Gary Passama

Gary Passama retired as president and CEO of NorthBay Healthcare on March 31, 2017. An active blogger since 2010, here’s a collection of his work.

An Imperfect Storm

July 21, 2016
 

California hospitals in recent years have shared one thing in common: an often overwhelming increase in visits to their emergency services.  The surge can be traced to the passage of the Affordable Care Act in 2010 (aka “Obamacare”) and the problem newly insured patients – particularly those covered by Medi-Cal – have in finding a primary physician to care for them.

In 2014, the first year of expanded Medi-Cal coverage made possible by the Affordable Care Act, emergency department visits by Medi-Cal patients increased by one million over the previous year. Not surprisingly, most were for non-urgent care.

Emergency rooms became medical traffic jams. It became more difficult to care adequately for both emergency cases and for non-urgent situations.

During the same period, California hospital emergency services began to see an influx of patients suffering from behavioral health problems. Medical hospitals are not really capable of providing the type of services these patients need. The influx stems from years of neglect by policy makers in Sacramento who have ignored the need for mental health services for these often difficult patients.

The responsibility for caring for these patients has been foisted on county governments, which in many cases have not filled the void.  Having no other place to turn, folks with behavior issues and their families seek care from the only place that is required by law to see all who cross the threshold — hospital emergency services.

Call it an imperfect storm caused by public policy that is big on promises but poor on funding. Hospitals, private and public, have been left to try to cope with this political negligence.

NorthBay Healthcare’s two hospitals and their emergency services certainly have felt the impact. In NorthBay Medical Center and NorthBay VacaValley Hospital, the two emergency services combined will average 180 to 200 patients a day, or about 70,000 patients a year.  On a given day, 5 to 10 of these patients are behavioral health patients for whom services are not readily available. Many of the rest are truly non-urgent medical patients who could be seen outside of busy hospital emergency services.

The California Hospital Association is working with its members to help find solutions to the overcrowding problem. There is no magic bullet, however. It is too complex to lend itself to easy solutions.

There are models in other states that can be used to help California remedy this situation.  What is clear is that public agencies cannot continue to dump this problem of accessibility caused by their inaction on hospitals.  To continue to do so threatens the ability of hospital emergency services to take care of the patients with real medical emergencies.

 

Comments

 
  1. July 21, 2016 at 12:00
     

    Gary, Great points. We (society) need to face the related problems of behavioral health and homelessness, both of which complicate hospital roles. Thanks for this report. Good to have factual data on this impact. Lyman

     
 

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