Emergency Rooms Suffer Financial Stress

Emergency Rooms Suffer Financial Stress


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OGDEN, Utah (AP) -- Emergency rooms in Weber and Davis counties are feeling the financial stress experienced by such facilities nationwide. Though none of the local facilities is facing imminent threat of closure, the situation nationwide is that fewer emergency rooms are having to serve increasing numbers of patients.

"Costs are continually increasing -- drugs, equipment, utilities, salaries," said Kayleen Paul, care center director for emergency, critical care and trauma services at McKay-Dee Hospital. "And reimbursement, especially from government payers, continues to decrease."

The problems are the same at Ogden Regional Medical Center and Davis Hospital and Medical Center.

"One of the biggest threats to the emergency department is the fact that people use it as their primary-care provider," said William Sheffield, emergency room director at Ogden Regional Medical Center and an ER physician at Davis Hospital and Medical Center.

"People know that if they come to the emergency room, we have to see them. Federal law requires that emergency rooms have to see everyone -- regardless of whether they can pay or not."

In 1986, the Emergency Medical Treatment and Active Labor Act banned "dumping," a practice in which uninsured patients are stabilized at one hospital and then transported to another.

By providing care mandated by that law, emergency rooms lose $4.2 billion a year in revenue, an American Medical Association study concluded.

The University of California, San Francisco, said nine emergency rooms in California closed last year. Los Angeles County has 75 ERs serving nearly 10 million residents. Ten years ago, the county had 94 emergency rooms.

Nationally, the major cause of ER overcrowding is lack of beds for admitted patients, which causes a backup in ER, Paul said.

She said the emergency department has become "sort of a safety net for people who cannot or should not seek care elsewhere."

McKay-Dee's ER has had a 22 percent increase in crisis patients seeking mental health services, she said. However, beds for mental health patients are extremely limited in Utah, and mental health services are chronically underfunded.

Aging or uninsured Americans also contribute to the ER-crowding problem.

Between 1993 and 2003, the annual number of emergency department visits increased from 90.3 million to 113.9 million, according to the Centers for Disease Control and Prevention. Some of the increase is caused by aging Americans with chronic medical conditions. Also, more than 45 million people are uninsured.

During the same period, the number of emergency departments decreased by 14 percent, leaving the nation's remaining 4,000 ERs to serve an increasing number of patients.

"The emergency department sometimes is the only place that can provide resources that patients need," Paul said. "There are also new treatments for some diseases like stroke and sepsis that can only be diagnosed or treated in hospitals. We want people to come to the emergency department, and quickly, for these."

Sheffield said people also may go to the ER when they can't be seen by their doctor the same day.

"In the emergency room, tests can be performed with immediate results in a lot of circumstances. People don't want to sit around and wait several days for results," he said.

In northern Utah, some patients wait two or three hours to be seen in the ER, Sheffield said, but to help, "Davis has doubled its size in the emergency room and Ogden Regional has plans to expand as well."

Another major problem is the ever-increasing number of regulations and documentation requirements that take up huge amounts of time and resources, Paul said.

New privacy requirements are an example, Paul said.

"Patient privacy is a good thing, but I think people may be unaware of the resources that educating on and complying with federal regulations consumes nationally, and these valuable dollars become consumed by generating required paperwork instead of taking care of patients," Paul said.

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Information from: Standard-Examiner, http://www.standard.net

(Copyright 2005 by The Associated Press. All Rights Reserved.)

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