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Emergency Room Crisis Demands Quick Treatment

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The Tampa Tribune

Published: December 26, 2008

A sobering report released earlier this month by a blue-ribbon panel of emergency physicians concludes the country's emergency care system is in serious condition and under more stress than ever before.

That won't come as a surprise to patients in Florida, who inevitably face hours-long waits to see an ER doctor or to the physicians, nurses and medical technicians who work tirelessly treating what seems a never-ending stream of sick people.

And the hospitals know it too. Just look at the billboards that advertise the benefits of one hospital's ER over another.

So the results of the National Report Card on the State of Emergency Medicine from the American College of Emergency Physicians should serve as yet another wakeup call to policymakers. Challenges remain, and the figurative storm cloud gathering on the medical horizon is getting darker.

The overall grade for the emergency care system in this country and in Florida is a C-minus, compiled from an analysis across five categories: access to emergency care, the environment for quality and patient safety, the medical liability environment, public health and injury prevention and disaster preparedness.

Of particular concern is the poor national score for access to emergency care, a D-minus overall and for Florida, an F.

That is not to say the quality of the medical care received in emergency rooms is poor. But it suggests there are significant problems that need addressing if patients are to receive the medical care they want.

"Florida's emergency care environment is a dichotomy, blessed with considerable strengths but also beset with glaring weaknesses," the report reads.

First off, Florida doesn't have enough emergency departments to service a growing population that includes many elderly residents with chronic ailments who are most in need of medical care.

The state also has a significant number of uninsured and underinsured residents who have come to look at emergency departments as though the ER is a typical office setting instead of an emergency facility.

And people use the ER because they don't have easy or timely access to primary care doctors. According to the report, Florida needs another 800 family physicians now.

A big part of the ER problem continues to be the backup of "boarded" patients who have been admitted to the hospital but must wait for a bed to open. Another issue is that ERs can spend hours looking for specialists who, fearful of liability and worried about getting paid, won't take their calls. Then, too, hospitals sometimes must hold open beds because they can't find the nurses to staff them around the clock.

And there are the financial challenges associated with decreasing reimbursement and the increasing numbers of uninsured patients. Declining reimbursement rates from public programs such as Medicaid and Medicare and decreased and delayed payments from private insurers reduce patient access to primary care providers and increase the amount of uncompensated and undercompensated care demanded of emergency departments.

Last year, congressional lawmakers, both Republicans and Democrats, introduced legislation to address these issues. The Access to Emergency Medical Services Act calls for the creation of a national bipartisan commission to examine the factors that affect the delivery of care in our ERs.

The legislation also addresses some of the financial difficulties facing emergency departments by increasing ER physician payments by 10 percent, and it takes on the specialist shortage by giving additional funding for all physicians who provide care in emergency departments.

The complex factors leading to the crisis in our emergency care system crisis have been known for years but talked about primarily by physicians groups and hospital organizations. The report shows clearly that there is an urgent need for public policy debate over what is a security issue in the United States. It must be part of the coming discussion about the future of health care in America.

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