Study: 75% of EDs have inadequate call coverage

A full three-quarters of all hospital EDs in the United States don't have enough specialists who specifically treat cardiac or neurological problems, according to a new study from the Center for Studying Health System Change. It further noted that 21% of premature deaths and complications resulting from delays in ED care are due to a lack of available specialists.

The study, titled "Hospital emergency on-call coverage: Is there a doctor in the house?" was based on site visits to 12 nationally representative metropolitan communities. "The diminished willingness of specialist physicians to provide on-call coverage is occurring as hospital emergency departments confront an ever-increasing demand for services," wrote the authors. "Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to nonhospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns."

They noted a number of strategies to secure on-call coverage, including:

  • enforcing hospital medical staff bylaws that require physicians to take call;
  • contracting with physicians to provide coverage;
  • paying physicians stipends;
  • employing physicians.

Reimbursement drops for emergency visits

A new study in the Annals of Emergency Medicine shows that payments for ED services declined for all patients over an eight-year period, with Medicaid paying less overall than uninsured patients do.

"Falling reimbursements to emergency departments were a consistent trend over the eight years we studied," said Renee Hsia, MD, of the University of California at San Francisco in California, in a prepared statement. "What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does."

This runs counter to the commonly held belief that the uninsured are universally poor payers, she says. The study found that, in fact, 35% of charges for uninsured visits were paid in 2004, compared with 33% for Medicaid visits.

The researchers studied charges and payments for 43,128 ED visits from 1996-2004. Nationwide, the overall proportion of ED charges paid for outpatient emergency department visits declined from 57% to 42%. The declines in the proportion of payments to charges over the eight-year study period tended to be sharper among patients with insurance than among the uninsured, although the share of charges paid was consistently the lowest for visits by Medicaid and uninsured patients, and consistently the highest for visits by patients covered by private insurers. Reimbursements fell the least for uninsured patients.

"Declining reimbursement ratios will cut into the ability of emergency departments to recover their actual costs of providing care," Hsia predicted.

Minnesota hospitals seek trauma designation

Hospitals in Minnesota are scrambling to meet the new state requirements and become part of the state's trauma system, as outlined in the recently passed Emergency Medical Services Regulatory Board statute. The deadline is July 1, 2009.

The new law is referred to as the "bypass legislation" because major trauma patients must not be transported to an undesignated hospital unless no state-designated trauma hospital is within 30 minutes transport time. This "30-minute rule" means a closer designated trauma hospital may be bypassed for a higher-designated trauma hospital that is within 30 minutes transport time. When the bypass regulation goes into effect in 2009, it will affect only severe trauma patients and only ambulance services, not helicopters. Hospitals still will be able to be designated after the deadline has passed, but if they are not designated by then, they may get bypassed in terms of transportation.