Baltimore Sun

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.

 ?? BALTIMORE SUN FILE ?? Maryland recorded the longest hospital emergency room wait times in the nation in 2022. How can this problem be addressed? The state should assemble a task force to recommend strategies.
BALTIMORE SUN FILE Maryland recorded the longest hospital emergency room wait times in the nation in 2022. How can this problem be addressed? The state should assemble a task force to recommend strategies.

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