One study found hospitals may be turning away ambulances for financial reasons by avoiding treating patients with government health insurance or no coverage at all.
John Diedrich and Kevin CroweA Chicago Fire Department ambulance transports someone to a Chicago area hospital.When hospitals close to ambulances, the people most affected tend to be sicker, older and poorer.
In some places, data is collected, but laws and policies bar it from being provided to the public. In other cases, the data collected is incomplete. For instance, the ambulance report for Tiffany Tate, who was turned away from Froedtert Hospital in Wauwatosa in August 2014 as she was having a stroke in a neighboring building, did not say she was diverted; it said “protocol.”
The study examined records for 22 million Medicare patients between 2009 and 2012 nationwide. The number one factor dictating whether someone called an ambulance was seriousness of illness, followed by socioeconomic level, age and whether the person had a primary doctor. Feldman and Hanchate are examining racial and ethnic health disparities due to ambulance diversion with a $2 million grant from the National Institutes of Health.A 2015 study examining 10 years of patient data from California found that cardiac care for patients was delayed during times of diversion, leading to a higher incidence of death in the following year compared to patients who were not diverted from the closest, best-equipped hospital.
“Diversion is bad for patients,” said Renee Hsia, an emergency room doctor and professor at the University of California at San Francisco who has studied the issue of diversion for years. “And its impact is felt differently.” “This paper suggests it is not just a defensive maneuver,” she said. “It's also potentially a payer-type issue."One of the financial factors long examined as a driver of ambulance diversion is elective surgery. Sometimes hospitals will “bed block,” which means reserving beds for lucrative outpatient surgeries on certain days of the week. That creates bottlenecks trapping patients in the ER when they cannot be admitted.
Richard Klasco, assistant professor of emergency medicine at the University of Colorado School of Medicine, and Richard Wolfe, chair of the Department of Emergency Medicine, Harvard Medical Faculty Physicians at Beth Isreal Deaconess Medical Center in Boston, wrote that elective surgery patients arrive at a set time, are well-insured and have procedures that are lucrative.
“There are very powerful economic incentives for hospitals not to fix diversion because you have elective, highly reimbursed patients who have cancer, cardiac disease or transplantation and so forth," Feldman, the Boston University professor, told the Journal Sentinel."Their capacity may be affected by admitting lower-income patients who have pneumonia, older patients with Medicare and Medicaid.
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