Op-ed: Ease ER overload

The following op-ed was published on December 3rd, 2008 in the USA Today.

Emblematic of soaring health care costs, which are projected to reach $3 trillion by 2011,is the nationwide crisis of emergency department overcrowding. More than $18 billion is wasted annually on unnecessary visits to the ER,with volume rising by 32% and wait times almost doubling to one hour during the past decade.Relieving this strain will be critical to any health care reform.

Contrary to popular belief, it is not just the uninsured who are utilizing emergency services. A recent study in the Journal of the American Medical Association showed that patients with health insurance were primarily responsible for the increase of emergency services over the past decade. Lack of access to an available doctor is the major reason.

Long waiting periods

In California, for example, nearly half of emergency patients felt their problem could have been handled by their regular physician, but with the wait being several months in states such as California or Oregon,appointments are scarce.

This doesn’t include the 56 million people without primary care providers, where the wait for a new patient appointment on average can be from 50 days to 100 days, according to a recent national survey by the Massachusetts Medical Society, the state’s largest physicians group.

Furthermore, many physicians do not have evening or weekend availability. So their answering machines direct patients to the hospital. In turn, easily treatable conditions are funneled to emergency physicians who are unfamiliar with a patient’s medical history. Tests are duplicated and comprehensive work-ups initiated, which explains why emergency care is the most expensive.

Access to specialty care is also a problem. A national survey by Merritt Hawkins & Associates, which places physicians and surveys trends, found the average wait to see a cardiologist, dermatologist, or obstetrician-gynecologist in 15 major cities was 18 days.

When you consider that an ER can provide a specialist consultation and diagnostic tests on demand, patients find the “one-stop shopping” appealing.

Hurdles ahead

The outlook for improving the situation is dismal.

Doctors face financial pressure to have fully pre-booked schedules, resulting in only 30% of patients being able to see their doctors on the same day that they seek an appointment.According to a 2007 Commonwealth Fund survey, this ranks the U.S. next to last among industrialized countries.

Even though primary care physicians can treat many emergency department cases, their numbers are decreasing because of wide salary and lifestyle disparities when compared with their specialist counterparts. The Journal of the American Medical Association recently reported that only 2% of graduating medical students say they planned to work in primary care internal medicine.

Relieving emergency department congestion involves improving physician access. This includes encouraging doctors to grant more same-day appointments, creating better incentives for medical students to choose primary care, and compensating physicians to provide patient care or guidance after office hours.

As Baby Boomers approach Medicare age, the system is poised for additional pressure, as the elderly are the greatest users of emergency care.

Any serious national plan to contain health care spending must find a way to decompress our already overburdened emergency departments.