Hospital emergency rooms are busier than ever, filled with patients who are sicker and poorer than ever.
But it's not just the uninsured who end up there. Now, people with Medicaid or other government insurance plans for the poor are making up a large share of the increased traffic, according to the latest federal numbers released this month.
It's a worrisome trend for both patients and health care providers. Emergency physicians say Medicaid patients must go to the ER because they can't get appointments with private physicians. Many doctors say Medicaid reimbursement is so low — about half that of the Medicare program for seniors in Florida — they lose money on each patient.
"When these patients get sick but can't get in to see a physician, they often wait until an illness has worsened to the point that they need care in an emergency department," said Dr. Angela Gardner, president of the American College of Emergency Physicians.
The delay in seeking care leads to patients who are sicker and care that costs taxpayers more, doctors say.
Emergency department visits are up sharply at many Tampa Bay area hospitals. Brandon Regional saw its ER traffic increase by 21.6 percent from 2008 to 2009. At St. Joseph's in Tampa, which runs the busiest ER in the area, adult visits were up 11.3 percent, to 95,000 in 2009, while children's ER visits went up 23.5 percent, to more than 50,000 in 2009.
Pat Donnelly, vice president of patient care services at St. Joseph's, hears of many Medicaid patients in the ER who say they can't find a doctor who takes Medicaid.
"If you're in that situation, and you've got a 102 temperature and a sore throat, you will go to the closest facility," Donnelly said. "We're the safety net, 24-7."
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More than 123 million people visited hospital emergency departments around the country in 2008, according to new federal figures. That's 6 percent more than the year before, and nearly 30 percent more than the 94.9 million visits in 1997. ER visits have increased at twice the rate of U.S. population growth.
Tampa General's ER traffic increased 7.6 percent from 2008 to 2009. Morton Plant Hospital in Clearwater saw a 12.2 percent increase. Community Hospital in New Port Richey was up 5.3 percent.
At the same time, enrollment in Medicaid ballooned from 28.5 million in 1999 to 42.6 million in 2008, U.S. Census figures show.
But the number of physician offices that accept Medicaid — and the volume of patients each can take — is decreasing. Nationally, about 62 percent accept it, down three percentage points from last year, according to SK&A, a health care information company. By contrast, more than 80 percent of physician offices accept Medicare, the government health insurance for the elderly and the disabled.
Dr. David Weiland, vice president of medical affairs at Bayfront Medical Center in St. Petersburg and president of the Pinellas County Medical Association, said Medicaid in Florida reimburses far less than any other program — about 56 percent of Medicare's rates. The rates vary by state.
The low Medicaid rates make it tough for practices with significant Medicaid caseloads to cover costs.
It's a situation Bonnie Mack of St. Petersburg knows all too well. The 72-year-old, who has both Medicare and Medicaid, said that even physicians who accept Medicaid patients will only take a limited number.
"A lot of times when you call, they've filled their quota and say they're not taking new Medicaid patients at this time," said Mack, who has diabetes and severe arthritis. "Some of them will put you on a list for when they get an opening, but often you don't get an opening for a long time."
To avoid the ER, Mack schedules her regular doctor visits well in advance and hopes nothing unexpected happens. "When I'm at the doctor's office, I always make my next appointment before I leave," she said.
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Doctors say few patients with alternatives would choose the hassle of a hospital visit over a regular physician appointment.
"People don't necessarily want to come to emergency departments," said Dr. Amy Conley, an emergency physician at University Community Hospital in Tampa, which saw a 6.4 percent increase in ER visits last year. "But we're the safety net."
Conley, who is president of the Florida College of Emergency Physicians, said people with chronic conditions such as coronary artery disease who can't get in to see their doctors may ignore symptoms such as shortness of breath or chest pains, or allow their medications to run out, worsening their condition.
"They can end up costing the health system much more," she said.
People are not going to the ER for minor issues, the latest data show. Less than 8 percent of ER visits were deemed nonurgent in 2007, down from 12 percent the year before.
Doctors worry that the new health overhaul law may make matters worse, because while the law aims to provide health coverage to more people, it does not address the Medicaid reimbursement problem.
"Health plans must provide fair payment for services or patients will suffer," said Gardner, the president of the American College of Emergency Physicians.
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With no relief in sight, emergency departments are trying various measures to accommodate the increased traffic.
St. Joseph's, which maintains one emergency room to serve its adjacent adult and children's hospitals, opens up additional bed space during busy periods.
At University Community Hospital, emergency medical technicians greet ER patients and family upon arrival. At Tampa General, ER arrivals are immediately assessed by a registered nurse.
Hospital Corporation of America, whose local hospitals include Brandon Regional, Largo Medical Center and St. Petersburg General, spent nearly three years studying ways to reduce wait times in its ERs. One initiative was advertising wait times on billboards and its website and through text messaging.
But Donnelly of St. Joseph's and Conley of University Community Hospital say such management efforts don't decrease the impact of more ER traffic on the entire hospital.
"It's not just about the emergency department," Conley said. "More emergency visits mean more admissions, and necessary followup care."
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330