(Bloomberg) With Obamacare bearing down on them, a doctors group said emergency rooms are less able to provide quality care, and more resources will be needed to handle an expected surge of patients from the new law.
Hospitals have fewer beds available, causing delays in ERs that saw visits climb to 130 million in 2010, according to a report from the Dallas-based American College of Emergency Physicians. Federal funding for disaster preparedness has fallen, so the hospitals are also less prepared to handle a sudden influx of injured patients, the group said.
This report card is sounding an alarm, Alex Rosenau, the physicians group president, said Thursday on a conference call. The need for emergency care is increasing, the role of emergency care is expanding, and this report card is saying that the policies are failing.
Care will become harder to access as people newly enrolled in the U.S. Medicaid program for the poor and aging baby boomers turn to ERs for medical services, the report said. The Affordable Care Act broadens Medicaid eligibility to more than 19 million people. A study published in Science this month found new Medicaid patients in Oregon visited ERs 40% more often than the uninsured.
Every year its a little worse, says Arthur Kellermann, dean of the medical school at the Uniformed Services University of Health Sciences in Bethesda, Md. But unless you find yourself in a stretcher in a hallway without a bed, you dont realize it.
Staffed inpatient beds fell 16% to 330 per 100,000 people in 2012 from 2009, and psychiatric care beds dropped 15% to 26 beds per 100,000, the group said.
Direct result
Emergency department crowding is a direct result of inpatient capacity, says Jon Mark Hirshon, associate professor at the University of Maryland School of Medicine in Baltimore, who headed the reports task force. ER physicians have to spend a lot of time finding a place to send somebody, he says.
The number of emergency physicians per 100,000 people rose to 13.5 from 11.8, the doctors group said. Thats not enough, Kellermann says.
ERs provide 28% of all acute care visits, but only 4% of doctors work in the emergency department, Kellermann says, citing a 2010 study published in the journal Health Affairs. If theres more people coming into the ER without a dramatic expansion in doctors and inpatient capacity, youll get a bottleneck.
Cash needed
The doctors report, which gave the nations emergency care a grade of D+, contained a range of recommendations, including funding for a commission to investigate the shortage of health professionals and for pilot programs aimed at improving care. Doctors should be given some liability protection for ER work, and federal money should be withheld from states that dont pass safety legislation like motorcycle helmet requirements.
Kellermann, who previously headed the department of Emergency Medicine at Emory University in Atlanta, also said access is declining faster in low-income communities.
Hospitals are also less prepared for disasters, the report said, due to decreased federal funding, which fell 31% to $9.52 per capita from $13.82 in 2009.
Times are not wonderful for a lot of hospitals: volumes have been declining the number of paying heads in the bed, and money is tight, says Sheryl Skolnick, an analyst at Stamford, Connecticut-based CRT Capital Group LLC.
