Specialists Decline To Staff Southern California Hospital EDs
Medical specialists in Southern California are declining to be on call at hospital emergency departments, citing patient backlogs, high numbers of uninsured patients and inadequate reimbursement rates, the Los Angeles Times reports.
About 20% of patients who seek treatment at hospital EDs need a medical specialist, such as an orthopedic surgeon or ophthalmologist, according to the Times.
Teaching hospitals, such as UC-Irvine Medical Center, Harbor-UCLA and Los Angeles County-USC, can use physicians in training from a roster of medical specialties, but community hospitals, which do not directly employ physicians, have faced difficulties contracting with specialists to cover their EDs.
Financial challenges have prompted many specialists to relocate their elective surgery patients, and in turn, their on-call duties for EDs, away from community hospitals.
Jim Lott, executive vice president of the Hospital Association of Southern California, said the reasons for a lack of on-call specialists at hospital EDs include:
- The higher risk of being sued treating new patients instead of longtime patients;
- Patients who are often drunk or on drugs; and
- Insurance companies that limit physician payments for ED services.
Moreover, hospitals could face more challenges recruiting specialists for EDs if the state follows through on plans to cut Medi-Cal payments to health care providers by 10%, the Times reports. Medi-Cal is California's Medicaid program.
Irv Edwards, former president of the California chapter of the American College of Emergency Physicians, said it is especially difficult to find specialists in Van Nuys, Panorama City and other areas where 30% of emergency patients lack insurance and 30% are Medi-Cal beneficiaries (Engel, Los Angeles Times, 4/25).
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An increasing number of stand-alone emergency departments have "spurred questions about their limited services, their ability to decrease the overall burden for area hospitals and their impact on health care spending," USA Today reports.
The number of such centers increased from 146 to 179, or 23%, from 2005 to 2006, according to the American Hospital Association, and about a dozen more are in planning stages.
The free-standing centers are open 24 hours a day and often offer shorter wait times than hospital-based EDs. Physicians and nurses staff the facilities.
According to USA Today, the centers "offer convenience to patients and can ease overcrowding in nearby hospital" EDs.
However, Jim Unland, a health care consultant, said that the centers can siphon off patients with minor ailments from urgent care centers or physician offices, which can increase costs for insurers and consumers.
In addition, some ambulances will not take critically ill patients to stand-alone EDs because they might not have the equipment or ability to treat some conditions, which would delay care while a person is transported to a hospital. Some ambulances will not take any patients to stand-alone EDs.
Robert Jepson -- associate vice president of Adventist HealthCare, which owns a stand-alone ED in Germantown, Md. -- said that the centers provide the same level of care given at hospital EDs and can handle almost all emergencies. He said that they can quickly stabilize patients and then transport them to hospitals for further treatment if necessary (Appleby, USA Today, 4/25).