Visits to hospital emergency rooms soared to an all-time high of 136 million in 2009, according to new estimates provided by the Centers for Disease Control and Prevention (CDC). This represents an approximately 10 percent increase from the 2008 statistic of 123.8 million. The CDC study is one of three examinations of ER use being released at the American College of Emergency Physicians meeting.
According to the CDC, patients under the age of 15 accounted for 21 percent of ER visits in 2009; patients between 15 and 24 made up 15 percent; patients between 25 and 44 accounted for 28 percent; patients between 45 and 64, 21 percent; and patients 65 and older, 15 percent. Breaking visits down by gender, the CDC noted that women visited the ER at a rate of 48 visits per 100, while men had a rate of 42.
The expected sources of payments for ER visits were private insurance, 39 percent; Medicaid or State Children’s Health Insurance Program, 29 percent; Medicare, 17 percent; other and unknown, five percent each. Nineteen percent of ER visitors reported that they had no insurance. The most typical reasons for visiting the ER were stomach and abdominal pain, 9.6 million; fever, 7.4 million; chest pain, 7.2 million; cough, 4.7 million; headache, four million; and shortness of breath and back symptoms, 3.7 million each.
Physicians attributed the sharp increase to both greater demand for services and improvements that allow ERs to treat patients faster. “With the economy, people have lost their coverage and, given the fact the emergency department is the safety net, they come to us,” said Dr. Jay Kaplan, an emergency physician at Marin General Hospital who serves on the board of the emergency physicians’ organization. The physicians contend that it is counterproductive to discourage patients from going to the ER to save money in healthcare costs because they say it doesn’t. “We’re efficient. We take care of acute patients and that’s what we do well,” said Dr. Paul Kivela, managing partner of Napa Valley Emergency Medical Group, and a board member of the American College of Emergency Physicians.
According to Dr. Michael Gerardi, an ACEP board member, he and his colleagues want comprehensive medical liability reform that includes indemnification based on recognized guidelines, caps on non-economic damages and medical courts where providers are judged by medical peers. “In America, we sue far too often for bad outcomes and not deviations from standard of care,” Gerardi said. “The overall anxiety of patients and the lack of acceptance that bad outcomes happen are driving costs.” Because ERs are safety-net providers, they have become increasingly overcrowded. One factor is the passage in 1986 of the Emergency Medical Treatment and Labor Act, which requires hospitals to provide people with emergency services, despite their inability to pay.
It has been estimated that 13.7 percent of all emergency room visits could be treated in retail medical clinics, which are typically based in pharmacies or grocery stores. These facilities are equipped to treat a limited number of minor conditions, such as throat infections or urinary tract infections. An additional 13.4 percent of emergency room visits could be handled by urgent-care clinics — an independent medical facility that can handle a broader scope of problems, such as minor fractures and more serious injuries. Urgent-care clinics typically are open on evenings and weekends, fulfilling the need for patients with occurring before or after typical physician office hours.