The call comes just before 5 a.m. She quickly dresses and rushes out the door.
When she gets to the hospital’s emergency department, he is already angry. He doesn’t feel good; he wants to go home.
She has accompanied her elderly father to various local hospitals’ emergency units more than half a dozen these past few years, each visit as horrendously long as the previous.
The episodes always begin with something going wrong: a fall, a breathing issue, a digestive problem. Time is always of the essence. But after the initial adrenaline rush to get there, everything descends to a standstill.
Even though he has nowhere to be, for him, the wait is excruciating. He is lying uncomfortably in the hallway at the center of a beehive for three, five, seven hours.
He says aloud to any passerby, “Are you a doctor? Do I have to stay here forever?”
She wonders the same. Why is a visit to the emergency room an oxymoronic experience?
A few days later, she goes in search in of answers.
She reaches out to the American Hospital Association, which suggests she chat with Dan Handel, chief medical officer for the central market of Atrium Health, based in Charlotte, North Carolina.
A Northwestern University grad and a practicing emergency department physician, Handel has studied patient flow in hospital emergency settings and is an advocate for positive change.
“This is a national issue,” he said. “It’s an input, throughput and output problem.”
There are often long waits to get into an emergency department, long stays once a patient is in the area and long waits to get out as staff often struggle to find the appropriate place for a patient to go.
It is also an aging problem, he said, which complicates the whole process.
Many older patients require immediate care for their condition. But many also need post-acute care, such as rehabilitation or skilled nursing, meaning they can’t just go home after their hospital visit.
Just as hospitals are short-staffed, so are those follow-up care facilities, Handel said.
Adding to the chaos and delays, he said, are Medicare Advantage plans, which are a popular alternative to Medicare, but are often disincentivized to approve post-acute care.
“We’re seeing a high number of rejections for Medicare Advantage claims when it comes to authorizing patients to get post-acute ongoing care,” Handel said.
With nowhere safe for a patient to go, they often stay at the hospital, reducing the number of available beds for incoming emergencies.
Handel said these insurance plans are growing in popularity. “This is only going to get worse. It’s kind of the perfect storm of not enough people to staff” and a slow system not inclined to cover post-hospital care.
“One of the things we’re advocating for is an alignment of incentives and accountability for Medicare Advantage plans, to get timely approval for patients who need post-acute care,” he said.
“Hospitals can’t say no to patients. We are the only resource for those types of conditions,” he said. “But there needs to be a shared sense of accountability for timely transition of patients. because it backs things up.”
What can people do in the meantime?
Many hospitals, including University of Chicago Medical Center, Copley Memorial Hospital in Aurora, Edward Hospital in Naperville and Ingalls Hospital in Harvey, are posting their wait times. Go to https://www.hospitalstats.org/ER-Wait-Time/search?zip=60487&distance=10 and punch in your zip code for a list.
Knowing how long the wait may be can help those who have options decide if they need a big hospital or if a smaller one might be able to handle their issue. It can also help a prospective patient decide if their condition requires emergency department care or if it can wait.
“Say you sprained your ankle and need an X-ray,” Handel said. “If you know you can call your doctor in the morning and get the care you need, you might opt to not go to the ED. But if it’s going to take weeks to see your primary, that might be an incentive to use emergency services.”
One way the public can help ease the pressure on an overtaxed system, Handel said, is to have advanced directives and care goals at the ready.
“It is good to have a power of attorney, someone you trust to make health care decisions in your best interest,” he said.
Unfortunately, a certain percentage of patients have been abandoned by family members, he said. When these patients need to go on Medicaid or need to be placed in a skilled nursing facility, the process can take months, Handel said.
Medicare Advantage plans, like HMOs, offer some good things, Handel said. Many include prescription medications and vision or dental care. They promote preventative care, Handel said.
“But they are one of the least likely (programs) to approve post-acute care even when it’s clinically appropriate,” he said.
Naperville Sun
Twice-weekly
News updates from the Naperville area delivered every Monday and Wednesday
That needs to change, he said. “There needs to be a shared sense of urgency across the continuum of care.”
The current setup, he said, stresses everyone: patients, medical staff and even patients’ family members.
“I’m a practicing ER physician. When I’m working a shift, the most stressed I am is about the person in the waiting room. No ER wants people in the waiting room. They may be OK, but they may not be,” he said.
donnavickroy4@gmail.com
Donna Vickroy is an award-winning reporter, editor and columnist who worked for the Daily Southtown for 38 years.