Shortages lead to real emergency - overcrowded ERs

It's almost a tradition to wait a long time in the lobby of your family physicians' office. Though when time is of the essence, patients may need to be seen quickly -- and the emergency room can't always deliver fast service. While waiting in the ER isn't a new phenomenon, recent funding and staff shortages that have plagued the health care industry are only leading to longer and longer lines with slower service. "Those trends we are seeing at HUP as well," said Sue Canning, director of administration and finance for the ER at the Hospital of the University of Pennsylvania. "[The problems] are multifaceted." Other Philadelphia area hospitals are also seeing their trauma units bursting with patients. Presbyterian Hospital, which is part of the Penn Health System, saw a 14 percent increase in ER patients in the year 2000. Health care professionals and industry experts attribute the overcrowding in the area to a variety of difficulties -- namely a loss of capital and patients who avoid a primary care physician. Some people "go to the emergency room for their main source of care," said Crawford Mechem, a Penn Emergency Medicine and medical director of Emergency Medical Services of Philadelphia. "Sometimes people feel that the ER is more capable," he added. "A lot of people who show up to the emergency room really don't need to be at the emergency room," echoed Mark Pauly, a Wharton Health Care Systems professor. "They need help and they get desperate," Pauly said of uninsured patients who use ERs as their primary source of care. And a loss of funds isn't helping things. Canning said that the Balanced Budget Act of 1997 -- which cut reimbursements to hospitals -- is the root of hospital financial difficulties, leading to staff cuts and long waits. "It begins and ends with the state of reimbursements from third party payers -- insurance companies and the government," Canning said. "Those payments are all down." This week, The Philadelphia Business Journal reported that spending reductions under the Balanced Budget Act cost area hospitals more than $1.5 billion. "And because of [the lowered reimbursements], we have had to downsize in terms of resources," Canning said. "Hospitals probably have been staffing in a more frugal way than they have in the past," Pauly said. "There are beds, but not staffed beds." After posting losses of more than $300 million over the past several years, the Penn Health System slashed 20 percent of its workforce last year in an effort to cut costs. Though no physicians were laid off, some nursing and support staff positions were eliminated. Philadelphia hospitals also lose money when patients without health insurance cannot pay their medical bills. "At the emergency room at HUP, we probably have about 15 percent of our patients without health insurance," Canning said. "I think among [the] adult population, HUP has a large share of [the city's] uninsured." And Philadelphia has not had a public hospital -- which is especially important for the uninsured -- since the 1970s, Canning said. Flu epidemics sometimes contribute to increased ER visits during the cold winter months, but Mechem has not seen an "incredible number of flu cases" yet. Hospitals in Philadelphia and across the country have been forced to stop accepting patients in some cases and divert ambulances to other hospitals. Parkland Hospital in Dallas for instance, was on divert status last night. "Divert status usually deals with the capacity of beds in the hospital," Parkland administrator Jessica Hernandez said. "If your beds are full you don't have the capacity to handle patients." Hernandez said Parkland was overcrowded in terms of patients who need to stay overnight. "We can handle the capacity of patients from an ER standpoint," she said. "When you get to the in-patient status, that's where there's a concern."

Please note All comments are eligible for publication in The Daily Pennsylvanian.