Impeding changes to our Health Care system

[TheMercenary]

The ER myth

By Marc Siegel
One of the major myths attached to the new health reform law is that it will lead to fewer emergency room visits. Instead of having to go to the ER, the claim goes, more efficient care will be administered to the newly insured in doctors offices by primary care physicians like me.
President Obama himself perpetuated this claim. A year ago at a town hall meeting on health care reform, he said, "We know that when somebody doesn't have health insurance, they're forced to get treatment at the ER, and all of us end up paying for it. ... You'd be better off subsidizing to make sure they were getting regular checkups." In late May, House Speaker Nancy Pelosi wrote in Roll Call that "the uninsured will get coverage, no longer left to the emergency room for medical care."

Now we know better.

It's not terribly surprising that real data from Massachusetts, which has had universal health coverage since 2006, show otherwise. From 2004 to 2008, ER visits in the Bay State rose by 9%, with no discernable improvement after 2006. Why? At least part of the reason has been the inability of patients to find primary care physicians for last-minute visits. Let's face it: The ER won't turn you away, but individual and overburdened doctors can and will. The Massachusetts Medical Society has reported that new patients wait for a primary care doctor visit up to two months.

A problem for all of us

With the new national health care law, Massachusetts' problem very well may be manifested across the USA. Already, we don't have enough doctors. Indeed, the Association of American Medical Colleges estimates that the U.S. will be 160,000 short by 2025. ERs, too, have downsized over time. A yearly survey by the American Hospital Association has shown a 10% decline in emergency departments from 1991 to 2008, despite an increasing demand for such care. So if we have depleted ERs, not enough doctors and millions of more patients, the math doesn't work.

To make matters worse, 16 million more patients will be eligible for Medicaid by 2014, but doctors are limiting the number of such patients they see. Where will these patients go? You got it. The ER. Medicare will soon have the same problem, as more than 70 million Baby Boomers begin to flood the system.

Yet instead of simply complaining about our impending doom as we add 30 million more people to the health insurance coffers, I suggest that the folks in Washington transitioning the health care reform from law into reality must deal with the world as it exists, not as it was sold to the American people.

What can be done?

First, tackle the doctor shortage. In June, Health and Human Services Secretary Kathleen Sebelius noted that $250 million will be set aside to create 1,700 new primary care doctors, new clinics and to implement strategies to expand the workforce. This is a step forward — albeit a very small one. Medical students need to have incentives — scholarships, loan forgiveness or better pay — that will push more of them into primary care rather than more lucrative specialties.

Second, we need strategies to make medicine more efficient so patients get better, rather than rushed, care. Recent research suggests that computer analysis and improved schedule strategies can decrease patient waiting time by 40%. Integrating nurse practitioners and physicians assistants into doctors' practices also would help.

Most important will be re-orienting our system away from emergency intervention. Diet, exercise and smoking cessation would unclog ERs in a hurry. New technology and education can help doctors and patients predict, prevent, diagnose and treat a disease before it requires an urgent medical visit.

Consider the ER challenge just one of many we're likely to see as the health care law reveals itself, bit by bit, to the American people.

Marc Siegel is an internist and an associate professor of medicine at New York University Langone Medical Center. He is a member of USA TODAY's Board of Contributors.

http://www.usatoday.com/news/opinion...mn28_ST1_N.htm