OUR VIEW: STATE OF EMERGENCY
Confront emergency room crisis with health care reform, better funding
The nation's emergency rooms turn away an ambulance a minute because they're overburdened.
They're also financially strapped and ill-prepared to handle mass influxes of patients after disasters -- anything from hurricanes to terror attacks to a flu pandemic.
That's the ominous prognosis from reports released last week by the Institute of Medicine, part of the National Academy of Sciences.
The same problems affect Florida -- where emergency care wait times average four hours, the fifth-longest in the nation -- and Brevard County.
Florida ranks near the bottom nationally in emergency departments per 1 million residents and needs more, according to a January report from the American College of Emergency Physicians.
The Florida Hospital Association says the situation is at crisis level, citing overcrowding that delays care and a shortage of physicians, including of specialists willing to work in an emergency department.
In Brevard, emergency departments have to send ambulances to other centers from 15 to 20 times a month during the winter when snowbirds swell the population.
That's according to Dr. John McPherson, a medical director at Holmes Regional Medical Center in Melbourne and president of the Florida Association of EMS Medical Directors.
As a result, it can take ambulances some 20 minutes longer to find a place to leave patients, worrisome delays when health is at risk.
The causes of the emergency care crisis are complex -- including population increases and, in Florida, a growing elderly population -- and solving it requires action on several fronts.
Locally, Health First is expanding its emergency care capacity at Palm Bay and Holmes hospitals and plans to build a full service emergency department at its proposed new hospital in Viera.
Other solutions include opening more alternatives to emergency rooms, such as urgent care sites and making sure emergency departments use existing resources efficiently.
But those are only a superficial salve for a problem rooted in a greater health care crisis:
The uninsured.
More than 46 million Americans, including more than 3 million Floridians, lack health coverage.
They, along with Medicaid recipients who can't find doctors, are using emergency rooms as a medical safety net, jamming the system and increasing waiting times for all.
And while ERs are required by law to treat the uninsured, they often aren't compensated for doing so.
One out of every four emergency department visitors at Wuesthoff Medial Center in Rockledge and Melbourne has no insurance coverage or money, and 99 percent of the organization's charity care and bad debt come from emergency care, according to spokeswoman Lisa Crites.
The costs of such unreimbursed care have contributed to the closing of more than 400 emergency departments nationwide since the early 1990s, says the Institute of Medicine study.
The study calls for Congress to establish a pool of at least $50 million to help hospitals recoup those costs.
It also says Congress should significantly boost the scant dollars it has provided so far to help emergency departments prepare for large disasters.
In the wake of devastating hurricanes in recent years -- and in light of the threat of flu pandemic and potential for more terror attacks on American soil -- Congress should follow those recommendations.
But that's still just a start on solving the emergency care crisis.
Nothing short of comprehensive health care reform to ensure more U.S. citizens have access to primary medical services will stem the flow of needy patients into the nation's ERs.
With no action to do that coming from Congress, it's up to states to tackle the challenge. Florida's plans to put Medicaid clients into private HMOs, however, may do more harm than good.
That's because the state will allow private plans to limit the scope of services patients receive, meaning the impoverished may still resort to emergency care.
A more comprehensive approach, such as a law recently passed in Massachusetts to make health care free or affordable to all, is needed and should be pursued by Florida's next governor.
Readers can discuss this editorial in Community Forums. http://community.flatoday.com
July 9, 2006
http://www.floridatoday.com/apps/pbcs.dll/article?AID=/20060709/OPINION/607090332/1004
Confront emergency room crisis with health care reform, better funding
The nation's emergency rooms turn away an ambulance a minute because they're overburdened.
They're also financially strapped and ill-prepared to handle mass influxes of patients after disasters -- anything from hurricanes to terror attacks to a flu pandemic.
That's the ominous prognosis from reports released last week by the Institute of Medicine, part of the National Academy of Sciences.
The same problems affect Florida -- where emergency care wait times average four hours, the fifth-longest in the nation -- and Brevard County.
Florida ranks near the bottom nationally in emergency departments per 1 million residents and needs more, according to a January report from the American College of Emergency Physicians.
The Florida Hospital Association says the situation is at crisis level, citing overcrowding that delays care and a shortage of physicians, including of specialists willing to work in an emergency department.
In Brevard, emergency departments have to send ambulances to other centers from 15 to 20 times a month during the winter when snowbirds swell the population.
That's according to Dr. John McPherson, a medical director at Holmes Regional Medical Center in Melbourne and president of the Florida Association of EMS Medical Directors.
As a result, it can take ambulances some 20 minutes longer to find a place to leave patients, worrisome delays when health is at risk.
The causes of the emergency care crisis are complex -- including population increases and, in Florida, a growing elderly population -- and solving it requires action on several fronts.
Locally, Health First is expanding its emergency care capacity at Palm Bay and Holmes hospitals and plans to build a full service emergency department at its proposed new hospital in Viera.
Other solutions include opening more alternatives to emergency rooms, such as urgent care sites and making sure emergency departments use existing resources efficiently.
But those are only a superficial salve for a problem rooted in a greater health care crisis:
The uninsured.
More than 46 million Americans, including more than 3 million Floridians, lack health coverage.
They, along with Medicaid recipients who can't find doctors, are using emergency rooms as a medical safety net, jamming the system and increasing waiting times for all.
And while ERs are required by law to treat the uninsured, they often aren't compensated for doing so.
One out of every four emergency department visitors at Wuesthoff Medial Center in Rockledge and Melbourne has no insurance coverage or money, and 99 percent of the organization's charity care and bad debt come from emergency care, according to spokeswoman Lisa Crites.
The costs of such unreimbursed care have contributed to the closing of more than 400 emergency departments nationwide since the early 1990s, says the Institute of Medicine study.
The study calls for Congress to establish a pool of at least $50 million to help hospitals recoup those costs.
It also says Congress should significantly boost the scant dollars it has provided so far to help emergency departments prepare for large disasters.
In the wake of devastating hurricanes in recent years -- and in light of the threat of flu pandemic and potential for more terror attacks on American soil -- Congress should follow those recommendations.
But that's still just a start on solving the emergency care crisis.
Nothing short of comprehensive health care reform to ensure more U.S. citizens have access to primary medical services will stem the flow of needy patients into the nation's ERs.
With no action to do that coming from Congress, it's up to states to tackle the challenge. Florida's plans to put Medicaid clients into private HMOs, however, may do more harm than good.
That's because the state will allow private plans to limit the scope of services patients receive, meaning the impoverished may still resort to emergency care.
A more comprehensive approach, such as a law recently passed in Massachusetts to make health care free or affordable to all, is needed and should be pursued by Florida's next governor.
Readers can discuss this editorial in Community Forums. http://community.flatoday.com
July 9, 2006
http://www.floridatoday.com/apps/pbcs.dll/article?AID=/20060709/OPINION/607090332/1004
