Area Experts Predict Emergency Rooms Will Stay Busy Despite Health Reforms

NORTH KANSAS CITY, Mo. – North Kansas City Hospital opened its new $18 million emergency room last week, and Peggy Schmitt said she couldn’t be happier.

“It feels better than I ever could’ve imagined,” said Schmitt, the hospital’s chief executive. “I think this new facility is going to make such a difference in the comfort and care that is provided.”

The new space, which took 18 months to build, has a zone dedicated to patients with less serious injuries. ER personnel also can isolate the space, if needed, to contain contagious viruses such as the flu.

Hospital staff said the new emergency room has more natural light than the previous ER. It has a roof-top landing pad for helicopter ambulances that replaced one that was across the street and it has 42 private treatment rooms, whereas the old space still had some areas separated only by curtains.

At roughly 36,000 square feet, it’s about double the size of the old facility, upping capacity by about a quarter. Hospital officials project the new ER will handle about 80,000 patients annually.

There’s new emphasis in the health care industry on health homes, coordinated care and other treatment modes that among other things are expected to help reduce the number of visits to emergency rooms because patients will get services more appropriately in other, less costly settings.

But Schmitt said the ER improvements made sense anyway. The hospital is in the heart of a fast-growing area and, she said, it could still be a while before the Affordable Care Act and other developments slow traffic to emergency rooms.

“Until that all takes place,” she said, “those patients are coming to the emergency room.”

Others agree that emergency rooms will continue to be busy in the foreseeable future.

The emergency room at the University of Kansas Hospital sees about 50,000 patients a year.

“I don’t worry about mothballing it and putting up the ‘closed’ sign anytime soon,” said Dr. Lee Norman, senior vice president and chief medical officer at KU Hospital.

Dave Dillon, spokesman for the Missouri Hospital Association, said that technology-rich emergency rooms are “highly convertible.” If ER volumes drop, he said, the spaces could serve other needs.

The question of whether expanded insurance coverage translates into fewer emergency room visits is a hot topic in academic medicine today, and researchers have looked to Massachusetts as a case study for how the ACA might play out across the nation.

Massachusetts’ 2006 healthcare reform served as a model for the federal reform.

One 2011 study, published in the New England Journal of Medicine, compared the number of ER visits in Massachusetts with Vermont and New Hampshire, neighboring states that had not enacted reforms.

They studied data from 2004 to 2009, and found “remarkably consistent” trends in all three states toward increased ER usage.

Dr. Matt Gratton, chairman of the Emergency Medicine Department at the University of Missouri-Kansas City School of Medicine, said he wasn’t surprised by those findings.

He holds the same position at Truman Medical Centers, which sees a volume of patients at its Hospital Hill emergency room about equal to the number seen at North Kansas City Hospital.

Gratton said he doesn’t believe people newly covered as a result of the Affordable Care Act will be more likely to see a primary care doctor than visit an emergency room, despite the hopes of many health care experts.

He predicted that emergency rooms would remain busy. Among other reasons, he said, many people still will find it difficult to make appointments with primary care providers.

“Wait, I can’t get an appointment with a primary care doctor because they aren’t taking Medicaid or I have an 8-6 job and I can’t just take off to go see a doctor during normal hours, so I’m just going to go to the ER,” he said, describing how he expects many newly covered people will react.

He also said that emergency rooms serve an important screening function by quickly deducing when a person’s problem is not life threatening, thereby avoiding an unnecessary hospital admission.

KU’s Norman said technological advances might decrease ER use. But more likely, he said, was that an aging population and the shortage of primary care providers would keep emergency rooms busy.

“I wish I could be more optimistic about that,” Norman said. “If coverage is expanded, people will seek more services and if they cannot get it in the primary care arena, then they will go the emergency department.”

The original story implied that North Kansas City’s new emergency room had a total of 31 rooms. The new ER has 42 rooms.

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