Emergency Room Closures Increasing

Throughout the Philadelphia region, temporary closures of hospital emergency rooms (ERs) have been steadily increasing. In 1998, temporary shutdowns totaled slightly more than 12,000 hours. In 1999, this number increased to 15,300 and jumped to almost 20,000 in 2000. Overcrowding, personnel shortages, and lack of beds are the primary reasons for the closures-during which hospitals attempt to divert patients to other facilities. However, the root causes of the problem are a bit more complex.

One of the primary reasons hospitals are sometimes forced to close their ERs is poor financial health. In Pennsylvania, four out of five hospitals run on negative operating margins, due to pressures such as inadequate reimbursement from health insurers, rising pharmaceutical costs, skyrocketing malpractice insurance rates, increasing salaries (to combat the growing shortage of nurses and other health professionals), and the costs of complying with federal regulations regarding medical records. To staunch the flow of red ink, many hospitals reduce personnel and staff fewer beds-thereby leading to bottlenecks in the ER.

"We're not turning away people because we are being selective," says Dr. Leon Malmud, president and CEO of the Temple University Health System. "We're turning people away because we cannot provide care under the optimal circumstances." Overcrowding in ERs is not limited to Philadelphia-cities such as Boston and Chicago are also struggling with the problem.

Although Congress's recent decision to allocate funds to help hospitals cope with the losses caused by the Balanced Budget Act of 1997 might help alleviate pressures, many do not see this as the solution. "That money is not going to be a panacea for the hospitals and health systems in the community," says Andrew Wigglesworth, president of the Delaware Valley Healthcare Council. "It is going to go for the salary enhancements that have already been given to nurses and other key caregivers in response to the shortage."

Financial problems are not the only causes of ER shutdowns; patient behavior is also a contributing factor. Urban areas are often home to large numbers of uninsured people who wait to seek medical treatment until their illnesses are so severe they end up in the ER. In addition, increasing numbers of people are using the ER as a doctor's office-seeking treatment for non-emergency ailments. Both of these practices lead to ER backlogs-a condition that is exacerbated during busy times such as flu season.

To combat the problem, hospitals and industry groups are seeking various solutions-from purchasing new equipment to speed up diagnoses to expanding the number of beds that can be used by the ER to encouraging routine flu care at physicians' offices and community health centers.

From the January 15, 2001 Philadelphia Business Journal article, "Area ERs Increasingly Post No Vacancy Sign," by John George