Affordable Care Act: Crowded emergency departments

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by Jay Crandall

azfamily.com

Posted on September 26, 2013 at 7:13 PM

Updated Thursday, Sep 26 at 7:20 PM

PHOENIX  -- More and more often, hospital emergency rooms are becoming ground zero for health care in America. They're not only the first place people go if there is a major trauma, but are also the last resort for those with nowhere else to turn. "The emergency department is the safety net of the health care field," says as Dr. Monees Bhow, Medical Director for the Emergency Department at Banner Good Samaritan.

That means doctors in the Emergency Department  will see everything from head wounds to earaches, like the one that brought in 12 year old Jordan Amendariz. “I had an earache all night last night,” he tells us.

And while doctors here are qualified to handle all types of medical problems, Dr. Bhow says that doesn't mean it is always the ideal place to be seen. “The negatives of that are the resources and volume that come to the emergency department," he says. "It is an expensive proposition to be seen in the emergency department.”

Jordan’s mother says she did try to get him in to see a regular doctor, but was told it would be two week wait, something Jordan was not looking forward to. “I thought I was going to have to go over it all over again," he says.

Sitting a few doors down in another ER exam room,  Marshae Roebuck tells us her doctor sent  her here after he couldn't diagnosis a sore foot. “They ran x-rays," she says. "They weren't sure because the x-rays came back normal, and before they weren't swollen, but now they are, so they said just go to the ER.”

Valley surgeon Dr. Jeffrey Singer says the current insurance system contributes to visits that could be handled elsewhere. “So if you are not feeling you are costing your patient, but you are costing some big deep pocket insurance company, you will tend to order a lot of tests that make the diagnosis less work for you," he says.

He worries the Affordable Care Act will encourage more people seek medical care in expensive settings like the ER, feeling since it is covered, why not?

But Dr. Bhow says for people without  insurance, this can seem like the only place to get medical help.“The law actually requires us to see everyone regardless of their ability to pay," he says.

And that means the ER becomes primary care for them as well under the current system.“If somebody doesn't have insurance and somebody truly needs critical care or they need some assistance we are here for them," he says.

That means added volume either way. To deal with that, Good Sam has split some functions of the department; treating acute injuries in an area separate from those less serious.

As to whether more people with more insurance can bring costs down, Dr. Bhow says that remains to be seen, but he does hope it leads to better care,wherever patients go.

“I hope that people can go to the perfect place to get the kind of care they need," he says.

That's something Jordan Armendariz couldn't agree with more. “I am kind of scared and I kind of feel happy because they could fix my ear," he says.
 

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