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January 16, 2014 at 10:54 AM
(Bloomberg) — With the Patient Protection and Affordable Care Act (PPACA) bearing down on them, a doctors’ group said emergency rooms are less able to provide quality care than three years ago, and more resources will be needed to handle an expected surge of patients.
Hospitals have fewer beds available, causing delays in ERs that saw visits climb to 130 million in 2010, according to a report from the Dallas-based American College of Emergency Physicians. Federal funding for disaster preparedness has fallen, so the hospitals are also less prepared to handle a sudden influx of injured patients, the group said.
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Care will become harder to access as people newly enrolled in the U.S. Medicaid program for the poor and aging baby boomers turn to ERs for medical services, the report said. PPACA broadens Medicaid eligibility to more than 19 million people. A study published in Science this month found new Medicaid patients in Oregon visited ERs 40 percent more often than the uninsured.
“Every year it’s a little worse,” said Arthur Kellermann, dean of the medical school at the Uniformed Services University of Health Sciences in Bethesda, Maryland. “But unless you find yourself in a stretcher in a hallway without a bed, you don’t realize it.”
Staffed inpatient beds fell 16 percent to 330 per 100,000 people in 2012, and psychiatric care beds dropped 15 percent to 26 beds per 100,000, today’s report said.
Direct result
“Emergency department crowding is a direct result of inpatient capacity,” said Jon Mark Hirshon, associate professor at the University of Maryland School of Medicine in Baltimore, who headed the report’s task force. ER physicians “have to spend a lot of time finding a place to send somebody,” he said in a telephone interview.
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The number of emergency physicians per 100,000 people rose to 13.5 from 11.8, the doctors’ group said. That’s not enough, Kellermann said in a telephone interview.
“ERs provide 28 percent of all acute care visits, but only 4 percent of doctors work in the emergency department,” Kellermann said, citing a 2010 study published in the journal Health Affairs. “If there’s more people coming into the ER without a dramatic expansion in doctors and inpatient capacity, you’ll get a bottleneck.”
