Can you believe that nine patients in the Austin, Texas-area used the emergency room 2,678 times over the past five years? This fact, reported by the Integrated Care Collaboration, is simply unbelievable until you consider that eight of the nine had a drug abuse problem, and were not doubt using the ER to make sure they had their fix of pain pills.

But this finding points to a larger problem; that our ERs are clogged, that they are often filled with patients for the wrong reasons, that ERs have a limited surge capacity in the event of a catastrophe. At a time when President Obama is considering expanding health coverage to all, the question is how to ease the overuse of ERs so more could be accomodated in a way that isn’t so expensive.

Consider that an average ER visit costs the hospital between $500 and $1000. Consider that ERs are NOT filled with the uninsured. A 2008 study showed that ONLY 14 percent of ER visits involve patients without health insurance. More than 50 percent of visits (most often for minor complaints) are for people who earn more than four times poverty level, and that 29 percent of the people going to ERs are not only insured, they also have regular doctors. Doctors that they can’t get in to see!

We have a growing shortage of doctors – especially primary care doctors. A Texas survey revealed that 60 percent of primary care doctors opted out of accepting Medicare last year. Approximately the same percentage of New York’s primary care doctors are also dropping Medicare. The increasing number of doctors dropping insurance will lead to even more ER visits, as will expanding the number of patients who are covered by insurance.

Imagine what will happen if we decrease reimbursements to doctors (and hospitals) further. ERs will be flooded, and no one will get taken care of.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

Today we heard the news that former Senate Majority Leader Tom Daschle has accepted President-elect Barack Obama’s offer to serve as Secretary of Health and Human Services. It seems to me that Obama is willing to hit the ground running and might make healthcare reform one of his top priorities.

I had the pleasure of meeting Senator Daschle years ago, and I left with the impression that he was quite knowledgeable in healthcare issues and indeed was very attentive to my concerns. But, as I said, that was many years ago.

So, what do we know so far about Senator Daschle’s credentials? Well, we can get an idea by looking at his voting record and some quotes from previous interviews.

Here’s what we know so far:

Senator Daschle supports a government-funded insurance program for the uninsured. Since 2004, he has been stipulating that everyone should have the same healthcare plan as members of Congress.

Another interesting concept that Senator Daschle likes is the creation of a Federal Health Board. Now, I’m not quite sure yet what he means by that, but it seems that this board could act as a federal clearinghouse for healthcare mandates.

With regard to his voting record, I give Senator Daschle a B+. He understands the national nursing shortage we are experiencing, and he has voted “yes” on allowing patients to sue HMOs and collect punitive damages. However, he voted “no” on limiting self-employment health deductions.

I’ll go on the record and say that when it comes to healthcare, I think that Daschle has demonstrated a balanced approach to his decisions. And, in the weeks to come, we should be getting a clearer picture of his immediate priorities.

Hopefully Senator Daschle and I will get the chance to have a one on one again soon. In the meantime, let’s all congratulate our new Secretary of Health and Human Services and wish him well―he’s got a big job ahead of him.

But let him not forget that it is important to evaluate all points of view and to maintain transparency in all aspects of healthcare reform. This is a change we must all expect.

Conventional wisdom has always been that Emergency Rooms are stuffed to overflowing by the uninsured. Without a regular doctor to go to, most health experts say, those without health insurance have little choice but to flock to the ER with the slightest sniffle or fever. An ER visit is quite expensive, but how many of the uninsured end up either receiving or paying these bills?     

When the Centers for Disease Control and Prevention reported that the number of visits to emergency rooms nationally rose 19% from 1995 to 2005, even as the number of hospital ERs fell by 9%, most experts continued to believe that it was the uninsured who were clogging the shrinking ERs. As hospitals relocate to the suburbs, a growing trend, they would likely be dealing with a growing number of insured patients, potentially leaving behind the uninsured blocking their ambulance bays with minor complaints.

Is conventional wisdom correct? Apparently not.

A new study published in JAMA this past week has suddenly called the conventional wisdom into question. The study reviewed 127 articles from 1950 to 2008 and determined that “available data do not support assumptions that uninsured patients are a primary cause of ED overcrowding, present with less acute conditions than insured patients,or seek ED care primarily for convenience.”   

According to this study, uninsured patients are far less likely to visit the ER for non-urgent care than insured patients. 17% of Americans are uninsured, but they account for only 10-15% of ER visits.

What are the likely reasons for this trend?

* Today’s managed care type of health insurance doesn’t give you instant access to your physician for minor problems. There are fewer primary care doctors these days. Unable to get an appointment or timely visit, you may turn to the ER.
* Whereas the uninsured could get hit with a large bill contrary to popular wisdom, on the other hand, an insured patient will only have to deal with the co-pay.
* Uninsured patients may not be in the habit of seeking medical care for minor complaints, whereas health insurance without deductibles may encourage or support hypochondria, or worry that leads to an ER visit.
* Laws keep the ER from turning you away, so if you have insurance, you will be seen and you won’t have to pay for it.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com