Remedy sought for ER waits

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BALTIMORE -- The solution to emergency-room crowding lies far from the emergency room, health care specialists say.

Their suggestions -- including that prevention, drug-addiction treatment and end-of-life planning can help reduce the crowding -- were discussed yesterday at a conference sponsored by the University of Maryland-Baltimore County Department of Public Policy and the Center for Health Program Development and Management.

Patients wait an average of four hours and seven minutes to be seen in Maryland emergency rooms, among the longest wait times in the country, according to the Maryland Chapter of American College of Emergency Physicians.

Dan K. Morhaim, an emergency physician and Maryland House member, said he and other lawmakers were also working to expand health coverage to the 780,000 uninsured Marylanders. At the first meeting of the Joint Committee on Health Care Delivery and Financing last month, Mr. Morhaim, Baltimore County Democrat and co-chairman Sen. Robert J. Garagiola, Montgomery County Democrat, said the state must create a health care fund as part of its budget balancing, either during a special session this year or when the legislature reconvenes in January.

Mr. Morhaim also encouraged Marylanders to complete advance directives, which dictate what kind of treatment is wanted or not wanted in the event a person cannot speak when they arrive at an emergency room.

Dr. Linda DeFeo, an emergency-medicine physician and consultant, said prevention is key, particularly considering the aging baby boomers, who account for about a third of the population.

"Unless we do something at the front end to prevent disease and injury, it's going to keep getting worse," Dr. DeFeo said at the conference.

Pamela Barclay, director of the Center for Hospital Services at the Maryland Health Care Commission, said emergency-room use is increasing. Such visits increased 18 percent from 1990 to 1999 and 23 percent from 2000 to 2006.

Mr. Morhaim said the problem is bigger than building more emergency rooms or other single-focus solutions.

"I think we need a broad-based fix in health care in general," he said.

Lawmakers and others are concerned about health care spending largely because it is increasing faster than the pace of inflation, affecting the ability of companies to hire employees and pay for health care and pensions. Total health care spending represented 16 percent of the gross domestic product of the United States in 2005, the latest year for which figures are available, according to the National Coalition on Health Care, a nonprofit health care improvement coalition.

Miss Barclay said 19 percent of emergency-room visits were by the uninsured, with those on Medicaid accounting for another 18 percent. Mr. Morhaim said addiction is responsible for 80 percent of uncompensated care in emergency rooms.

If policy-makers could address addiction, injury and disease prevention and end-of-life issues, "you decompress the whole system," he said.