The ER crisis

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The E.R. Crisis. What’s causing us to choose emergency medical care, and the steps we need to take before the crisis becomes a disaster.

Dale Davis has no college degree, no medical training, but could be considered an expert on the inner workings of a hospital emergency room. He suffers from cirrhosis of the liver, gout, and cognitive disabilities from a traumatic brain injury from a motorcycling accident. Due to this impressive list of ailments, he visits his local E.R. about three times a month, sometimes more. “There’s no comfort level at all in a big city hospital,” says Davis. “I know a lot about…metro hospitals where there is a lot of chaos in the emergency room, a lot of waiting.”

According to Davis’ experience, not everyone that comes to the E.R. is in critical condition. “Some of the people that are there, are there just for the sake of being there and aren’t really there for an emergency at all. And then some of the people there that are really there for emergencies, can suffer greatly.”

This chaos that Davis mentions, is the re-emerging and troubling trend that experts call “The E.R. Crisis.” The E.R. Crisis is a blanket phrase for the overcrowding of emergency rooms nationwide, especially in urban, densely populated places like Atlanta. The New England Journal of Medicine has published that visits to the E.R. have increased 26 percent since 2006. Why they are increasingly more crowded is a matter of opinion, and varies based on who you talk to. When it comes down to it, there are three possible answers; limited access to healthcare, diminished funds for hospital emergency care, or limited access to primary and preventive care options.

Dr. Stephen Pitts, doctor of Internal and Emergency Medicine at Grady Memorial Hospital, says lack of primary care physicians is a driving force of these mounting numbers. “People try to go to their doctor, but they can’t get in,” says Pitts. “To stay in business in primary care, you have to see another patient every fifteen minutes. If they can’t do that, they have to fire their office staff. Economic forces have put them in a bind, it makes them not able to give people the care they want to.” Dr. Pitts says that lack of access to primary care physicians is because of their unwillingness to accept uninsured patients and their preference for other private, more profit resulting insurance plans.

But it’s not the uninsured populations who are filling up E.R. beds. “The fact is the uninsured come to the E.R. less than other categories of patients. They’re worried about having a bill, and wait longer to be seen,” says Pitts. “Medicaid patients have the highest rate of visits, something like 50 to 60 people out of 100 in a year.”

In fact, with the Patient Protection and Affordable Care Act, the year 2014 is expected to cover 16 million more Americans with the Medicaid insurance plans. That is 16 million more people newly insured, and perhaps more likely to visit their local E.R. The projected data is troubling for most city hospitals. When the Medicaid expansion is implemented, the previously uninsured patients may no longer be concerned about the big bills, and may adopt the visiting frequencies of the patients who are currently on Medicaid.

The government is anxiously developing a solution to this impending aggravation of the E.R. Crisis. To stem the influx of emergency room patients, the government is developing programs to entice primary care physicians to be more likely to accept Medicaid insured patients. By offering more monetary incentives to take on these patients, the government hopes to lessen the burden of the emergency rooms, and channel patients to begin to choose primary and preventative avenues, rather than emergency care options.

Despite these measures, the initial stages may still be devastating. To some experts, the problem is the cost burden of E.R. visits and the toll it takes on the entire system.

Michael Rovinsky, President of Integrity Consulting Group, a healthcare consulting group based in Atlanta, says the E.R. is the currently the most expensive endeavor of the entire healthcare system and will continue to be.

The E.R. is the biggest problem in healthcare, says Rovinsky. “It is overused by people who do not have a critical condition. The worst part of emergency care, is it’s the most expensive kind of healthcare. It costs the payers of healthcare a tremendous amount of money.” According to Rovinsky, the behavior, and the culture of the population who uses the E.R. as a primary care solution, will be among the hardest thing to change.

Likewise, many lawmakers are not in favor of the law, and will further hinder primary care expansion to prevent extreme overcrowding in emergency departments. Rovinsky says, this will only worsen the current problems. “A number of governors across the country are against the expansion of Medicaid. Hospitals treat patients anyway, without any money. It’s in their best interest to accept the expansions, because it’s costing the system more money without it. The ultimate goal is the overall reduction of healthcare costs for the entire population.”

More importantly, there is an underlying issue that is often neglected and failed to be targeted in government acts or motions of reform. Patient responsibility is also a topic this rarely mentioned. If everyone was insured, everyone had a primary care physician, and everyone had access to these programs, people still will continue to get acutely ill.

Rovinsky says, it’s because of an unwillingness of some patients to take care of themselves. He explains it simply that the biggest cost to healthcare is using healthcare services. Things that prevent acute illness lessen the amount of money being spent. Simply stated, yet rarely understood, or even mentioned in public debate.

“Anything that leads to poor health, tremendously increases the cost of healthcare,” says Rovinsky. “The big thing that no one will speak about is personal responsibility for wellness. The obesity crisis, the diabetes crisis, drives the cost of healthcare up. The public should take personal responsibility for living a healthier lifestyle. That’s the missing piece in the healthcare discussion.”

All in all, even if all these reforms and preventive measures take a successful hold, the healthcare world is just a world of maybes. Maybe people will seek primary care physicians instead of the emergency room. Maybe primary care physicians will take to the incentives to take on Medicaid patients.

Maybe, maybe not.

In the meantime, the crisis will rage on. Until 2014, it is very unlikely experts will have a clear vision of the new horizons of healthcare. People like Dale Davis will continue to be subject to an increasingly burdened system, with a very foggy future.

But he remains optimistic about the quality of care he receives. “I’ve been extremely lucky,” says Davis. “I’ve been uninsured through times of my life, and I haven’t always been fortunate enough to get the care I needed. But it comes down to taking care of yourself too. You stop drinking, you stop treating your body badly, and you can save yourself a lot.”

With eagerness in his voice, he looks forward to his placement on the transplant list for a new liver later this month. Davis also acknowledges the importance of personal responsibility in healthcare, and claims it’s what turned his life around.

“Yeah, it comes down to you. How badly you want the second chance. You have to prove you want to be healthy, you need to prove you deserve the new life. There’s always someone around the corner who may need it more than you, and that may be the one thing that will scare you straight.”