More Americans are seeking care in hospital emergency rooms. Yet, almost a third of urban and suburban emergency departments have closed over the past two decades.
The number of ERs in non-rural areas in the U.S. fell 27 percent between 1990 and 2009, according to a study published last week in the Journal of the American Medical Association. That’s an average of 89 closures per year.
Illinois has lost 23 non-psychiatric hospitals — and their emergency rooms — since 1990, with the most recent closure being that of Michael Reese Hospital in 2009, according to the Illinois Hospital Association.
Illinois hospitals are not allowed to close an emergency room unless the hospital closes, said Danny Chun, a spokesman for the association.
The loss of emergency rooms nationwide since 1990 is a concern because ER visits have increased 35 percent since then, said Renee Hsia, author of the new study.
“The demand for care has increased and has rapidly outpaced our supply. They’re going opposite directions,” said Hsia, an assistant professor of emergency medicine at the University of California, San Francisco.
Other studies show that the more crowded emergency departments become, the less able they are to give optimal care, and they remain America’s health-care “safety net,” she said.
Financial pressure on hospitals is largely to blame. Hsia and her colleagues found that emergency rooms that shut down were more likely to:
◆ have low profit margins
◆ serve patients below the poverty level
◆ serve patients with poorer forms of insurance, including Medicaid
◆ be inside for-profit hospitals
◆ be located in more competitive markets.
Rural hospitals weren’t included in the analysis because they generally receive special funding from federal sources.
Illinois hospitals faced additional strain in the 1980s and 1990s because of the Illinois Competitive Access and Reimbursement Equity program, which was launched in 1985, the state hospital association said.
The program set up a new payment system in which hospitals contracted with the state to provide a fixed number of days of care to Medicaid patients at a set price. Before, hospitals were paid for a potentially unlimited number of Medicaid patients based on their own costs.
The program successfully drove down the state’s rising Medicaid costs. But it was also responsible for a steep drop in reimbursement rates to hospitals, from 81 percent of the cost of providing care to 56 percent.
“It was following the implementation of ICARE that the state began to see these failures,” said Howard Peters, executive vice president of the hospital association. The now-defunct program “played a major role in changing the landscape in terms of availability of care,” he said.
The Chicago Department of Public Health, in a report on hospital trends from 1999 to 2003, also noted that most closures since at least 1980 had occurred in areas with the highest concentration of hospitals, suggesting competition was a factor.
Emergency rooms could become even more crowded after millions of Americans become newly eligible for Medicaid in 2014 as part of federal health-care reform. Already, many Medicaid beneficiaries seek care in emergency rooms, because they can’t find providers willing to accept their insurance. Contrary to popular belief, patients with public insurance, such as Medicaid, account for a higher proportion of emergency department visits than the uninsured.
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