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Quality of U.S. Emergency Room Care Falls, Physicians Say

With Obamacare bearing down on them, a doctors’ group said emergency rooms are less able to provide quality care, and more resources will be needed to handle an expected surge of patients from the new law.

Hospitals have fewer beds available, causing delays in ERs that saw visits climb to 130 million in 2010, according to a report from the Dallas-based American College of Emergency Physicians. Federal funding for disaster preparedness has fallen, so the hospitals are also less prepared to handle a sudden influx of injured patients, the group said.

“This report card is sounding an alarm,” Alex Rosenau, the physicians’ group president, said today on a conference call. “The need for emergency care is increasing, the role of emergency care is expanding, and this report card is saying that the policies are failing.”

Care will become harder to access as people newly enrolled in the U.S. Medicaid program for the poor and aging baby boomers turn to ERs for medical services, the report said. The Patient Protection and Affordable Care Act broadens Medicaid eligibility to more than 19 million people. A study published in Science this month found new Medicaid patients in Oregon visited ERs 40 percent more often than the uninsured.

“Every year it’s a little worse,” said Arthur Kellermann, dean of the medical school at the Uniformed Services University of Health Sciences in Bethesda, Maryland. “But unless you find yourself in a stretcher in a hallway without a bed, you don’t realize it.”

Staffed inpatient beds fell 16 percent to 330 per 100,000 people in 2012 from 2009, and psychiatric care beds dropped 15 percent to 26 beds per 100,000, the group said.

Direct Result

“Emergency department crowding is a direct result of inpatient capacity,” said Jon Mark Hirshon, associate professor at the University of Maryland School of Medicine in Baltimore, who headed the report’s task force. ER physicians “have to spend a lot of time finding a place to send somebody,” he said in a telephone interview.

The number of emergency physicians per 100,000 people rose to 13.5 from 11.8, the doctors’ group said. That’s not enough, Kellermann said in a telephone interview.

“ERs provide 28 percent of all acute care visits, but only 4 percent of doctors work in the emergency department,” Kellermann said, citing a 2010 study published in the journal Health Affairs. “If there’s more people coming into the ER without a dramatic expansion in doctors and inpatient capacity, you’ll get a bottleneck.”

Cash Needed

The doctors’ report, which gave the nation’s emergency care a grade of D+, contained a range of recommendations, including funding for a commission to investigate the shortage of health professionals and for pilot programs aimed at improving care. Doctors should be given some liability protection for ER work, and federal money should be withheld from states that don’t pass safety legislation like motorcycle helmet requirements.

Kellermann, who previously headed the department of Emergency Medicine at Emory University in Atlanta, also said access is declining faster in low-income communities.

Hospitals are also less prepared for disasters, the report said, due to decreased federal funding, which fell 31 percent to $9.52 per capita from $13.82 in 2009.

“Times are not wonderful for a lot of hospitals: volumes have been declining the number of paying heads in the bed, and money is tight,” said Sheryl Skolnick, an analyst at Stamford, Connecticut-based CRT Capital Group LLC.

Critical Component

The National Hospital Preparedness Program, which provides grants to hospital and health-care systems, “has been very successful at the hospital level and has evolved steadily to become a critical component of community resilience, enhancing the response capabilities of our nation’s health-care systems,” said director David Marcozzi in an e-mail. Marcozzi didn’t respond to questions about future funding plans.

The report also found a wide range in the number of emergency drills conducted from state to state. Mississippi averaged 0.1 drills per hospital, while Rhode Island averaged 18.8.

“Where you’re going to start cutting corners first is in disaster preparedness because the tyranny of the urgent trumps preparing for the more downstream events,” Kellermann said.

Doctors at the Brigham and Women’s Hospital in Massachusetts, which treated 31 victims of the Boston Marathon bombing last April, practice disaster response procedures repeatedly, said Eric Goralnick, the center’s medical director of emergency preparedness.

“The first several minutes are the most critical during a response,” Goralnick said. “Drills are critical so your muscle memory will just kick in.”

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