San Francisco Chronicle –
Oct. 17: New hospital data show an increase in emergency room visits, a jump
physicians attribute to both a swelling of demand for services and improvements
that allow emergency departments to treat patients faster.

Visits to emergency departments rose by almost 10 percent in 2009, the largest
increase since the government started tracking the figures in the early ’90s,
according to preliminary estimates being released today by the U.S. Centers for
Disease Control and Prevention.

U.S. hospital visits jumped to more than 136 million in 2009, the most recent
year available, from 123.8 million in 2008. Emergency physicians, who are
gathering this week for an annual meeting of the American College of Emergency
Physicians in San Francisco, say emergency medicine is playing a growing role
in American health care. At least in the short term, the increased demand for
their services appears to be a sign of the tough economic times.

“With the economy, people have lost their coverage and, given the fact the
emergency department is the safety net, they come to us,” said Dr. Jay
Kaplan, an emergency physician at Marin General Hospital who serves on the
board of the emergency physicians’ organization.

The physicians argue that it is counterproductive to dissuade patients from
going to the emergency department to save money in overall heath care costs, it
doesn’t, they say. “We’re efficient. We take care of acute patients and
that’s what we do well,” said Dr. Paul Kivela, managing partner of Napa
Valley Emergency Medical Group, and also a board member of the American College
of Emergency Physicians.

Reform liability to cut costs

The emergency room physicians argued cost savings in health care could be
better focused on liability reform that would reduce the pressure on physicians
to perform unnecessary tests or admit patients to the hospital out of fear of
getting sued, he said.

“The fear of malpractice litigation is not the cause of the increase in
emergency department visits, but it’s clearly a reason for the cost of
emergency care,” Kaplan said.

California has a long-standing medical liability law that caps the amount for
noneconomic damages or “pain and suffering” at $250,000, but leaves
unlimited the amount plaintiffs can seek for other damages such as medical
costs and lost wages. The emergency physicians’ group is pushing for liability
reform on a federal level.

There are signs that physicians are being pushed to increase their malpractice
insurance, even in California. Catholic Healthcare West, which is based in San
Francisco and is the largest private hospital system in the state, is
considering requiring its doctors to boost their annual liability coverage from
$3 million to $5 million.

“Like other hospitals across the country, CHW is re-evaluating the minimum
requirements for medical liability coverage that corporate medical groups
contracting with us carry,” the company, which includes St. Mary’s Medical
Center and St. Francis Memorial Hospital in San Francisco, said in a statement.
“In some cases, these requirements have not been modified in 25 years, and
in that time medical care has grown more complex and carries greater

“That has the potential of dramatically increasing health care costs in
California,” Kivela said. “If our costs go up, the costs to the patients
and health plans go up as well.”

Primary care resources

While the doctors say emergency departments are not the places to cut costs,
other health care experts contend the federal health law will force health care
providers and policymakers to re-evaluate how to spend money in the health

“Were spending way too much on surgery, hospitals and emergency rooms and
not enough money on primary care,” said Walter Kopp, a health care
consultant based in San Anselmo. “If primary care had more resources, we
could do a better job in providing primary care.”


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