Posted by Guest Blogger on Fri, Dec 04, 2009 @ 05:00 PM
By Wesley A. Curry, M.D.
I'm not the first healthcare professional to point out that this country already has variants of a "public option" in health care. The Senate's latest rendition will hopefully reverse a trend and not further burden hospitals and ER physicians with more uncompensated care. But the fact is any new program will be the "fifth" public option since 1965. And each one has ultimately increased the economic challenges on the emergency care system.
The existing public option variants are Medicare and Medicaid, both established in 1965 and both obviously financed by tax payer revenue. Another is the Health Maintenance Organization Act of 1973, which gives HMOs certain economic advantages including the ability to force non participating physicians and hospitals to accept lower reimbursement for treatment of HMO patients. Lastly there's the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, an unfunded mandate that ensures public access to emergency services regardless of the individual's ability to pay.
Medicare and Medicaid patients are becoming less desirable to healthcare providers because of decreasing reimbursement rates (legislated decreases or because rates have failed to keep up with inflation). That means more people are coming to hospitals under the mandates of EMTALA. The problem is, it remains unfunded and is the "last resort" for people without health care. Their default option then becomes the hospital ER.
Emergency care providers and hospitals can ill afford to have another "public option" that does not adequately reimburse primary care physicians and specialists. Increasingly hospitals have had to make up the difference and provide financial support for emergency care providers and on call physicians. Some hospitals have closed and the number of emergency rooms has dropped nationwide as the average reimbursement continues to decrease for patients in emergency rooms.
A fifth public option is a good thing for the country - but only if more people get access to primary care. The covered services must be limited and tort reform needs to be included, because whatever form the public option takes, the benefits won't be equivalent to the best commercial insurance plans which are quite expensive in comparison. With more people covered by medical insurance, the rise in cost will be mitigated if the hospitals and health care providers don't have to factor in significant losses from uninsured and underinsured patients. There is no free lunch and no free health care. I would appreciate hearing your thoughts and comments.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:18 AM
By Carlos Medina, M.D.
The old saying "if you want something bad enough just try harder" could have been coined around the topic of "advocacy". But what exactly does advocacy mean to us in the medical field?
First of all, what we're talking about here is voicing your opinion about a particular piece of legislation that will affect what we do or where we practice - either negatively or positively.
Sounds easy enough, right? But in order to be a successful advocate for an important issue, you need to know how to monitor the legislative process and then how to gain access to your specific legislator(s) either in a letter or over the phone. Luckily, it doesn't have to be hard - especially if you follow a few simple rules. And as we in California know first hand thanks to our recent budget woes, it really IS important to be an advocate for a position that will affect your livelihood, your hospital, and your community. And the more you write or call, the more likely legislators are to listen.
To write to your legislator, here are a few tips to follow:
- Get a grasp of the bill and your position
- Identify yourself, what you do, where you live
- Describe how the proposed legislation will affect the community, patients and EDs
- Use local examples and refer to common interests
- Be timely and state when the bill is scheduled to be heard or voted on
- Stick to ONE subject. Be brief and to the point. Use short sentences and short paragraphs
- If calling, ask for the staffer who deals with Health Care. The key to a good relationship with the politician is through a good relationship with their staffers - they look to them for information/opinion
In addition, here are some useful links that should help you in the advocacy process:
http://www.calacep.org/advocacy/ (Advocacy Section)
http://www.acep.org/ (Advocacy Section)
http://www.legislature.ca.gov/ (Legislators and Districts)
Successful advocacy is important - and it's something we can all do! I'd love to hear your comments or ideas on this topic!
Posted by Guest Blogger on Wed, Dec 02, 2009 @ 01:40 PM
By Wesley A. Curry, M.D.
It's always of interest to read about large studies on the performance of emergency rooms that see over 120 million patients a year, and serve as the nation's health care safety net. The recent survey report from Press Ganey 2009 Emergency Department Pulse Report: Patient Perspectives on American Health Care helps to spotlight a major concern every person has -"will I or my loved one be seen by a health care provider and treatment started in a timely manner?" The report focuses on "average wait times" but in my opinion, averages don't tell the whole story, since there is a significant disparity between emergency rooms across the nation.
Why do we dwell on the average and not the best performances and worst performance by emergency rooms across the nation? I think the public would want to know, and the news media could better serve the public by pointing out the good and the bad performers.
I agree with the conclusions of the survey, that patient satisfaction is related to the length of time patients wait to be seen in the emergency room. The CDC reported average emergency room wait times of 55 minutes in 2006. We can only presume that wait times have increased since then for 2007 and 2008. So if the average wait time to see a provider in the ER dropped only 15 minutes from that, patients across the country would save more than 30 million hours of waiting, pain, and suffering.
If the time to provider (TTP) and turn around times (TAT) for admitted and discharge patients were required reporting for emergency rooms, consumers could more easily judge which emergency room is providing timely service. These operational metrics are excellent indicators of efficiency and quality, and we know strong performance in these areas also drive market share and revenue, something every hospital is concerned about today.
For example, in our large emergency physician practice partnership - with 3 million patients in 65 hospitals across seven states - we have seen a drop of 14 minutes in the time to provider. This is 14 minutes off a time to provider which was already 15 minutes below the average wait time of 55 minutes according to the results reported in a 2006 survey by the Centers for Disease Control (CDC). This is an indicator of improved efficiencies which have greatly increased patient satisfaction.
We can no longer blame uninsured patients and lack of reimbursement for long wait times. Nor can we keep blaming the nurses or the emergency physicians and lack of staffing. What is in short supply is effective physician, nurse, and administration leadership to address emergency room overcrowding issues.
We know that using the same emergency physicians and nurses - but changing the emergency room management and patient flow systems - can transform a poorly performing emergency room into a high performing one. And it can be done without significant capital expenditures. So let's have those who have achieved exceptional performance metrics speak up and challenge the media to get the real stories out about what's working well, not just what's the "average". Patients can then make an informed choice and will vote with their feet and choose the ER that makes them wait less. And we will all be the better for it.