ER wait times: Maryland’s ranking of worst in nation highlights larger problem
As complex as health care has become in the age of gene therapy and artificial intelligence, it’s made even more in this state so by one very simple and sad fact: Maryland’s hospital emergency rooms often make their patients wait a long, long, long time for treatment. Not always, of course, but often enough.
The average wait time of 3 hours and 48 minutes for emergency room care in Maryland is, in fact, the worst in the nation, according to the U.S. Centers for Medicare and Medicaid Services. And this isn’t exactly a new circumstance. Maryland has been bringing up the rear of this unfortunate statistic since 2015. And the second worst state, neighboring Delaware, is not even close to our time, with an average wait there of under 3 hours.
That such a pitiful performance is taking place in the state that is home to CMS — not to mention Johns Hopkins Hospital, the University of Maryland Medical Center and many other well-regarded emergency service providers — is shameful. We should be better than this.
Yet policymakers must be careful to not to take the wrong lesson from the lengthy ER wait times. This is not a moment to throw more costly hospital beds, or even bigger ER departments, at the problem. Nor should it be taken as evidence that the “Maryland All-Payer Model,” the state’s effort with CMS to reduce Medicare costs and better manage care, has failed.
What appears to be happening is that emergency rooms are swamped, and there is one overarching reason: Too many patients are showing up at the emergency room for treatment. Why does this happen? Often, it’s because people did not get medical care for problems earlier, when their maladies were more manageable and not presenting as emergencies. Therefore, at least part of the answer for Maryland might be to take a page from private providers like Kaiser Permanente, where services from primary care to urgent care are under
one roof. Members are steered toward periodic checkups and appropriate treatment. In short, it’s a system designed to keep you healthy and not just respond to a crisis.
Granted, that may not work for individuals struggling with substance abuse and homelessness on top of psychiatric conditions. Much of that particular problem centers on the state’s failure to invest sufficiently in outpatient behavioral health services, a circumstance that has only worsened since Maryland shuttered its psychiatric hospitals many years ago in places like Crownsville, Baltimore and Chestertown. The clear lack of treatment options for people suffering a behavioral health crisis turns the ER into a de facto psychiatric hospital.
As reluctant as we are to endorse bureaucratic task forces, the General Assembly would be well served to look beyond the immediate crisis of crowded ERs to consider how best to lighten the load. Granted, this issue has been investigated before, but this is also the first
year of a new term with a new governor and new health secretary. It would seem prudent to pull together a task force to study the ER problem, chaired by someone of Gov. Wes Moore’s choosing, and recommend solutions by Jan. 1, 2024, which would be well-timed for the next legislative session.
The job won’t be easy if only because the interest groups affected — from labor unions to hospitals and health care providers — have a big voice in the State House. But without a deeper understanding of the problem and how it’s been better managed elsewhere the risk is that policymakers will embrace the simplistic, the easy, the ineffective. Put in that category recent efforts by the state health department to create a real-time psychiatric bed registry, which mostly proved that the state has an insufficient number of beds. Maryland needs greater ER efficiency, but it also needs better access to health care overall. The long waits are likely a symptom of that much larger problem.