Emergency Rooms in the Red

WASHINGTON – Hospitals and doctors are considering a variety of innovative paths to solve what they say is an unsustainable health care system that has resulted in busting hospital budgets and the closing of emergency rooms around the country.

According to the American Hospital Association (search), hospitals had to absorb the cost of $22 billion in unpaid bills last year. In the last decade, hundreds of emergency rooms have shut down because of budget problems.

"Uncompensated care is a very serious nationwide problem ... Most people believe that is a trend and trending upward as we see more and more employers cutting back on health care coverage and more and more consumers dropping insurance coverage. The emergency department becomes often their sole source of care," said Carmela Coyle, AHA senior vice president for policy.

"Until we have a national solution that creates coverage for all, we will continue to see our emergency health care system at a breaking point." Coyle said.

According to the 2002 Census, more than 43 million Americans or 15 percent of the population are without health insurance. That number is up by 2.4 million from the previous year.

Under the 1986 Emergency Medical Treatment and Labor Act (search), medical care cannot be denied on the basis of whether or not the patient can pay for the treatment. Hospitals are required to diagnose and stabilize the patient. If they do not, hospitals and physicians can be fined.

The biggest problem for hospitals is emergency rooms, which are often unable to collect their fees, but must treat the patients.

"The burden of the uninsured is really falling on emergency medicine," said Laura Gore, a spokeswoman for the American College of Emergency Physicians (search).

Now, health care administrators and providers are considering ways to provide care without lowering the quality of service. Ideas have ranged from building more community health centers (search), government involvement in bridging the gap for those unable to pay their bills and even a national insurance scheme.

The AHA backs a universal health care system, which Coyle said would solve the problems of overburdened and undercompensated emergency rooms. But national coverage has not been given serious consideration since former first lady Hillary Clinton offered a plan 10 years ago, and critics say that even with popular support, a national system could not be established in short order.

Representatives from the National Association of Community Health Centers (search) say clinics are an important element in the nation's health care system and with more funding, they can be an important element in helping to reduce the strain on hospitals.

"Studies have shown that community health centers do reduce long lines at emergency rooms. They offer primary and preventive care regardless of how much money people have in their pocket," said Amy Simmons, communications director for NACHC. "The answer is that you’ve got to increase the number of centers so that you have access to health care for more people who can't afford it."

According to the Health Resources and Services Administration (search), more than 3,500 such centers are located across the country. President Bush has made their expansion a major initiative. In his first year in office, Bush launched a five-year initiative to add 1,200 new and expanded health center sites.

Community health centers are mostly funded by federal and state funds, with just about 5 percent coming from patient self-pay. Part of their charge is to accept everyone regardless of their ability to pay.

Simmons said that community health centers provide primary and preventive care and can often treat people at lower costs than emergency rooms, which are sometime overburdened by people with relatively minor illnesses. These centers also have doctors that patients can see regularly rather than having to go to emergency rooms when their condition reaches a crisis point.

While improving the primary provider system is vital, it is also necessary to change hospital funding streams.

"We treat health care as a fundamental right," said Dr. Todd Taylor, an emergency room doctor and spokesman for the American College of Emergency Physicians (search). "Everybody has access to health care through the emergency department, and because of the government's approach to this, that burden has been placed on the backs of private health care providers."

Taylor said that people do not like to think of medicine as a business, but in order for hospitals to deliver a top-quality product, administrators must think along these lines. As the cost of uncompensated care is shifted to other patients or to the hospitals themselves, emergency rooms are either forced to shut down or tighten belts, leaving them unable to hire some specialists.

"Like any other business when you are providing a service and the customers you are providing that service to are not required to pay for those services at the time of service, then collecting that payment becomes not only a huge logistical problem, but a financial problem as well. The way I look at it is hospitals are being forced to extend unsecured health care loans to anyone and everyone," Taylor said.

Taylor said that this system should be replaced with "what I have characterized as a low cost government health care loan program. Because right now I am the low cost loan program. Let the federal government take on that burden. Get me out of that business."

Taylor argued that this system would make sense because then the federal government is paying for the care or at least assuming the financial risk of the care, which Congress mandated that hospitals provide.