Two Percent

 Alison Haddock, MD

EMRA Legislative Advisor 2009-2011

Tacoma General Hospital

Tacoma, WA

 

Patients arrive on our doorsteps every day, sick and crashing, anxious and in pain. The two-day-old and the 103-year-old, the homeless alcoholic and the high-tech CEO, he local farmer and the international visitor – we care for them all. And we see the value of the care we provide as we resuscitate the critically ill, manage pain, and make the diagnosis for a worried mother.  

Not everyone sees our work in this way. They take special note of the frequent fliers; the drug seekers; the uninsured with toe pain – and believe that these patients
make up the majority of work in the emergency department.  

After a shift with a few particularly demanding patients, it’s tempted to see your work in the same way. Resist this impulse! The care we provide has incredible value to the healthcare system – we must first appreciate our own work if we are to prove our worth in an era of flux and reform.  

Just two percent. Looking at skyrocketing healthcare costs, legislators and regulators are searching for areas to cut spending without compromising patient care. hey are also looking for an area where their cuts will be more than just “budget dust.” One popular scapegoat is the “expensive emergency department.”  

Of the $2.4 trillion in US healthcare spending, how much is used for emergency care? A mere two percent according to the Department of Health and Human Service’s (very credible) Medical Expenditure Panel Survey. Compared to other care environments, this is an incredibly low number. Consider that some of our most valuable care – resuscitating critical patients – is some of the most expensive care we provide.  

In truth, increases in healthcare spending are being driven by the increasing burden of chronic illness in an aging population, pricey branded prescription drugs (particularly chronically prescribed medications), and technologic innovations – not by increasing utilization of the emergency department.  

92 percent of emergency department patients have significant illnesses requiring care in one minute to two hours. The CDC’s National Center for Health Statistics runs the numbers every year – they have concluded that the vast majority of our patients have diagnoses requiring emergent care. Even if the patient’s primary care physician (PCP) took on a few of these visits – consider that two-thirds of emergency department visits occur after business hours and on weekends – when PCP offices are quite closed. 

Emergency physicians provide a vital safety net for patients, who do not choose when a dangerous medical problem might strike. We provide care to anyone who arrives on our doorstep under the Emergency Medical Treatment and Active Labor Act (EMTALA) mandate, which requires us to provide care to all patients, regardless of ability to pay. This makes emergency physicians one of the leading providers of charity care in the medical system today.  

So the next time you’re feeling frustrated after a run of difficult patients – remember the last time you brought back a critically ill patient (using your expertise in the resuscitation in shock). Remember your last uninsured patient, the one you treated for a critical medical problem when nobody else would.  

Also consider how important your emergency department is to your community. The number of emergency departments has been dropping while the number of emergency department visits has been rising, compromising the critical safety net we provide. Our emergency departments are becoming even more crowded as volumes rise while admitted patients linger in their gurneys due to bed and nursing shortages on the inpatient floors. Your community needs you to be there, providing care 24/7 to every patient with emergent medical concerns, regardless of their age, gender, income, or level of acuity.  

If you’d like to discuss these issues with those who have the power to make a difference, come to ACEP’s Leadership and Advocacy Conference in Washington, D.C. May 20-23. Sunday, the Residents and First-Timer’s Track will provide you with the foundational health policy knowledge you’ve been looking for, all in interactive sessions hosted by EMRA leaders. Continue expanding your new knowledge base on Monday with additional leadership and policy presentations. On Tuesday, you’ll have the chance to speak with your own legislators about issues you find important as an emergency physician. Ask your program director and department chair if they can sponsor you in the 2012 EMRA Chair’s Challenge. Last year 130 residents attended. This year, I hope to see you there!  

 

 

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