07/31/07 — Emergency room visits helping drive up health care expenses

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Emergency room visits helping drive up health care expenses

By Anessa Myers
Published in News on July 31, 2007 1:46 PM

With unnecessary emergency room visits increasing, growing demand for Medicaid and a shortage of health-care workers, the cost of providing medical care is becoming more and more of an issue, health care officials say. The problem is nationwide and Wayne County is no exception, officials at Wayne Memorial Hospital say.

Emergency room visits, which are partly responsible for the increased costs, on average cost nearly five times more than a visit to a doctor's office.

According to Wellmark BlueCross BlueShield, the average emergency room charge is $1,049, while the average physician's office charge amounts to $153.

But a doctor's office is not open 24 hours and people seeking medical care often do not want to wait. Most of the patients who come through the doors at Wayne Memorial Hospital's emergency room show up at night, said Rebecca Craig, vice president of finance and chief financial officer at Wayne Memorial.

Emergency care includes six levels at Wayne Memorial -- with critical care rated sixth.

Most emergency-care patients usually come in for reasons that are less serious. Between April and June of this year, 4,345 patients who came to the emergency room were rated at the third level of care, which includes people with the flu, sprains, migraine headaches and relatively minor work-related injuries.

"Most people come in thinking what they have is something worse, so they want to get it checked out and make sure," Mrs. Craig said.

The next largest group of patients come in at Level Four, with fractures, lacerations or chest or abdominal pain. They usually require admission. About 3,700 patients were at this level of care were seen in the emergency room during the past three months.

Levels Five and Six are the most critical -- heart attacks and motor vehicle accidents. In those instances, "You're here because you need to be here," Mrs. Craig said.

In the last three months, 1,929 patients at the emergency room were rated at Level Five care. Eighty-seven were rated at Level Six -- the smallest group to be seen by emergency room doctors.

Emergency rooms everywhere are becoming more crowded, medical experts say, and facilities are looking for ways to expand to accommodate the increasing numbers of patients.

And at Wayne Memorial, the numbers are no different. They increase every year, Mrs. Craig said, with hospital officials looking for ways to address the growing need.

"There is a plan to expand the emergency department," said Amy Cain, hospital public relations director. "That will take some time, though."

Emergency room costs also factor into concerns about uncollected fees that are part of almost every hospital's budget worries. The elderly and patients without insurance or adequate medical coverage are more likely to use emergency room services as their primary source of medical care -- whether or not the illness or injury is urgent.

One glaring reason is payment -- physicians' offices usually require proof of insurance before they treat patients. Emergency rooms do not.

"Anyone who came to the emergency room with an emergency would not be turned away. It's just not going happen here," Ms. Cain said.

Uninsured patients who depend on the emergency rooms are draining hospitals coffers. In North Carolina, 20.2 percent of adults are uninsured, and of those, 18.1 percent are working adults, according to the Centers for Disease Control and Prevention.

"The problem isn't that we have large amounts of unemployed people just coming in here," Ms. Cain said. "The problem is that some employers can't afford to provide health insurance for their employees."

The percentage of uninsured patients has increased steadily since 1998.

Medicaid costs in North Carolina, specifically Wayne County, have also increased.

One out of every eight people in the state is served by Medicaid. This year's budget for the program is over $10 billion, according to the N.C. Division of Medical Assistance. The payments made to recipients have almost doubled since 1990, from $2,531 going to each recipient in 1990 to $4,602 in 2003.

In Wayne County alone, Medicaid costs are predicted to rise to $8.4 million this year.

Mental health services also has caused Medicaid costs to swell. More than 3,000 people in Wayne County use mental health facilities supported by Medicaid, costing nearly $15 million, according to the state Division of Medical Assistance.

Bill Fuqua, Stoney Brook Behavioral Health Program's director for behavioral health, said that a reason more people are using mental health facilities is that there is less of a stigma. Fuqua said he has seen an increase in the number of people utilizing psychiatric beds at Wayne Memorial. But Medicaid does not nearly cover the entire cost of a stay.

"If our average daily cost is about $900, the insurance only pays about $625," he said.

People who have Medicaid also are more likely to use an emergency room for health problems than those who are privately insured, according to the 2003 National Hospital Ambulatory Medical Care Survey Emergency Department Summary. That also contributes to the emergency room overflow.

Along with the increased numbers comes decreased reimbursement for patients who used Medicaid.

In the last two years, Wayne Memorial has not seen an increase in the reimbursement amount from Medicaid. At the same time, hospital costs and salaries are going up, leaving the hospital with more money going out while the money coming in stays the same.

"We do get higher payments from Medicaid because of the higher poverty level here but if we didn't have that, this hospital, frankly, wouldn't be open," Ms. Craig said.

Wayne Memorial is a non-profit organization, overseen by a board of trustees that sets the cost of services. This year, Mrs. Craig said, the current rates will likely increase between 7 and 9 percent.

Among 51 eastern North Carolina hospitals, Wayne Memorial charges only 74 percent of what they could be expected to charge for services, making it the fifth-lowest in costs to patients.

Competition for health care professionals is also a challenge. Many specialists seek out larger cities, where they can make more money.

Wayne is constantly trying to recruit doctors to the area.

Recently, the hospital added two psychiatrists to its staff as well as a thoracic surgeon. There is still a need for a plastic surgeon and endocrinologists.