Reform Law Could Add to ED Overcrowding, Wait Times, Experts Say

[CAL/AAEM News Service]

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July 2, 2010
Reform Law Could Add to ED Overcrowding, Wait Times, Experts Say

The California Healthline<http://www.californiahealthline.org/articles/2010/7/2/reform-law-could-add-to-ed-overcrowding-wait-times-experts-say.aspx>

Although provisions in the new health reform law are designed to provide insurance coverage to as many as 32 million more U.S. residents, the overhaul might increase wait times and contribute to overcrowding in hospital emergency departments, according to researchers, the AP/Atlanta Journal-Constitution reports.
Analysts predict that the newly insured will continue to seek care in EDs, citing research that found the insured are just as likely as the uninsured to use the ED (Johnson, AP/Atlanta Journal-Constitution, 7/2). A recent CDC report concluded that most ED visitors in 2007 had health insurance and required emergency services, challenging a common assumption that the ED population is composed primarily of uninsured individuals seeking routine care (California Healthline, 5/20).
Massachusetts -- which often is cited as an example of how the nationwide overhaul might play out -- saw a 7% increase in ED visits from 2005 to 2007, after it enacted legislation that required most state residents to obtain insurance.
Possible Effects of Medicaid Expansion
An expansion of Medicaid -- whose beneficiaries typically use the ED in high numbers -- also is expected to contribute to increased use of EDs. In addition, analysts say that a nationwide shortage of primary care physicians might contribute to a growth in ED patients.
Elijah Berg, a Boston-area ED physician, said that insured individuals seek care at EDs "because they don't have access to alternatives."
However, an HHS spokesperson said that the new reform law, coupled with federal funding, will provide resources to train an additional 16,000 PCPs.
Solutions Could Be More Complicated
Experts say that devising ways to address high rates of ED use is more complex than providing additional funding. For example, a recent American Hospital Association survey found a 10% decline in the number of EDs from 1991 to 2008, leaving remaining facilities to care for growing populations of elderly patients and patients with chronic illnesses, such as diabetes.
In addition, many hospitals lack adequate bed space to accommodate both ED patients who require admission to a facility and patients who are scheduled for elective surgeries, according to Arthur Kellermann, a RAND researcher. Hospitals must craft strategies to handle patients more efficiently, Kellermann said.
Some Hospitals Addressing ED Issues
Some hospitals have had success in developing ways to improve care for ED patients.
For example, Indianapolis-based St. Francis Hospital and Health Centers has started assessing nurse managers on how long admitted ED patients wait for a bed. St. Francis hospitals also have slashed ED wait times by offering after-hours clinics staffed by PCPs.
Another hospital, Advocate Trinity in Chicago, employs "greeters" who take waiting patients' vital signs and let other staff members know if a patient appears ready to leave without receiving care (AP/Atlanta Journal-Constitution, 7/2).
Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine
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