Emergency Rooms and Docs Brace Themselves For Newly Insured

Though new health reform laws won't take effect for at least three months and most provisions won't come into play until six months to four years, hospital emergency rooms and physicians are bracing for an onslaught almost immediately.

"People will start coming because they think they have health coverage" when they don't or reform provisions that apply to them don't kick in for quite some time, says Angela F. Gardner MD, president of the American College of Emergency Physicians.

When universal health coverage took effect in Massachusetts, she says, emergency room visits immediately rose 7%, even though that state already had a higher than national average percentage of insured residents.

Because other states start out with higher numbers of people who have been uninsured than Massachusetts had, hospitals nationally can expect to see a 10% surge in their emergency room load, Gardner estimates.

That could have a serious impact on two aspects of emergency room care: the number of patients who are boarded—that is retained in the emergency room while they await admission to an inpatient bed— and the number of emergency room visitors who leave without being seen, says Gardner, a full-time emergency physician.

"What you can anticipate is that an additional volume of people [coming for emergency care] will have a very major effect, and I think hospitals need to be prepared," she says. "The same 20% of these [new] patients will need to be admitted."

Another load of patients will come from physician office practices, she predicts. "More and more physicians in the community will send patients to the ED instead of the office when they know the patient will probably need admission. That's because of a growing trust of what emergency department physicians can do."

Another important bit of planning advice she has for hospital administrators is to make sure that they have a plan for overcrowding in the emergency department. Surprisingly, she says, The Joint Commission has no standards for how hospitals should respond to problems involving boarding and overcrowding in their emergency rooms, although such policies are in development.