Emergency rooms face crisis
Last Modified: Wednesday, November 12, 2008 at 11:27 p.m.
Dr. Amorette Miller doesn't know if the patient she's treating in the emergency room has insurance.
She doesn't know how the hospital where she works - Helen Keller in Sheffield - will get reimbursed for the services she and others are providing.
What Miller knows at the moment is that the patient needs treatment.
"Most of the time, a patient won't even mention his insurance status," she said. "But the key there is, when we do an intervention and ask the patient if he has a family doctor and he says 'no,' and he's young and healthy or older and healthy, we often hear they just don't see a need to have a family physician."
Emergency rooms at local hospitals are often the health-care option of choice for people Miller describes as those who are otherwise healthy but lack either a family physician or insurance to cover regular physician visits. The result: an often overcrowded emergency room.
A new study by the University of Michigan reveals that people who lack insurance may not be the only ones in crowded emergency rooms. Researchers say the overcrowding is more complicated, and widely repeated perceptions about the uninsured and emergency care may be rooted more in assumption than in solid fact.
"The crisis in emergency medicine and the problems of the growing uninsured population have been conflated," Dr. Manya Newton, lead author of the study and an emergency room physician, said in a news release about the study. "The rise in ER use has much more to do with the aging of the population, the increase in chronic diseases and the decrease in available primary care than with the uninsured. Policies based on false assumptions risk diverting energy and money from confronting the true drivers of emergency department crowding."
Alabama and the Shoals have not been immune to the causes Newton lists.
According to census data, more than 12 percent of the state's population is 65 or older. In the Shoals, more than 15 percent of the population is in that age group.
Compounding the age issue is the fact that Alabama ranks in the top five on several chronic disease lists, including obesity, heart disease and diabetes.
Perhaps of most concern to ER doctors is the fact that fewer and fewer medical students are opting for family medicine as their specialty. And this fall, statistics from medical schools across the country revealed that enrollment was down by 6 percent.
"Primary care physicians see the gamut, from cardiology patients to endocrinology. It's across the board," Miller said. "We refer to primary care physicians as do specialists, so what we're seeing now is a bottleneck there."
An additional component to emergency medicine in the United States is that hospitals with an emergency room can't pick and choose the patients they see. It's a law designed, in part, to ensure that an emergency patient gets the most appropriate care as quickly as possible without regard to his ability to pay.
In Alabama, the law has been tweaked somewhat.
"The state requires that if you have a hospital other than a psychiatric or rehabilitation facility, you've got to have an ER," said Carl Bailey, chief executive officer at Eliza Coffee Memorial Hospital in Florence.
Unfortunately, he said, the state's track record for reimbursements on its Medicare and Medicaid patients is not good, and it's a situation which often forces hospitals to operate their facilities at a loss.
The question is, then, how long can these facilities do this and still give appropriate, up-to-date care?
"It sounds cold and heartless to turn people away," Bailey said. "But it sounds even more cold and heartless to close a community hospital. Our number of uninsured patients is up this year by 1 percent, but 1 percent translates to $7.5 million over the course of the year. That's probably $1.5 million to the bottom line in a negative impact."
Clinics in outlying rural areas of Lauderdale County, such as those in Greenhill and Lexington, have helped ease the burden on the emergency room at ECM, Bailey said.
But it also presents a loss in revenue, too, as ER patients often translate into patients who are then admitted into the hospital for care.
"I know I sound all doom and gloom, but we're on the verge of a health-care crisis," he said. "Alabama is a little more vulnerable than other states because of our high population of uninsureds. We have the lowest Medicare payments in the country and Blue Cross/Blue Shield doesn't pay hospitals as well as other third-party insurers. All you have to do is look at Decatur to see how this is playing out."
Earlier this year, Decatur lost its last group of obstetricians and gynecologists, citing low reimbursements and rising numbers of Medicaid patients among reasons for pulling out.
Miller said improvements must be made in how the state allows doctors and hospitals to practice emergency medicine.
"One solution that I've witnessed is to allow hospitals to sponsor urgent-care clinics that are staffed with physicians who are ER physicians and that's funded by the hospital," she said. "Some of the physicians would need to be trained in ER medicine as well as primary care medicine"
This solution is short term at best, Miller said, but it would ensure that the patient who leaves the ER without a primary care physician will have one for follow-up care.
"Unless we come up with an alternative (to our situation), it's possible that the system will stop functioning altogether," she said.
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Comments
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November 13, 2008 6:55:09 am
RE: Link
Pleeeease, would someone tell me this is a soap opera!
Having used ER rooms a few times in the past, when did you ever get past the front desk without telling them if you have insurance? How much tx did you get before they had a copy of your card? How many meds did you get before they asked "Have you met your deductible?"
And if you did not have insurance, how fast did the tx plan change?
November 13, 2008 7:12:09 am
I agree with what you are saying there LMN,but,that is in the front,and those things are generated from administration. The Docs,nurses,and techs back in the actual treatment area have no knowledge of a persons insurance status when they walk into that patients exam room.
It has become an overwhelming issue. Far too many people use an emergency room for their medical clinic,too many things which can be seen by a doc the next day,or in many cases,the next week, as they are NOT life threatening,or even deemed serious.
we cannot put all the blame on the hospitals. Joe Public has more than his fair share of blame on the problems our ERs are facing.
November 13, 2008 7:17:29 am
Sounds like one to me. I know when my daughter was sick while I was in the Quad Cities, I had to fight with the hospital to accept Tri-Care. They actually wanted me to go to Huntsville. Heller Keller even once place a negative item on my credit report for non payment. The funny thing is I was not even in the country when services were supposedly rendered. It was also funny since I have not lived in the Quad Cites since '97. After a few phone calls from a JAG Officer I got it removed
November 13, 2008 7:29:43 am
The article aside, the pic is a hoot. Four nurses to take a woman to L&D? Pulease... Then there's the one on the left with the untethered hair. (Yes, I see some like that.) In case any of you guys think that's cool, just remember that before she's coming to take your temp she just picked up a full bedpan from the room next door. If her hair is damp, it's not perspiration. Can you say pheeeew?
November 13, 2008 8:15:12 am
Why does the doctor care about how the hospital is getting paid? She bills separately! Yes, that's correct â?? the price of a trip to the ER does not include the doctor! Helen Keller will bill you $7500 for four stitches and just when you think it can't possibly get any worse you'll get another bill from the doctor! $1000 for 5 minutes!
Try billing them your going rate for the 3 hours you sat bleeding from the head in the waiting room while not one single person was taken in... Try figuring out why it took three hours to get in when you are the only patient in siteâ?¦ Try asking how much anything is going to cost or what they are doing or if it is neededâ?¦
Overcrowded? Underinsured? PUUHHHLLLLEEEEAAASE!!!!
Try slow, inefficient, overpriced, careless, and insane bunch of whiners!
November 13, 2008 8:40:18 am
If you can do it better do it and put them out of business.
November 13, 2008 8:44:00 am
Bravo for Dr. Doogie. The same thing happens at Gadsden Memorial. $1700 plus $855 for 10 minutes with the doctor.
November 13, 2008 8:51:07 am
Four stitches generally is not an emergency, go to a minor med instead of the ER and you can get that done for less than a hundred dollars. The emergency room is not a primary care physician, people using it for one is a big part of why you wait hours to see a doc.
November 13, 2008 8:51:48 am
Smurph, I agree the ER's are used for the wrong reasons but I disagree the docs don't know the insurance status of the patient or change tx.
Brief story: My dad was taken to ECM ER for a heart attack. He was in assisted living at the time on Medicare.
We got there at 9am. We sat in a tx room for over an hour until a heart doc arrived. He was in 5 minutes, ordered tests and was gone. At 6pm after tests results, the doc was siting at the center desk with his back to me talking to another doc who could see me. He was saying, "well I could do surgery or I could do this tx or I could send him here or there, but since his family doesn't care about him and he has no insurance, I don't know what to do." The other doc would just look at me, then down, the whole time the guy was talking. They finally took him to a room at 6:30. By 7:30 he had died of cardiac failure. I have never used them again.
November 13, 2008 9:00:36 am
Flo, I have not heard that name in years, my dad served in the Navy for 20 years.
I am in a similar mess with a hospital in Arkansas. My husband fell while on a temporary assignment and broke both knees. It has been a nightmare. This was in March.This week we got a collection notice saying we never paid for the 2 ambulance rides. Problem is, we were never billed and neither was our insurance. My husband called the collection agency and explained and she said that regardless of the situation, it will remain on our credit record for 7 years.
He called the ambulance service who said they did not have our address to bill us or our insurance info. My husband told them the hospital had all that. They said they were not allowed to ask for the info. He signed a waver to ride in the ambulance. Looooger story.
Why did the collection agency have no trouble getting the info and harassing us, but the ambulance service could not?
I am fed up with all the bureaucrats and red tape.
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