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Emergency Docs Say Sebelius is Wrong About ED

Cheryl Clark, for HealthLeaders Media, July 16, 2009

A statement yesterday from U.S. Health and Human Services Secretary Kathleen Sebelius seems innocuous enough: A lot of people seeking care in emergency departments are uninsured.

But the nation's leading group of emergency physicians immediately took issue with her remarks, saying she's perpetuating a myth about hospital care and is missing a much bigger problem.

In her statement, Sebelius said statistics from a database managed by the Agency for Health Research and Quality show that in 2006, one in 5 patients seen in emergency department settings was uninsured, that low-income patients accounted for almost one-third of patient visits, and residents of rural areas comprised one-fifth of emergency room care.

"Our health care system has forced too many uninsured, rural and low-income Americans to depend on the emergency room for the care they need," Sebelius said. "We cannot wait for reform that gives all Americans the high-quality affordable care they need and helps prevent illnesses from turning into emergencies."

Upon hearing of the release, Nick Jouriles, MD, president of the American College of Emergency, says her statement "perpetuates the myth that patients who come to emergency rooms don't need to be there, and if there were more primary care doctors, they wouldn't be. But the facts just don't bear that out."

Even the Centers for Disease Control and Prevention's "own statistics say that only 12% of patients seen in emergency departments don't need emergency care within 24 hours; everyone else needs to be there," says Jouriles, an emergency room physician in Ohio.

Sebelius' statement implies that emergency rooms would not be crowded, and patients wouldn't have to wait as long—and would get better care—if there were more primary care doctors who would see them in their offices. That's a message perpetuated not just by the Obama administration, he said, but the Clinton and Bush administrations carried that incorrect message too.

In this case, Jouriles says, Sebelius and the White House appear to have an agenda: To beef up support for expanding primary care physicians while ignoring the needs of hospital emergency departments.

"We know we need more primary care providers, but that's a long-term project, one that will take 10-15 years to accomplish," Jouriles says.

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