Report: Emergency Departments Feel Fiscal Pain

The county’s emergency room departments collectively drained $23.5 million from hospitals in fiscal 2002, as more uninsured and underinsured patients turned to them for care, according to a recent report by the California Medical Association.

The fourth annual report on emergency room losses found that California hospitals lost $460 million and doctors $175 million in uncompensated emergency care for the fiscal year ending in June 2002, an 18 percent rise from fiscal 2001, the association said.

The emergency room situation has gotten worse every year, said Dr. Roneet Lev, an emergency room physician at Scripps Mercy Hospital in San Diego.



Lev is also the chairwoman of the Emergency Medicine Oversight Commission, a group of local doctors, nurses and hospital representatives aiming to improve the situation at the county’s 20 emergency rooms.

“It’s not new that the ERs are in a crisis,” Lev said about California’s emergency rooms. But, she warned, “the emergency room situation will collapse if there is no relief.”

In San Diego County, the losses for emergency care actually declined from $26.3 million in the fiscal years 2000-01 to $23.5 million in the fiscal years 2001-02.

But Lev is quick to argue that the declining losses don’t translate into better patient care.

“The report is about money, what really counts is when you’re sick and you need emergency room services,” she said.

The reality is that the number of patients turning to ERs for treatment has risen in recent years. This has resulted in longer wait times and even more overcrowding, Lev said.

In her own analysis, 9 percent of patients coming to local emergency rooms get so frustrated with the long wait times that they end up leaving. That is up from 6 percent last year.

Lev considers it “seriously dangerous” and potentially harmful to the community when patients who are seriously ill don’t get treated.



But some ERs are busier than others.

According to the report, the fiscal shape at emergency departments in the county varied.

For example, the 236-bed Pomerado Hospital in Poway lost $794,355, or $37.14 per patient in fiscal year 2002.

By contrast, the 183-bed Scripps Memorial Hospital in Chula Vista lost more than three times that amount, $3.3 million, or $97.80 per patient in the same period.

The payer mix and patient volume provide insight for the discrepancy.



Pomerado reported 206 uninsured emergency room visits; 1,477 visits from patients on Medi-Cal (the state-funded health program for the indigent); 3,776 visits from patients on Medicare (the federal health program for the elderly); 93 county indigent visits; and 13,140 insured visits , totaling 18,692 visits.



Scripps in Chula Vista reported 3,174 uninsured visits, 2,230 county indigent visits and 10,281 Medi-Cal visits, which Lev said translates into no pay and not enough reimbursement.

Children’s Hospital in Kearny Mesa and Sharp Grossmont Hospital in La Mesa reported the largest emergency room losses in the county.

Children’s Hospital topped the list with a $4.8 million loss, or a $102.65 average loss per visit, which Lev attributed to its “safety net” status for all local children.

Grossmont ranked second with a $3.5 million loss, or a $57.66 average loss per visit.

Lev attributed the losses to a rising demand, a greater uninsured population, and the new nurse-to-patient staffing ratios, which put a financial strain on local hospitals, given the severe nursing shortage.

“Grossmont suffered because Scripps Memorial Hospital East County closed (in 2000) and absorbed a tremendous increase in uninsured patients (more than 7,000 in fiscal year 2002),” Lev said.

Grossmont recently spent $63 million to build a 165,000-square-foot emergency and critical care center to meet the rising demand.

Michele Tarbet, the chief executive officer of Sharp Grossmont Hospital, said the renovation was needed to serve an estimated 30,000 more emergency patients, up from 70,000 per year now.



The association’s report comes at a time when doctor groups lobbying for an initiative on the November ballot, Proposition 67, that would raise roughly $600 million for emergency room services and community clinics in California through a tax on in-state telephone use.

Lev considers the measure pertinent for all.

“Everyone who thinks they need emergency services should vote for this,” she said. “Fifty cents a month or 90 cents a month is not a big price to pay for life or death matters.”

She said that while in many ways San Diego County’s emergency care is better than its counterparts in Los Angeles and the San Francisco Bay Area, it is worse in terms of patient beds per capita.

She finds that while our county has a well-developed trauma system, the ERs are faced with more patients coming in and there aren’t enough beds available. Patients will face longer wait times and more instances of diversions into other hospitals.

According to Lev, emergency room patients fall into three roughly equal groups: Insured, uninsured and underinsured people.

Providing care for the uninsured is not reimbursed at all and underinsured patient care is reimbursed inadequately, she said.

Lev said if doctors and hospitals aren’t reimbursed for the care they provide, the losses will be greater and the problem will get worse.



“Everybody agrees that there is a problem, but nobody wants to pay for it,” Lev said.