ER-Forum Blog

Are more emergency department patients really a problem?

By Wesley A. Curry, MD

While the focus regarding health care reform has been on the complexity, cost, and political posturing, one issue hasn’t gotten nearly enough coverage. It’s the very real question of whether health care reform will increase ED patient volumes across the country. 

An internal review of the often quoted Massachusetts experience by our emergency physician group suggests the stated 9% increase over three years may not be a reliable indicator of the impact of health care reform in the future.

For example, our client hospitals almost equal (67) the total number of hospitals in Massachusetts (75).  But we likely see more total patients in the emergency room because the average patient volumes in our client hospitals are higher. Over the past three years we’ve seen a similar increase in patient volumes, as reported from the Massachusetts experience – particularly in California practice locations where there is no health care reform.

As the chart below indicates, we’ve already seen an increase in 30 million patients per year in the past 20 years before health care reform and with declining physician reimbursement for certain patients it seems every year.  Interestingly, this is also about the same number of newly minted insured’s we can expect from health care reform once implemented. I think there is still capacity in our health care system, even if we don’t agree that the emergency room is the ideal place to see more patients. So are more people with insurance a problem? I don’t think so.

It’s likely that in every state there are a number of factors such as competition for market share, managed care, limited primary care access, convenience, less hospitals and fewer insured patients combining to drive up patient volume in the emergency room. It seems unlikely the only thing that changed in Massachusetts was more insured people.

With health care reform and the increasing number of insured patients in the coming years – most, if not all, will still face the problem of timely access to see a primary care provider. If needed, people will seek care in the emergency room as an alternative. This, along with the fact that many professional, social, and government entities are forecasting a severe shortage of primary care providers and nurses, suggests that the challenge is real. 

My view is that many current heath care providers and nurses will leave the industry as the economy improves, and the impact of health care reform on income and working conditions outweighs the economic benefits for those able to retire.

So what does the future look like? I believe there will be fewer, but larger emergency rooms able to handle 150,000-250,000 patient visits per year. Let’s not panic about more “insured people” – what I call “tomorrow’s hospitals-today” already exist. These hospitals function without patient crowding, and with shorter wait times than many hospitals seeing only 30,000-40,000 patients per year.

As a physician still in practice, and the CEO of a large emergency physician group, I believe this new health care era represents many opportunities and challenges for those of us in emergency medicine. If anything should be mandated, it is clinical and administrative systems and technologies that enhance patient care and improve patient throughput in the ED. We should embrace this tectonic shift in our health care system and be prepared for the many predictable – and unpredictable – changes that are certain to come. This is our chance to truly shape the future of emergency medicine.

What are your thoughts or concerns on the future of emergency medicine? Please share your opinions and insights.