Emergency Health Care Safety Net is in Danger
Emergency physicians are truly on the front lines of the COVID-19 crisis. We are proudly accepting our roles at this unprecedented time, while also risking our own health and putting those we love at heightened exposure to keep our communities safe.
While we focus on caring for sick patients, the underlying health care system is being severely strained, especially our nation’s emergency departments. Emergency physicians are only four percent of all physicians but provide health care to over two-thirds of the uninsured and over half of the Medicaid population. Our doors are always open — 24/7/365 — to serve our community’s acute unscheduled care needs, regardless of our patient’s ability to pay for their care.
We are the nation’s health care safety net and we are being pushed to the brink of collapse. When you add the renewed effort by Congress to slip necessary, yet unresolved legislation to end surprise medical billing in the next COVID-19 relief package — you have a perfect storm brewing.
You see many other professions have been able to mitigate issues arising from COVID-19, including drastic reductions in patient volumes by closing offices or limiting hours. But the Emergency Medicine (EM) reality has been much different. In the face of patient volume losses of 50 percent, we have incurred significant costs while continuing to staff our Departments and provide standby capacity during this crisis. The cost of providing this care has increased despite decreased revenues. Unlike elective surgeries and other medical care, our losses can never be recuperated. This is why we have fervently sought assistance from the CARES Act Provider Relief Funds made available by Congress.
These funds were created for this very reason and emergency care is urgently in need of this additional financial assistance. Congress took swift and decisive action to allocate $175 billion in Provider Relief Funds, and at this point, the Department of Health and Human Services has dispersed most of these funds to Hospitals and certain providers. However, almost four months into this pandemic, we estimate that we have only received seven to fifteen percent of the dollars we desperately need.
Many have the misconception that physicians are primarily employed by hospitals and have already been provided significant support. In reality, fewer than 24 percent of EM physicians are hospital employees. Financial support sent to hospitals is rarely shared directly with EM provider groups. With approximately $50 billion of the monies approved by Congress yet to be dispersed, there is a tremendous opportunity to support most emergency care without additional Congressional action.
Without appropriate support, Emergency Departments will close, and physicians will have to leave their communities. This affects underserved and rural communities the most. Studies have shown that, in those communities where local hospitals and Emergency Departments have closed, mortality increases upwards of 5 percent for those needing emergent care. We can prevent this from happening.
Short-term relief is critical. However, we must not ignore other realities. Not only are front-line providers in the midst of an unprecedented pandemic, but at the same time, the nation is attempting to find a balanced and sustainable solution to the ongoing debate over Surprise Medical Billing (SMB). We all can agree the cost of health care should not be unfairly leveraged on the backs of patients, so I remain hopeful there is a path forward that does not take providers off the front lines and close emergency departments during a global pandemic.
This is well past theory. In many cases, providers are losing 50 percent of revenue or more —even after adopting significant and painful cost-saving measures. My colleagues and I are living with these realities — incurring more risk than ever before and trying to stay open for patients now and in the future.
It’s imperative that we sustain the front lines of emergency care during a global pandemic. Longer term, it’s imperative that we address patient protections. It’s imperative that we bend the cost curve in health care. But we cannot let a perfect storm happen when we have the resources to prevent it. We must dedicate ourselves to solutions that protect patients and at the same time, protect the very system they rely on for their care.
Our health care system is at a crossroads. Failing to act threatens our ability to respond to this pandemic and the future waves that are sure to follow. It also puts the long-term viability of our system at risk. Put bluntly, emergency departments that close their doors for good because of this crisis will not be available to care for patient’s needs now and after the pandemic. But it doesn’t have to be that way, please support us so our safety net remains secure.
Dr. Don Powell, of Michigan, is a Physician at Emergency Care Specialists and the incoming Chair of the Emergency Department Practice Management Association.