By American College of Emergency Physicians
Naples Daily News
WASHINGTON — The nation’s emergency physicians have taken issue with statements made last week by Kathleen Sebelius, the secretary of Health and Human Services, about emergency medical care and suggested the secretary engage emergency physicians in planning the nation’s health care reform.
“We are dismayed the top health official in the United States appears uninformed about the crisis in emergency medical care,” said Dr. Nick Jouriles, president of American College of Emergency Physicians. “The public and policymakers, including Secretary Sebelius, have a tendency to engage in perpetuating myths about the causes of emergency department crowding. The bottom line is that larger numbers of patients are drawing on fewer resources, and most patients in the emergency department need to be there.
“Instead of trivializing the nation’s emergency care system, I am asking Secretary Sebelius to involve emergency physicians to help to address the problems facing emergency patients.”
According to the Centers for Disease Control and Prevention, an agency of the U.S. Department of Health and Human Services, only 12 percent of emergency visits are for patients with non-urgent medical conditions. Jouriles said while insuring all Americans is a worthwhile goal, the Massachusetts experiment proves it does not reduce visits to the emergency department. In fact, the opposite is true.
“Emergency medical care is extremely effective, which is why primary care physicians refer their patients to us,” said Jouriles. “The streams of patients fearing swine flu who flooded emergency departments last week point to the central fallacy of the ‘medical home': In an emergency — which a pandemic certainly is — the emergency department is everyone’s medical home. Many of the patients who came to the emergency department were sent there by their primary care physicians. Some emergency departments, already at full capacity, were overwhelmed by sudden surges in patients. This bodes ill for future disasters.”
In addition, Jouriles said you cannot solve 100 percent of the health care problems by tinkering with 3 percent of the nation’s $1.5 trillion in health care expenditures, which is what emergency medical care costs.
“Physicians in Massachusetts found that, to date, visits to their emergency departments went up, not down, after everyone in the state was provided with health insurance,” said Jouriles. “Universal coverage does not lead to universal access, nor does it put an end to emergencies.”
Jouriles said emergency departments are a health care safety net for everyone, insured or uninsured, and emergency physicians are leaders in preventing medical emergencies.
“Emergency physicians treat 120 million patients a year, a number that is expected to balloon as baby boomers age into retirement,” said Jouriles. “Our safety net is under extraordinary pressure during the best of times, and last week we saw what might happen in the worst. The country cannot afford a collapse of its emergency medical care system, and yet that seems like a very real possibility when all discussions of health care reform seem more focused on shrinking patient numbers rather than growing patient resources. It’s a little like saying the subways wouldn’t be so crowded if people didn’t use them to get to work.
“The nation’s emergency physicians are firmly behind the president’s health care reform principles,” said Jouriles. “We will work to achieve the long-term benefits that reforms should bring. But in return we ask Secretary Sebelius and Congress to recognize and fund the central role that emergency medicine plays in health care system.”
Emergency departments have a federal mandate (Emergency Medical Treatment and Labor Act) to care for all patients, regardless of ability to pay. This mandate is unfunded. Given the standby costs of staffing and equipping emergency departments to treat all patients and all illnesses and injuries 24/7, the extra costs (or marginal costs) of seeing an additional patient for an urgent or non-urgent medical problem are much less than what it would cost to open a private physician’s office after hours or on the weekend or to build an urgent care center. The fixed costs of the nation’s emergency department will not go away unless emergency care is eliminated altogether, which is not only implausible, it is unethical.
The American College of Emergency Physicians is a national medical specialty society representing emergency medicine with nearly 27,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
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