Kaiser: Recession has EDs under severe pressure
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Kaiser conducted a series of interviews with heads of EDs in selected hospitals throughout the United States, as well as officials of groups representing emergency physicians and nurses. The 12 interviews took place in July.
According to Kaiser, nearly every ED reported dealing with a rising number of cases, to the point where they are operating well over capacity. Comments from the interviewees suggested the situation was getting increasingly dire, with reports of EDs being “overwhelmed” and “close to the breaking point.”
The interviewees said several factors contributed to the increasing strain under which their EDs are operating, including inadequate access to healthcare for both the insured and uninsured, the rising number of uninsured patients, the inability of people to afford out-of-pocket medical costs and the swine flu.
The number of previously insured persons who have lost jobs — and their insurance — because of the recession, is a particularly troubling trend for EDs. According to interviewees, few private practices will accept uninsured patients, while sliding fee clinics are tremendously backed up. Consequently, the uninsured have little choice but to look to emergency rooms for treatment.
And, according to the interviews, even those patients with insurance choose to come to EDs because they either face unacceptable waits to see private physicians, or are unable to pay the high deductibles or copay requirements necessary to see them.
Consequently, overcrowding in EDs has become a major problem. According to Kaiser, the current average wait in one large, urban hospital is 18 to 24 hours. Kaiser quoted one ED physician, who observed: “It is only a matter of time before people are dying in the waiting room.”
It is not only the overcrowding that is a burden to EDs. Arranging for follow-up care for uninsured patients is a tremendous problem, Kaiser reports, which impacts how ED doctors practice. For example, they might feel compelled to order extensive and costly work-ups for sick patients without insurance to ensure their safety.
In order to deal with the increasing pressures, Kaiser said that hospitals need to add clinical staff and services for their EDs, as well as add inpatient capacity, which, Kaiser says, is easier said than done in an economic environment where hospital reimbursements are declining, endowments are down in teaching institutions and fewer patents are able to pay their bills.