EMERGENCY CARE: Fewer Specialists Work On Call
Some California hospitals, including many in the Sacramento area, lack specialist physician back-up in emergency rooms, and the situation is getting worse, according to a task force studying the issue. Fewer specialists are signing up for the "nightmare job" of being on-call in the ER, since they receive little or no pay for their time. One ER physician, wishing to remain anonymous, said, "I've personally seen patients come to harm. It's certainly been a serious problem in Sacramento for some time." According to the task force, formed by the California Medical Association and California Chapter of the American College of Emergency Physicians, the fundamental dispute is who should pay for specialists in the ER. Under federal law, hospitals are required to provide treatment for all patients, even those who cannot afford the services. While hospitals absorbed those costs in the past by shifting them to patients who could pay, it has become increasingly difficult to recover those costs with the flat fees managed care provides. Also, contractual agreements between provider networks and health plans often leave some physicians "out of the payment loop." Dr. Loren Johnson, an ER physician and co-chair of the task force, said, "On-call physicians get hammered by a refusal ... to pay for their services." Hospitals and health plans assign payment responsibilities to each other. Dr. Bruce Spurlock, the other co-chair of the committee, contends that the government and health plans should pick up the slack, arguing that the system will completely dissolve if hospitals are expected to pay. The task force did provide a number of solutions, including fair pay provided by a combination of managed care plans, the government and hospitals in exchange for specialists' services. In addition, some have proposed a ballot initiative that would allow emergency services to be funded by part of the state's tobacco settlement. The state Department of Health Services is looking into the issue (Robertson, Sacramento Business Journal, 12/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.