Strain in the ER

Yellow alert: Pressure builds at hospital entry points as health-care network starts to fray.

January 12, 2001

SURE, IT'S flu season and winter weather always sends more people to emergency rooms. But the current crush of ailing Marylanders in the local ERs is symptomatic of something larger and more troubling.

Emergency rooms get too crowded too often. Six days out of 10, a hospital in our area is on yellow alert, meaning more sick people are there than can be handled.

That's happening year-round in Maryland, not just during the frigid flu season.

Last year, the number of hours of yellow alerts in the Baltimore region more than tripled compared with 1995, 1996 or 1997.

And it's not the flu that's responsible; flaws in the nation's health care system are contributing massively to the problem.

Managed-care insurers have sharply curtailed payments to hospitals and reduced treatment payments to customers. Medicare and Medicaid have cut back sharply on what they pay providers and what treatments they will pay for.

The result is a double dose of bad medicine. Denied revenue, hospitals curtail services, reduce beds, close wards. Patients, denied treatment, flood emergency rooms because they know that under federal law, those bills will be picked up.

Similarly, nursing homes have been crushed by steep cuts from Medicare, Medicaid and HMOs. They, too, have trimmed services. No wonder more sick elderly show up at emergency rooms.

The failure of the state's hospital rate-setting commission to recognize the severity of this crisis has exacerbated matters. This isn't a time for more penny-pinching. Health-care providers are under extreme duress.

Elected leaders have failed to focus on this situation, even though it has an impact on most of their constituents. They need to pay close attention to what's happening in ERs and in the state's hospitals before matters go from bad to worse.

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