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The Front Door

If you’re looking for a sure sign of the need for health care reform, you should take a visit to an Emergency Department.  It has become the de facto “front door” to our health care system for millions of patients who turn to hospitals to provide routine medical care not because they want to, but because often they have no other choice.

Hospitals are required by federal law to provide individuals with emergency medical care regardless of their ability to pay. The law, known as EMTALA, was enacted in 1986 to prevent hospitals from refusing to treat uninsured patients, a practice known as “patient dumping.”  It basically says if you are a hospital and you hold yourself to be an emergency service provider, you’re responsible for assessing and providing emergency (only) care for anyone who presents with a life-threatening or limb-threatening emergency and/or is in active labor.

On the surface, it makes complete sense.  But in the real world, EMTALA regulations are not without flaws. These regulations prevent basic triaging of non-emergent patients, resulting in long waits and high costs. It fosters the use of the emergency department as a primary care site, one of the most expensive environments possible for that to happen, instead of directing non-emergent patients to a more cost-effective community resource such as a hospital-based primary clinic, an urgent care facility, community health services or a primary care physician setting.

There are plenty of places where people can seek care, beyond the emergency department that are more efficient and certainly more time-sensitive to the person’s needs, a lot less expensive and maybe even a better and safer clinical setting.

The current health care reform debate offers a unique opportunity to solve many of these EMTALA-related problems; the prospect of equal health coverage for all will likely mitigate concerns about hospitals “dumping” uninsured patients. I hope Washington will next address the over-utilization of Emergency Departments for non-emergent care, and provide a more cost-efficient and timely alternative to allow hospitals to triage non-emergencies and safely refer patients to more appropriate primary care settings.