How do we reduce emergency room overcrowding and waiting times?
Certainly, people have pointed to reducing the ranks of the uninsured, who lack primary care and end with worst health conditions as a result; and to prevent budget cuts, that threaten some ERs directly, and the coverage and benefits and clnics that help people avoid the ER in the first place.
But to follow-up on Hanh’s post about the new study on Emergency Room use, there’s another important solution that needs to be in the mix as well: make sure the insured get timely access to care.
“…What’s new is the rise … in frequency in visits, and that’s occurring in the insured,” said Dr. Stephen Pitts, author of the report and a CDC fellow who teaches emergency medicine at Emory University’s School of Medicine.
Pitts said the difficulty in getting primary care appointments could be contributing to the rise in emergency room use, particularly by those with insurance or on government programs such as Medicare or Medicaid.
“The likely cause is there are just fewer and fewer primary care physicians,” he said. “If you were to get the flu and your doctor says, ‘Sure, I’ll see you in two weeks,’ you may not be able to wait. It’s hard for even insured people to get quick appointments and be seen quickly.”
Under managed care plans, people agree to a limited network of providers with the assurance that that network has enough doctors, hospitals, and specialists to provide timely and appropriate care. The state Department of Managed Health Care (DMHC) is charged with ensuring that there is “network adequacy” and people are able to get “timely access” to care.
There is currently a stakeholderregulatory process at DMHC to implement standards for timely access, as required by AB2170(Cohn). Health Access California, the sponsor of that bill, along with Western Center on Law and Poverty, California Pan-Ethnic Health Network, and other organizations, are representing consumers against many, many provider groups.
We hope the resultion will not only ensure that people get timely access to care… and in turn, help with the ongoing issue of ER overcrowding.