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Alternative Prescription For ER Crisis

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By RONALD HAMMERLE Special To The Tampa Tribune

The Tampa Tribune

Published: December 31, 2008

Your (Dec. 26, Our Opinion) editorial recommending "quick treatment" for "our emergency room crisis" may run the risk of prescribing the wrong medicine. Three of the underlying causes you cited may be better, more quickly and more economically treated by other means.

"Chronic ailments," the first symptom you (and the ER physicians' professional association) cited, are clearly managed better outside of a hospital emergency room. High cost emergency rooms are not designed, built or professionally staffed to manage chronic ailments; primary care offices and chronic disease management programs are - and do so measurably better at fraction of the cost.

Secondly, the use of emergency departments as a "typical doctor's office" is not limited to "uninsured and underinsured" patients. Patients from all backgrounds have been encouraged to seek care there after local medical offices typically close. ER physicians acknowledge that between 40 percent and 85 percent of patients coming to emergency departments do not have true medical emergencies. Many of those can now be treated - faster, less intensively and at about one-tenth the cost - at free standing walk in clinics or at many convenient care clinics now operating in major retail stores. Federal, state and employer-based insurance plans can and should take immediate, administrative steps to financially and clinically encourage more appropriate utilization the latter facilities.

Thirdly, there is clear, statistical evidence that both Florida and the nation lack an adequate number of primary care physicians. Three legislative steps can be taken to address that problem. First, the Florida Legislature can extend the scope of practice for nurse practitioners and physician assistants both of whom are substantially underutilized owing to restrictive licensing laws - not their qualifications or training to provide primary care.

Here, as in most states, the state's own licensing laws have been used by special interest groups to restrain trade, limit supply and preserve special economic interests - all operating against the interests of the people of the state as a whole. Secondly, physicians here and elsewhere have clearly said that Florida's failure to address the issue of professional liability reform and the state's more recently enacted "three strikes" legislation, both inhibit the attractiveness of this as a place in which to practice medicine.

Finally, a larger, more time consuming and politically challenging task is to reform payments made to physicians in order to encourage and retain primary care physicians. The United States has a physician training and payment system built upside down. For decades, we have allowed and financially supported a system that encourages a preponderance of highly paid medical specialists and subspecialists, while actively discouraging and underpaying physicians for primary care-including preventive care and chronic disease management. It does not take a professional economist to tell us that these rank high among several reasons why American medical costs vastly exceed every other country in the world, why we justly write that "Florida needs another 800 family physicians now" and why our national healthcare ranking, among nations of the world, currently stands at 37th.

Thus, prescriptions to build more hospital emergency departments and increase the pay for hospital-based emergency specialists - while good for ER physicians - are not the best prescriptions for congestion in the emergency department, securing more primary care services or measurably improving our personal, state and national health.

Ronald L. Hammerle of Valrico is a national speaker, author and adviser on health issues and has served as an adjunct faculty member and lecturer in graduate schools of medicine, business and pharmacy.

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