By David Phelps, Staff Writer
Star Tribune (Minneapolis, MN)
Copyright 2006 Star Tribune
All Rights Reserved
With seven helicopters spread among four airports, 115 ambulances at 22 transportation centers and a new $20 million treatment center, the emergency department of North Memorial Health Care is an anomaly in the world of emergency health care.
It actually makes money.
Overloaded with a large number of uninsured patients, and walk-in patients who can’t wait to see their family practitioner, emergency rooms long have been a melting pot for medical treatment.
A recent report by the Institute of Medicine in Washington decried emergency care across the U.S. as overburdened, underfunded and basically ill-prepared to handle natural and man-made disasters. But in the Twin Cities, emergency-care providers are bucking the trend.
For one thing, Minnesota has a program called MnTrac that allows emergency departments to communicate their availability throughout the day, sending ambulances to hospitals where there’s spare capacity.
And there’s more: In the Twin Cities, emergency units have introduced new programs to help those who can least afford to pay and created quick-care centers to deal with ear infections and ankle sprains and other minor ailments. Some are trying to develop specialties for public health crises, such as avian flu. And some are even taking the approach that losing a little money in the ER isn’t actually a bad thing.
“The ER is the vehicle through which a lot of patients get admitted into the hospital,” said Robert Town, an associate professor at the University of Minnesota’s School of Public Health. “You lose a little in the ER in exchange for having inpatients.”
The efforts at changing the emergency-room experience are starting to pay off.
North Memorial, which will officially open its new 48-bed emergency operation next month, is turning a profit, thanks to its extensive feeder system with hospitals throughout the state and into western Wisconsin.
To transport patients to its Level I trauma center in Robbinsdale, North has high-speed helicopters based in Brainerd, Redwood Falls, Princeton and, most recently, Lakeville. It has nearly two dozen ground stations covering Minnesota and western Wisconsin from Park Rapids in the North to Waseca in the south and Marshall to the west that can transport patients to Robbinsdale by traditional ambulance.
Patient visits are up 35 percent in the past seven years, and the department generates anywhere from 2 to 5 percent more revenue than its $12 milllion in annual expenses.
“We’ve been pleasantly surprised from a business perspective,” said Maribeth Woitas, North Memorial’s director of emergency services. “We’ve recognized that this is a specialty area.”
For patients, the perks include more creature comforts. Among other things, treatment rooms now have doors instead of cloth screens and there’s more room for waiting family members.
Other providers add services
North Memorial isn’t the only hospital that’s investing in emergency services.
United Hospital in St. Paul is planning a new $30 million emergency facility designed to handle mass events such as bioterrorism and bird flu along with car accidents and mental health needs. It will open later this decade. The current 21-bed facility was enlarged in 1992 to handle 26,000 visits a year, but the current volume is 41,000 patients a year.
Regions Hospital in St. Paul, which is also a teaching and research center for emergency care, spent nearly a year to regain its Level I emergency room status, which enables it to treat more trauma cases. It is the only hospital in the east-metro area with such a designation. Regions’ Level I status lapsed in 2005 when it changed its neurosurgeon team.
Hennepin County Medical Center, the state’s largest emergency facility in terms of patient volume with 110,000 patient visits a year, is spending $5.4 million to expand its psychiatric crisis center and build a new urgent care center. HCMC showed a net loss of about $5 million last year on emergency services although the hospital overall finished in the black.
“Its a challenge,” said Dr. Joseph Clinton, chief of emergency medicine at HCMC. “The simple approach is we take care of anybody. We scrimp and scrape and try to get by, but the future doesn’t look bright.”
Caring for the sickest patients
A big part of running an emergency department has to do with plain old traffic control.
At United Hospital in St. Paul, emergency department staff track the progress of patients electronically with a system known as Navicare that allows them to know in a flash whether and where beds are available. The system frees nurses from the task of phoning around the hospital in search of vacant space.
“The emergency department directs the flow of patients through the hospital so we can take care of the sickest people,” said Dr. Jay Westwater, medical director of United’s emergency department.
Contrary to popular belief, it’s not just the uninsured who tend to show up unannounced, said Dr. Brent Asplin, medical director of emergency medicine at Regions Hospital and one of the authors of the Institute of Medicine report.
“The biggest myth is that people without traditional care use the emergency room more,” Asplin said. “The fastest growth in emergency-room use has been people with private insurance.”
Nevertheless, finding a way for people to pay for their care is an increasingly big concern. While Minnesota has the lowest number of uninsured residents in the country at 7.4 percent, that number is growing as employers strain to cut their health care bills.
At Regions, which saw 66,000 emergency patients last year, financial counselors are available in the emergency department around the clock to help uninsured patients. Even though counselors help nearly 1 in 10 patients to find programs such as medical assistance to foot part of the bill, Regions still writes off $32 million a year in charity care.
Hospital executives admit there’s still room for improvement.
Most emergency departments report that their mental health beds are filled nearly every day with cases of drug overdosing and mental breakdowns and that demand is increasing.
The other concern is the potential for a catastrophic event involving large numbers of people. The Twin Cities is home to major sports venues, an international airport and the Mall of America. A mass event at anyone of those locations, from a terrorist attack to a virus outbreak, could mean disaster.
“We don’t have buffering capacity for unanticipated events,” HCMC’s Clinton said. “We’re fortunate we didn’t a flu epidemic this year. There’s very little surge capacity in the system.”
In the end, though, the emergency department, with all of its new technology, is still like the old country doctor who treated everyone, able to pay or not.
“I’m just looking at the patient. We don’t talk about money,” said United’s Westwater. “Some part of the hospital has to direct this kind of care, 24/7.”