri@yahoo.com
Wed, 11 Feb 2004 10:09:54 -0800 (PST)
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Submission by Paul Windham
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February 3, 2004The Shifting Burden of Emergency CareBy REED ABELSON
CA, the health care giant, has found itself, rather oddly, in the thick of the battle between full-service and specialty hospitals.
The battle lines are familiar: full-service institutions, often with deep roots in communities, say that hospitals specializing in cardiac care, orthopedics and other lucrative areas siphon away profitable patients, but shirk the burden of providing emergency care. Specialty hospitals counter that their rivals merely fear competition.
HCA, the nation's largest chain of for-profit hospitals, would seem an unlikely standard-bearer for community hospitals. But the company, which operates OU Medical Center in Oklahoma City, is in the same situation as other full-service hospitals competing with specialty operations.
In Oklahoma, OU is the only hospital now providing care for the most critically injured trauma patients. The proliferation of specialty hospitals has worsened the shortage of specialists like neurosurgeons who are willing to cover emergency rooms, causing other hospitals to send more and more patients to OU. Roughly two-thirds of the time when ambulances in Oklahoma were diverted from a hospital's emergency room to another's, the reason was a lack of such physician coverage.
With millions of dollars in losses from trauma care, OU threatened to stop providing those services in November. "We need more players," Jerry Maier, the chief executive of the hospital, said at a news conference at the time. OU executives declined to be interviewed.
John Sacra, an emergency room physician who is advising Oklahoma on the problem, said, "It was going to be a disaster."
State officials responded by temporarily requiring all hospitals to provide emergency care, make specialists available or contribute to a state fund for trauma care. The Legislature will take up the issue this spring, and OU has promised to keep its trauma center open until the end of June.
While Congress has put a temporary ban on construction of specialty hospitals, full-service hospitals say that these hospitals, often owned by the doctors providing the lucrative care, remain a significant threat.
Defenders of these hospitals say the only threat is healthy competition. "Specialty hospitals aren't doing anything to affect the trauma system," said Michael Lipomi, president of the American Surgical Hospital Association, who says his group is gearing up for many battles on the state level as well as the continuing push before Congress.
"We, as a small association, are faced with the task of fighting the major lobbying groups," like the American Hospital Association, Mr. Lipomi said.
But many hospital executives say they are providing important services that these competing hospitals do not. "We are the safety net," said Nancy Farber, chief executive of Washington Hospital Healthcare System in Fremont, Calif. "Our emergency room is the front door for people without insurance, the homeless, the underinsured," leaving the hospital with losses, she said.
After pushing last year for legislation that would require new specialty hospitals in California to provide emergency care, Ms. Farber plans to bring it to the attention of lawmakers again this year.
"This continues to be a pressing issue," agreed Carmela Coyle, an executive with the American Hospital Association, which helped win an 18-month moratorium on any new building, which was adopted as part of last year's Medicare bill. "It is on the top of the radar screen for many hospitals."
The Federation of American Hospitals, which represents for-profit chains like HCA and Tenet Healthcare, has also weighed in with concerns about specialty hospitals and supported the moratorium on new hospitals.
While there is no exact count, the General Accounting Office, the investigative arm of Congress, estimates that there are roughly 100 specialty hospitals open in the United States, largely in states where there is little oversight of new construction. The G.A.O. described these hospitals as "much less likely to have emergency departments" than full-service hospitals, with slightly fewer than half offering emergency care, compared with 92 percent of general hospitals.
Other states are also feeling the shortage of specialists. "It's an increasing problem," said Darren Whitehurst, an executive at the Texas Hospital Association, who says some Texas hospitals have been unable to find neurosurgeons and other specialists to cover emergency rooms. Lawmakers have promised to take a close look at the issue, he said.
To deflect some of these concerns, some specialty hospitals are offering emergency care. In Milwaukee, the two heart hospitals that have opened recently both offer a basic level of emergency services, although neither can treat trauma cases. MedCath, a for-profit chain of heart hospitals, which helped build the Heart Hospital of Milwaukee, says that all of its hospitals provide such care and that its doctors routinely cover emergency rooms at other hospitals.
The other, the Wisconsin Heart Hospital, says it also plans to offer emergency services as soon as it can. "This would be another resource for the community," said Norma McCutcheon, president of the hospital, which is a joint venture between heart doctors and a community hospital system. The hospital has already worked out agreements with local hospitals that do handle trauma on how to transfer patients, she said.
On the federal level, officials have promised to study the impact of specialty hospitals on full-service hospitals to determine whether more oversight or restrictions are needed. Ohio has a moratorium similar to the one enacted by Congress, said Scott Becker, a lawyer who represents the association of specialty hospitals, and numerous states are likely to weigh some sort of new laws, he said. Hospital groups "have more resources on the state level," he said.
Mr. Becker also expects significant activity in various communities, as hospital groups push for local laws. In Oklahoma, he said, some communities are requiring additional review of new facilities to see how they might affect existing hospitals, and others are considering similar steps that will result in increased debate.
"I think you'll have more and more of that," Mr. Becker said.
Some hospital executives are also taking steps to combat the doctors who are forming these competing ventures. OhioHealth, a hospital network in Columbus, asked 17 doctors who are investors in New Albany Surgical Hospital, a new specialty institution, and who refer patients there to give up their privileges at OhioHealth by the end of January. The hospital says it believes that doctors should not have a financial interest in these facilities, said David Morehead, OhioHealth's chief medical officer. The system's board felt doctors "can't be competitors and partners at the same time,'' he said.
Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine
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<DIV>Submission by Paul Windham</DIV>
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<H5>February 3, 2004</H5><NYT_HEADLINE type=" " version="1.0">
<H2>The Shifting Burden of Emergency Care</H2>
<DIV></NYT_HEADLINE><NYT_BYLINE type=" " version="1.0"><FONT size=-1><STRONG>By REED ABELSON</STRONG></FONT><BR></DIV></NYT_BYLINE>
<DIV>
<TABLE cellSpacing=0 cellPadding=0 align=right border=0>
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<TD></TD></TR></TBODY></TABLE></DIV><NYT_TEXT>
<P><A href="http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=HCA"><IMG height=34 alt=H src="http://graphics7.nytimes.com/images/dropcap/h.gif" width=31 align=left border=0>CA</A>, the health care giant, has found itself, rather oddly, in the thick of the battle between full-service and specialty hospitals.</P>
<P>The battle lines are familiar: full-service institutions, often with deep roots in communities, say that hospitals specializing in cardiac care, orthopedics and other lucrative areas siphon away profitable patients, but shirk the burden of providing emergency care. Specialty hospitals counter that their rivals merely fear competition.</P>
<P>HCA, the nation's largest chain of for-profit hospitals, would seem an unlikely standard-bearer for community hospitals. But the company, which operates OU Medical Center in Oklahoma City, is in the same situation as other full-service hospitals competing with specialty operations. </P>
<P>In Oklahoma, OU is the only hospital now providing care for the most critically injured trauma patients. The proliferation of specialty hospitals has worsened the shortage of specialists like neurosurgeons who are willing to cover emergency rooms, causing other hospitals to send more and more patients to OU. Roughly two-thirds of the time when ambulances in Oklahoma were diverted from a hospital's emergency room to another's, the reason was a lack of such physician coverage. </P>
<P>With millions of dollars in losses from trauma care, OU threatened to stop providing those services in November. "We need more players," Jerry Maier, the chief executive of the hospital, said at a news conference at the time. OU executives declined to be interviewed.</P>
<P>John Sacra, an emergency room physician who is advising Oklahoma on the problem, said, "It was going to be a disaster."</P>
<P>State officials responded by temporarily requiring all hospitals to provide emergency care, make specialists available or contribute to a state fund for trauma care. The Legislature will take up the issue this spring, and OU has promised to keep its trauma center open until the end of June. </P>
<P>While Congress has put a temporary ban on construction of specialty hospitals, full-service hospitals say that these hospitals, often owned by the doctors providing the lucrative care, remain a significant threat. </P>
<P>Defenders of these hospitals say the only threat is healthy competition. "Specialty hospitals aren't doing anything to affect the trauma system," said Michael Lipomi, president of the American Surgical Hospital Association, who says his group is gearing up for many battles on the state level as well as the continuing push before Congress. </P>
<P>"We, as a small association, are faced with the task of fighting the major lobbying groups," like the American Hospital Association, Mr. Lipomi said.</P>
<P>But many hospital executives say they are providing important services that these competing hospitals do not. "We are the safety net," said Nancy Farber, chief executive of Washington Hospital Healthcare System in Fremont, Calif. "Our emergency room is the front door for people without insurance, the homeless, the underinsured," leaving the hospital with losses, she said.</P>
<P>After pushing last year for legislation that would require new specialty hospitals in California to provide emergency care, Ms. Farber plans to bring it to the attention of lawmakers again this year. </P>
<P>"This continues to be a pressing issue," agreed Carmela Coyle, an executive with the American Hospital Association, which helped win an 18-month moratorium on any new building, which was adopted as part of last year's Medicare bill. "It is on the top of the radar screen for many hospitals." </P>
<P>The Federation of American Hospitals, which represents for-profit chains like HCA and <A href="http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=THC">Tenet Healthcare</A>, has also weighed in with concerns about specialty hospitals and supported the moratorium on new hospitals. </P>
<P>While there is no exact count, the General Accounting Office, the investigative arm of Congress, estimates that there are roughly 100 specialty hospitals open in the United States, largely in states where there is little oversight of new construction. The G.A.O. described these hospitals as "much less likely to have emergency departments" than full-service hospitals, with slightly fewer than half offering emergency care, compared with 92 percent of general hospitals.</P>
<P>Other states are also feeling the shortage of specialists. "It's an increasing problem," said Darren Whitehurst, an executive at the Texas Hospital Association, who says some Texas hospitals have been unable to find neurosurgeons and other specialists to cover emergency rooms. Lawmakers have promised to take a close look at the issue, he said.</P>
<P>To deflect some of these concerns, some specialty hospitals are offering emergency care. In Milwaukee, the two heart hospitals that have opened recently both offer a basic level of emergency services, although neither can treat trauma cases. <A href="http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=MDTH">MedCath</A>, a for-profit chain of heart hospitals, which helped build the Heart Hospital of Milwaukee, says that all of its hospitals provide such care and that its doctors routinely cover emergency rooms at other hospitals.</P>
<P>The other, the Wisconsin Heart Hospital, says it also plans to offer emergency services as soon as it can. "This would be another resource for the community," said Norma McCutcheon, president of the hospital, which is a joint venture between heart doctors and a community hospital system. The hospital has already worked out agreements with local hospitals that do handle trauma on how to transfer patients, she said. </P>
<P>On the federal level, officials have promised to study the impact of specialty hospitals on full-service hospitals to determine whether more oversight or restrictions are needed. Ohio has a moratorium similar to the one enacted by Congress, said Scott Becker, a lawyer who represents the association of specialty hospitals, and numerous states are likely to weigh some sort of new laws, he said. Hospital groups "have more resources on the state level," he said. </P>
<P>Mr. Becker also expects significant activity in various communities, as hospital groups push for local laws. In Oklahoma, he said, some communities are requiring additional review of new facilities to see how they might affect existing hospitals, and others are considering similar steps that will result in increased debate. </P>
<P>"I think you'll have more and more of that," Mr. Becker said.</P>
<P>Some hospital executives are also taking steps to combat the doctors who are forming these competing ventures. OhioHealth, a hospital network in Columbus, asked 17 doctors who are investors in New Albany Surgical Hospital, a new specialty institution, and who refer patients there to give up their privileges at OhioHealth by the end of January. The hospital says it believes that doctors should not have a financial interest in these facilities, said David Morehead, OhioHealth's chief medical officer. The system's board felt doctors "can't be competitors and partners at the same time,'' he said. </P><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC-Irvine<p><hr SIZE=1>
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