Congress, the White House, and the public still don't appreciate the essential need to strengthen rapid response expertise within hospitals, says a coalition of emergency room doctors who launched yet another campaign to set the record straight.
"The national health reform debate is coming to a head," says Gordon Wheeler, spokesman for the American College of Emergency Physicians. "But despite the letters we've written and our own activities on the Hill, we keep hearing that if we just pass legislation to get more primary care physicians, and got everyone insured, people wouldn't need to go to the emergency room.
"Well, we know that's not true. We know that many of those 120 million patient visits to the emergency room a year will continue, some of them at the behest of their physicians. So what are we doing to invest in our emergency medicine infrastructure? Not very much."
The organization, which represents some 28,000 emergency room doctors in the U.S., has felt bruised and underappreciated since President Obama took office. First, ACEP was excluded from an early White House health reform summit in March.
Second, state by state, policymakers seem to be un-phased by the growing number of emergency room patients being "boarded" in hallways and broom closets, an indication of overcrowding and the decline in the number of emergency rooms nationally.
And third, they feel insulted by Kathleen Sebelius, Health and Human Services secretary, who they say keeps trivializing the importance of emergency room care. She suggests that most patients who go there could have had their medical issues dealt with in other, less expensive and more efficient settings. That's simply not true, the group maintains.
The campaign points to four "myths" about health reform that ACEP believes are being perpetuated in the health reform debate. And the group wants to clear the air.
Myth: America's emergency departments are full of people who don't need to be there.
Fact: Arguably, only 12% of patients who go to an emergency room don't really need to be there. And many of those have symptoms of a medical emergency that turns out, after appropriate exams and testing, are determined to not be emergencies. But the patients needed to be in the emergency room to find that out, according to ACEP.
Myth: Emergency care is inefficient and expensive, and decreasing visits will save significant amounts of healthcare dollars.
Fact: Emergency care is only 3% of total yearly healthcare spending. "Keeping personnel and facilities open 24 hours a day does cost more than keeping an office with no emergency room open 40 hours a week. No matter when patients are sick, we are open," says ACEP.
Myth: Demand for emergency care will decrease when health reforms are passed.
Fact: Massachusetts experienced a 7% increase in emergency visits after providing universal coverage. "Emergency providers are the front-line for natural and man-made disasters, and as such, will be in even greater demand," says ACEP.
Myth: Emergency care will be there when you need it.
Fact: With the decline in the number of hospitals with operational emergency rooms in recent years, there are far fewer facilities to see patients and they are farther apart. Emergency visits have increased an average of three million patients per year over the past decade. And boarding, the practice of leaving patients in the emergency department instead of placing them in inpatient hospital beds, leads to 30% of the nation's emergency beds as unusable for new emergency patients.
So as health reform language is punched, squeezed, and twisted into various marks this month, ACEP is spending $110,000 on a print, broadcast and Web-based campaign to get their message across. They want lawmakers and the public to give emergency room care more attention, more resources, and more respect.
"We expect significant increases in emergency visits across the national if national universal coverage is enacted," noted ACEP president Nick Jouriles, MD.
The campaign calls for these overall policy changes:
- Tort reform, so emergency room physicians won't spend what ACEP estimates is billions of dollars on defensive medicine. Emergency physicians order more care out of fear of litigation than many other specialty providers, Wheeler says.
- Computerized systems that link emergency departments with the medical record files in the systems of patients' physicians and other caregivers, so drug, blood, and imaging tests that have already been performed aren't repeated. "Even if the physician is sound asleep (in the middle of the night), an emergency room doctor could see the patient's files, and know that he or she had already had an MRI, and see the doctor's notes. It would make a huge difference," Wheeler says.
- Elimination of the practice of boarding, in which patients are allowed to stay in hallways and even closets when the emergency room backs up while they wait for an inpatient bed to become available.
- National surge capacity plans to help emergency departments prepare for H1N1 or other infectious disease pandemic, a terrorist attack or other catastrophe.
- Health reform proposals that may be included in some of the many amendments under discussion this week include a 5% pay differential that would enable physicians to sign up for emergency department call, and not worry about a loss of income if they end up providing too much uncompensated care. "There's a tremendous problem with the supply of on-call physicians," Wheeler says.