Staffed by board certified emergency medicine physicians, nurses and support staff, the Emergency Department (ED) at Broward General Medical Center has over 67 treatment areas and 10 rooms that are dedicated to the treatment of non-critical care to “fast track” patients quickly. In an effort to give cutting-edge diagnosis and treatment to all patients, the ED faces a number of challenges that include over utilization; Cobra/EMTALA laws; consumerism; the threat of decreased reimbursements; fewer specialists wanting to take call in the ED, and; fewer primary care physicians to provide preventive care.
As a tax-assisted, not-for-profit facility, Broward General Medical Centers ED is responsible for seeing all patients, regardless of insurance coverage and/or citizenship status. This leads to two hurdles. One is over utilization and the other extends to Cobra/EMTALA laws. With over utilization, there has been an influx of patients coming into the ED that cannot access other healthcare providers, patients who are either under-insured or not covered at all and patients who are seen for less acuity illnesses. With regard to Cobra and EMTALA laws, the ED is required to evaluate all patients. This poses a challenge, especially in South Florida where there are a high percentage of undocumented aliens, as well as foreign tourists who become ill while traveling. As a result, the amount of uncompensated care continues to increase.
Another challenge is consumerism, where patients are becoming accustomed to higher standards of technology in healthcare. As recently as 15 to 20 years ago, providing a thorough exam met the standards of quality care. Today, patients have come to expect services such as Xrays, CT scans, MRIs and advanced laboratory testing even for relatively uncomplicated injuries or maladies as part of their emergency department visit.
Decreased reimbursements and the shrinking pool of specialists are a challenge for emergency departments across the country. At the same time healthcare costs continue to rise due to a number of variables including improved technology and higher expenditures for hospital supplies and pharmaceuticals are required, reimbursements from Medicare and Medicaid continue to decline. Such an imbalance between cost and income causes a negative impact on revenue. In order to compete with the shortage of medical specialists, it is now necessary to provide higher salaries. Many specialists once saw working in the ED as a way to build their practice, but now see it as a liability. As a result, it is becoming increasingly more difficult to have a full compliment of on-call physicians.
With the shortage of primary care physicians, it is more difficult for patients to find convenient, quality healthcare. It is anticipated that the shortage will worsen in the coming years, when baby boomers reach retirement age and will be in greater need of health care assistance. In an effort to reverse this trend, the Council on Graduate Medical Education, a panel that Congress created for recommending how many doctors the nation needs, advised that 3,000 more doctors a year should be trained in U.S. medical schools.
Although the Emergency Department does have its challenges, the department is committed to providing patients with the best possible healthcare through superior treatment options and resources. In the emergency department environment, where lives are saved and seconds count, the ED team provides timely, cutting-edge care for every patient treated.
