ER Docs say HHS Chief 'Uninformed'

John Commins, for HealthLeaders Media , May 7, 2009

The nation's largest emergency physicians' group called newly appointed HHS Secretary Kathleen Sebelius "uninformed" and accused her of "perpetuating myths" about their role in delivering healthcare after she said this week that emergency room care presents the "least effective, most expensive" option.

American College of Emergency Physicians President Nicolas J. Jouriles, MD, called on Sebelius and the Obama administration to "engage" emergency physicians and provide them with a speaking role in the ongoing healthcare reform discussion.

"We are dismayed the top health official in the United States appears uninformed about the crisis in emergency medical care," Jouriles says. "The public and policymakers, including Secretary Sebelius, have a tendency to engage in perpetuating myths about the causes of emergency department crowding. The bottom line is that larger numbers of patients are drawing on fewer resources, and most patients in the emergency department need to be there. Instead of trivializing the nation's emergency care system, I am asking Secretary Sebelius to involve emergency physicians to help to address the problems facing emergency patients."

Sebelius appeared Sunday on NBC's Meet The Press and said using emergency rooms as the first line of treatment for the uninsured "presents itself as why we desperately need a reformation of the health system."

"One of the reasons people visit emergency rooms is that we have far too many Americans who don't have health coverage, who don't have a doctor to call, who don't have a health home. This situation that we're in links directly into health reform," Sebelius said. On Wednesday, Sebelius told the House Ways & Means Committee that the nation must move to a medical home primary care model because emergency care is the "least effective, most expensive" option.

Those comments riled the 27,000-member ACEP. "Emergency medical care is extremely effective, which is why primary care physicians refer their patients to us," Jouriles says. "The streams of patients fearing swine flu that flooded emergency departments last week point to the central fallacy of the 'medical home:' In an emergency–which a pandemic certainly is–the emergency department is everyone's medical home. Many of the patients who came to the emergency department were sent there by their primary care physicians."

Jouriles says Sebelius should know that the Centers for Disease Control and Prevention, an HHS agency, reports that only 12% of emergency visits are for non-urgent medical conditions. He also noted that emergency physicians treat about 120 million patients each year but their costs represents about 3% of the $1.5 trillion spent each year on healthcare in this country.

While the ACEP supports universal health coverage, Jouriles says it won't ease emergency room crowding. He noted that Massachusetts' statewide mandated care experiment increased ER volumes. "Universal coverage does not lead to universal access, nor does it put an end to emergencies," he says.

John Commins is a senior editor with HealthLeaders Media.

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