Reality Check: What does the Obamacare Ruling Mean For Emergency Departments?

As the talking heads and pundits blather on and on about what the greater implications are for the country, the economy, and healthcare from the Supreme Court ruling on Obamacare, the folks
in the emergency department are going to have to deal with the real world right now and into the future.

In the ugly reality were emergency departments operate, the ruling offers no immediate changes to the trends of increased usage and decreased revenue.  As the program kicks into operation, however,
there will be some big changes in the ED:

My “most likely scenario”: 

Massive numbers of patients will become eligible for federal programs, with most being scheduled for Medicaid;

Reimbursement will continue to decline for Medicare, Medicaid, and government approved health plans;

Most states will be unable to take on the increased participants in Medicaid, and those that can will be slow in paying;

Hospitals, pharmacies, physician practices, and nursing homes will face potential financial ruin and close or restrict services;

Doctors will begin retirement at earlier ages and  restrict practices while replacement levels fail to keep pace with the retirements, let alone increased demand;

Times for appointments for even those with insurance will stretch out from days or weeks to 8 to 14 weeks as in Canada, and those frustrated patients will seek immediate help in the ED.

Rinse — escalate — and repeat.

By the way… this prediction would not have changed much had the Court ruled against Obamacare, but the pace of escalation would have been slightly less in my opinion.

My conclusion?

Existing trends in the emergency department are going to continue at ever-increasing rates for the foreseeable future until either the economy or healthcare totally implodes.  A remote chance of
the acute onset of economic and fiscal responsibility accompanied by the political will to define social and personal obligations and values could prevent the implosion – but I will leave it to quantum physics to calculate the odds on that occurring or what such an event would even look like.

So what should you do?

It is actually what you should not do.  Don’t expect things to get better in your ED because of anything that will or won’t happen in Washington.  I have never seen a law from Washington or a regulation from a bureaucrat improve the operation of an ED.

All ED’s – like all elections – are local, so how your ED fares will depend on your efforts to expedite quality care to the folks in your community within the means available.  The one thing that I see that makes the most dramatic difference in any ED that I visit is ATTITUDE.  Right behind that is organization.
Both of those depend on leadership.

It is the ED roll to help the community and the organization survive small emergencies up to and including major catastrophes.  The rules and the obstacles keep changing, but ED folks persevere
…they are the hospital special forces that get their communities through the bad times.  We will need that.

In the mean time, like I suggested in 2000, keep your licenses up to date, so your family can at least have access to home healthcare.  You might also consider adding an online source of
income and taking up home gardening (after the current drought eases) as contingency plans.

And one more thing…

You should probably hire an extra person on each shift and begin training them now… you can call the position “ED Education Officer” or something like that.  This person will be the one who explains the new rules to all of the uninsured people who come in and want their “free” healthcare.  This will free up other ED staff to do their jobs.  And maybe you should also hire a couple of MMA-trained body guards to assign to the Education person.  If you think I am kidding, just wait.   You can fund these positions by canning your patient satisfaction survey agency, since you already know where that score is going.

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