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Emergency Rooms and Docs Brace Themselves For Newly Insured

 |  By cclark@healthleadersmedia.com  
   March 25, 2010

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.

Some people may seek care in the emergency department thinking they have coverage. However, according to the Senate Web site's immediate benefits timeline, health reform will provide "access to affordable coverage for the uninsured with pre-existing conditions" within 90 days.

Though the legislation also provides $5 billion in immediate federal support to help pay for affordable coverage, Gardner says that to be eligible, patients will have to show that they applied to commercial health plans and were turned down because of pre-existing conditions.

There are potentially millions of newly insured, but Gardner isn't sure that hospital emergency teams will be slammed. "Honestly, I don't think anyone can get a handle on this. Even for those of us who have been involved in this topic for 18 months, it's so complex and huge. I've been chin deep in this 18 months and even I can't predict everything that will happen when this takes effect."

The new health reform law includes 29 provisions scheduled to take effect in 2010, but patients will probably not see the impact of any one of them for at least three months, and most will not take effect until this fall or later.

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