Dr. Mark Langdorf

Dr. Mark I. Langdorff

While a big part of health reform focuses on providing preventive care to keep patients away from costly hospital emergency rooms, the editor-in-chief of a premier emergency care journal expects a 4% to 10% rise in yearly emergency room visits at UC Irvine Douglas Hospital, and elsewhere nationwide.

The problem, said Dr. Mark Langdorf, editor-in-chief of the Western Journal of Emergency Medicine, is that while some 37 million newly insured Americans are expected to enter the nation’s healthcare system under the Affordable Care Act (ACA), the government didn’t provide adequate funding to cover the additional cost.

“So you take the group of Medi-Cal patients [which make up 35% of UC Irvine’s emergency room visits], which now will be a higher number of patients under the Medi-Cal expansion, but there will be no new money available in the system to cover the cost of care,” said Dr. Langdorf, who is also a specialist in emergency medicine at UC Irvine Medical Center.

ACA also did not provide incentives to increase the number of primary care physicians, which are already in short supply, Dr. Langdorf said.

“Health reform didn’t do anything to increase the number of primary care doctors to accommodate the influx of newly insured people,” he said. “There is a powerful motivation to go into the higher paying specialties and not become family doctors.”

In addition, he said, Americans have become accustomed to getting quick results and immediate answers.

“It’s an immediate culture, and people don’t want to wait,” he said. Hence, when primary care doctors are unavailable to give answers to medical questions right then and there, patients flock to the emergency room.

“The culture of immediacy works against the intentions of the ACA to create a primary care medical home,” he said. “Not only do primary care doctors not have the capacity to see new patients, they often don’t have the capacity to see existing patients, and then patients come to the ER instead.”

In the short term, Dr. Langdorf foresees longer waiting times, more dissatisfied patients and an increase in patient volume at hospital ERs nationwide.

UC Irvine’s Douglas Hospital has taken several steps to try to improve efficiencies and reduce waiting times. Creating more space and increasing staff were priorities.

The hospital is currently waiting on licensing approval to open up a new 20-bed observation area outside the ER, which will free up beds inside the ER to accommodate new patients.

Dr. Langdorf said that the earliest the observation area will open is mid-December, pending approval.

The hospital ER also has added two nurse practitioners, who will be available 10 hours a day to see patients with less acute problems, and two more emergency physicians. It also expanded its residency program from six to eight, he said.

The hospital ER has about 48,000 patient visits a year, which comes out to about 135 patients a day. A 4% to10% rise in annual patient visits would exacerbate an already challenging situation at the hospital’s emergency department.

“Our philosophy is to have an open door policy and see everybody, but we have to have the resources to do that well,” Dr. Langdorf said.

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