Medicare payment cuts threaten more strain on overloaded EDs

Physicians warn that emergency departments will become overwhelmed if declining Medicare payment rates squeeze patient access.

By David Glendinning, AMNews staff. June 20, 2005.

Washington -- Emergency department physicians have been dealing with a one-two punch of increasing patient visits and declining resources for years. Now the pending Medicare payment reductions could add a third trauma to that list of troubles.

If Congress does not step in before six consecutive rounds of Medicare cuts start in January, seniors who can't find a doctor will come into EDs in unprecedented numbers when their chronic conditions become unmanageable, said Robert Suter, DO, an emergency physician in Dallas and president of the American College of Emergency Physicians.

"We are the last refuge for those who don't have access to primary care," he said. "Every emergency department in the country is at risk for this problem."

Doctors already are seeing increasing numbers of patients of all ages with emergencies, even as hospital closures are decreasing the numbers of EDs. A recent Centers for Disease Control & Prevention report concluded that the number of emergency department visits went up 26% between 1993 and 2003, while the number of available EDs went down 12.3%

A growing percentage of seniors are making visits to EDs, helping to drive the increase. If declining payment rates force physicians to stop seeing new Medicare patients or drop some of their current ones, the American Medical Association worries that this problem of patient overload could become a full-blown crisis.

"That's a very genuine fear and very likely to happen if the Medicare cuts are not corrected," said J. Edward Hill, MD, AMA president-elect and a family physician from Tupelo, Miss.