Emergency room visits increase in Mass., plus more hospital news

The Boston Globe: In Massachusetts, "[t]he number of people visiting hospital emergency rooms has climbed … despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use. According to state data released last week, emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year. When the Legislature passed the insurance law in 2006, officials hoped it would increase access to primary care doctors for the uninsured, which would improve their health and lessen their reliance on emergency rooms." But according to a Division of Health Care Finance and Policy report, "expanded coverage may have contributed to the rise in emergency room visits, as newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician" (Kowalczyk, 7/4).

The Wall Street Journal: In New York, several hospitals "are offering outpatient hospital care late into the night or on Saturdays to alleviate weekday crowding," including elective joint-replacement surgeries, MRIs and CT scans, radiation and echocardiograms.  "For decades, most hospitals have scheduled surgery from about 7 a.m. to 3 p.m. weekdays. But as the population ages, hospitals are performing more procedures and staffs are working later into the day. Some physicians say they prefer to perform some elective procedures on Saturdays, rather than late into the evening, to keep their staff fresh" (Sataline, 7/6). 

Meanwhile, hospitals in the Philadelphia area, are "experiencing a spike in insurer denials for short hospital stays, which could potentially cost them millions of dollars as well as more out-of-pocket costs for patients," The Intelligencer/phillyBurbs.com reports. "Annual hospital stays in Philadelphia were 29 percent higher than the national average in 2008-09 (372 days verses 289 days), according to Milliman, an independent actuarial and consulting firm. … The Philadelphia region's largest insurer, Independence Blue Cross, says it started cracking down on what it deemed inappropriate inpatient admissions about 18 months ago, as part of the national trend of pushing patients into outpatient treatment as a health care cost-control and efficiency measure, said Don Liss, the company's senior medical director of clinical programs and policy. Over the last year, local hospital administrators say they noticed a growing pattern of insurers downcoding hospital stays of less than three days to observation care" (Ciavaglia, 7/6). 

The Detroit News: In Detroit, private surgical centers are competing with hospitals for patients. "Doctor-owned surgery centers have begun to pop up across Metro Detroit and Michigan as advances in medical technology make it possible to perform more surgeries outside a hospital setting. ... Doctor-owners say the facilities are cheaper to operate and predict they will become more of a health care mainstay as the government and insurance companies seek to trim medical costs. Patients benefit as well because they no longer have to go to a major hospital or medical center for relatively routine procedures, such as a hip replacement or cataract removal. Still, some industry observers question whether doctors who have an ownership stake in a surgical facility may be tempted to order more surgeries than physicians who don't (Rogers, 7/6).

Meanwhile, on Thursday, "the ACLU sent a letter to the Centers for Medicare and Medicaid Services asking the agency to clarify that hospitals receiving government funds may not deny patients 'emergency reproductive health care,'" the Los Angeles Times blog Booster Shots reports. "The law in question is the Emergency Medical Treatment and Active Labor Act, which 'requires hospitals to stabilize or transfer patients who are facing an emergency,' according to the letter. … In some extreme cases, proper treatment involves terminating a pregnancy. With 15% of the country's hospital beds operated by Catholic hospitals, the risk that some of them may be violating the law is real. The ACLU outlined three cases in which women already in the midst of miscarriages were denied necessary care by Catholic hospitals; one of those women 'developed pulmonary disease, resulting in lifetime oxygen dependency' as a result, the letter says" (Kaplan, 7/3).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.