|
HOME > ABOUT > PRESS > PAYING THE PRICE TO PROVIDE CRITICAL CARE
Article published - May 12, 2008
Credit: NAPA VALLEY REGISTER
Queen's ER: Paying the price to provide critical care
While a steep bill from an emergency room visit might lead you to think otherwise, ERs are typically money-losers.
The emergency department at Queen of the Valley Medical Center wrote off almost $6 million in unpaid patient bills last year. Excluding this loss, the department cost about $13 million to run in 2007, said Shannon Watkins, the Queen’s emergency services director.
“If you can come in at no loss, no gain, you’re pretty happy,” he said.
Ned Laubacher, the Queen’s vice president of operations, said the emergency department retrieved just 26 cents out of every dollar it billed patients last year.
Reimbursements have dropped about one to two percent per year since 2005, and are expected to drop by two percent next year, he said.
The reasons include rising medical costs, population growth and shrinking reimbursements to California hospitals and physicians from Medicare, Medi-Cal and private insurance companies. But in spite of all that, the quality of emergency medical services in Napa remains stable.
Dr. Paul Kivela, a physician who works at the Queen’s ER, said the quality of ER care is higher than the average in rural counties.
“(The Queen) is the only trauma center in Napa and Solano counties (and) one of only a few hospitals north of San Francisco that have been consistently staffed exclusively with emergency physicians board certified by the American Board of Emergency Medicine,” he said.
While financial strain prompted the 2005 closures of several Southern California ERs — including Valley Plaza Doctors Hospital in Riverside County and Brea Community Hospital in Orange County — Napa’s relatively small population and other factors combine to soften financial blows to the Queen’s emergency department.
Gunshot wounds and other crime-related traumas are more common in urban areas, Laubacher said, so the Queen’s ER staff treats fewer labor-intensive trauma cases — mostly motor vehicle accidents and household injuries.
Laubacher said in some of Southern California’s heavily populated areas there are also higher rates of state-subsidized insurance like Medi-Cal — which contribute to more crowding in underfunded emergency departments.
Not surprisingly, these factors — coupled with today’s longer life spans — are adding up to serious challenges for California’s ERs.
According to a state assembly bill that would require hospitals to provide more beds for patients in overcrowded ERs, California ranks worst in America “in the number of emergency departments available to its residents, with 6.16 emergency departments per 1,000,000 people.”
Access to care is further thwarted because many California primary care doctors and specialists — unable to overcome the combination of rising costs and dwindling Medi-Cal and insurance reimbursements — will not accept new Medi-Cal patients. As Medi-Cal patients and the uninsured find fewer primary doctors to take them in, California’s emergency departments are feeling the pinch because they are legally obligated to treat patients regardless of their ability to pay.
The safety net
Primarily serving the uninsured, Medi-Cal and Medicare patients, Community Health Clinic Ole keeps foot traffic to the Queen’s ER at a minimum.
In theory, the Queen’s ER might have been more than 50 percent busier last year without it. More than 30,000 patients visited the Queen’s ER in 2007, and Clinic Ole physicians saw 17,686 patients last year, according to Dr. Robert Moore, the clinic’s medical director.
“(Other) communities do not have that situation,” Kivela said, adding that relatively few uninsured patients come to the Queen’s ER for medical treatment.
Watkins said only about 12 percent of patients who visited the Queen’s ER in 2007 had no primary care physician outside of the hospital.
“Predominately, the people who use the ER as primary care are the under- and uninsured. ... (They may not) know about other community resources or they’re unable to get into physician offices,” said Watkins.
Dr. Robert Moore, medical director of Clinic Olé, said 68 percent of the clinic’s patients have no regular health insurance. About 27 percent of Clinic Olé clients have some kind of government-subsidized insurance and just five percent have private insurance, he said. “Every county is different and every region is different in how their ERs are impacted by the uninsured and a lot of that is (affected) by other services offered,” said Moore.
Some of that translates to how long ER patients can expect to wait before receiving treatment. At the Queen’s ER, patients wait an average of 40 minutes before seeing a doctor and patient stays average about 130 minutes, according to Watkins. However, the average wait in California’s emergency rooms is about 230 minutes, according to a study conducted by Press Ganey Associates Inc., which tracks patient satisfaction data for more than one-third of American hospitals. With the longest wait time, Arizona averages about 297 minutes, while Iowa leads the country with an average wait time of about 138 minutes, according to the study.
In addition to constantly fluctuating patient intake and demand, another factor that makes the finances of running hospitals a guessing game is a constantly shifting regulatory environment.
Earlier this year, Gov. Arnold Schwarzenegger proposed to finance a statewide universal care program by hitting everyone involved for part of the cost: insurers, patients and caregivers. The ambitious proposal collapsed this spring.
But the governor’s proposed 2007-08 budget includes a 10 percent cut in Medi-Cal.
How will that affect the Queen? Physicians say the direct impact will not be that large, but the pressure the cuts put on other primary care physicians may end up driving some patients to the ER.
Kivela said the budget cuts will have a more immediate effect in Southern California. “In (Los Angeles), where maybe half of the patients don’t pay at all ... it doesn’t add up.”
What’s in store for Napa?
“Outside care providers will stop being providers. My suspicion is, come July,” Kivela said, referring to the time the budget is supposed to be adopted and in place, “we will see a lot more patients.”
|
