Modesto Bee Article

By Modesto Bee Staff Reporter
last updated: August 22, 2008 03:27:32 AM

A new state study confirms what people who have ever waited five, six hours or longer in an emergency room in Stanislaus County already knew: A whole lot of residents are using ERs and many don't need to be there.

Stanislaus ranked highest among 16 large counties for emergency room visits by population, according to the study by the Public Policy Institute of California. San Joaquin, Fresno and Stanislaus counties also rated high for the percentage of ER patients who could have been treated as effectively at a doctor's office or urgent care clinic.

The study disproves a couple of common stereotypes -- that ERs are filled with undocumented immigrants and people without insurance. "(W)e find that even after accounting for health status and other social and economic factors, foreign-born Hispanics and Asians remain significantly less likely than U.S.-born non-Hispanic whites to visit an emergency department," wrote the authors, both researchers at PPIC.

And the most frequent users of emergency rooms are those on Medicare and Medi-Cal. The former is no surprise; those over 65 tend to have more health problems. People with state-sponsored Medi-Cal insurance often have a difficult time getting appointments because many private physicians take a limited number of Medi-Cal patients or none at all because the reimbursement rates are so low.

Local medical experts suggest some other explanations for the high use of emergency rooms:

Hospitals are required by law to treat anyone who shows up and they cannot require payment upfront -- although they obviously will send bills after the fact. Community health clinics, in contrast, usually ask for some payment upfront.

People with insurance cannot get same-day appointments so their doctor's office refers them to the ER, sometimes for problems that could wait a day or two.

And, people don't realize that same-day appointments and urgent care services are available in community health clinics and some private practices. For example, the county still operates its Urgent Care Center in a new location, as part of the Paradise Medical Office in west Modesto. It is open on evenings and weekends, but hasn't been busy this summer. The waits there are substantially shorter than in an ER.

While hospitals cannot redirect people to urgent clinics, Golden Valley Health Centers is trying to make it easy for people to see an alternative. Golden Valley is expanding its clinic across the street from Doctors Medical Center. That would be a more appropriate place for someone with an ear infection or other nonemergency condition.

The high and inappropriate use of emergency rooms is not just an inconvenience, something that creates long waits for frustrated patients. National experts say crowded ERs can hurt the quality of care for patients who need the most specialized treatment.

Furthermore, the cost is huge. The PPIC study notes that emergency room treatment can cost two to three times what it might cost for the same treatment in a physician's office or urgent care clinic.

One thing contributing to the valley's high ER use is a shortage of physicians. That's one of the best arguments for a medical school at the University of California at Merced. But even if the school is started on the current timetable, it won't be producing fully trained doctors until 2021 or beyond.

Local health care leaders argue, persuasively, that the high ER usage is only a symptom of a broken health care system. No doubt about that, but the national solutions seem so distant that it's obvious some interim strategies have to be employed to reduce the inappropriate use of emergency rooms so that the sickest and most severely injured people can be treated quickly.