As a volunteer for the Carroll County Hospital and LifeBridge Health boards, I have observed the challenges Maryland hospitals must deal with trying to provide excellent care in our state’s emergency departments.
Reporter Angela Roberts (“A broken system: Report identifies reasons behind long ER wait times in Maryland”) did an excellent job outlining the issues related to the long wait times in the emergency departments of Maryland’s hospitals. I would like to add some observations, suggestions and notes on how our local institutions are trying to meet these challenges.
First and foremost, Maryland has a unique hospital funding system due to an experimental arrangement our state has with the Center for Medicare and Medicaid Services. Under this agreement, Maryland is the only state in the nation that sets hospital rates for services, as regulated by the Health Service Cost Review Commission (HSCRC), so everyone pays the same rate for the same service.
Each Maryland hospital has a specific number of certified beds and receives a set amount of funding based on that bed count, not the number of patients admitted for treatment. Carroll Hospital is certified for 166 beds.
When the hospital has more than 166 admitted patients — a frequent reality since COVID-19 — it is obligated to provide medical services to those extra patients, but is not reimbursed for them. In Maryland, more inpatients do not provide hospitals with more revenue.
While Carroll Hospital averaged around 76% capacity pre-COVID, during, and since COVID, the hospital is usually about 90% capacity or higher.
When a hospital is full or near capacity, the emergency department gets backed up with patients who need to be admitted, even if the hospital does not have an appropriate bed available.
These patients are called “boarders” and are in emergency department beds that could be used for patients in the waiting room. During busy times, Carroll Hospital could have more than 20 boarders waiting for a bed to become available.
We need more hospital beds in Maryland and throughout America. As was pointed out by Roberts, while the population in Maryland has increased, “the number of hospital beds in Maryland declined from 12,000 to 11,300 from 2015 to 2021.” Maryland has the fifth-lowest number of hospital beds in the nation (1.82 per 1,000 people), below the 2.38 beds per 1,000 people nationally.
A second issue related to overcrowded hospitals backing up patients in emergency departments is the lack of discharge placements for patients, the amount of time it takes to find a placement and the time it takes for insurance companies to approve the recommended placement. Meanwhile, hospitals are required to hold patients until an appropriate placement is found.
The average hospital stay for patients at Carroll Hospital is just over four days, slightly less than the Maryland average. But discharges could happen quicker if hospitals had more options for patients who can’t go home because they can’t take care of themselves and don’t have the resources to pay for private home care (about $30 per hour).
Meanwhile, nursing homes, rehabilitation centers and other discharge options for patients are also operating at or near capacity. Thus, many patients are sitting in hospital beds waiting for a placement to become available or waiting — sometimes for days — for their insurance company to approve the identified placement. A friend recently spent six extra days in the hospital waiting for her insurance company to approve her placement into a rehabilitation center.
It would be helpful if government regulators limited the time insurance companies are allowed to approve post-hospital placements. Currently, they are allowed up to 14 days. This is unnecessary and is causing significant backups and wait times in hospitals.
Also, many of Maryland’s non-profit nursing homes are being purchased by for-profit, national chains. These businesses are more selective in the patients they accept, making it more difficult to find placements for more challenging patients. We need more alternative placements for patients, especially the elderly.
At Carroll Hospital, administrators are doing their best to keep patients moving forward from the time they walk into the emergency department to the time they are discharged or admitted. Last year, the waiting room received a significant renovation to improve patient experience.
This year, the board approved about $9 million to renovate the emergency department to improve the flow of patients and improve their overall experience. These renovations will be completed in 2028.
LifeBridge Health recently purchased several Express Care sites to give patients additional options for emergency care. By taking advantage of these options, patients will help reduce the overcrowding in emergency departments.
A good question frequently asked is why our emergency departments and hospitals are more crowded today compared with the past. There are many variables contributing to this. As previously stated, we have a growing population without a correlational increase in hospital beds.
In addition, doctors are reporting that patients are sicker because worsening weight and dietary issues are causing more cases of diabetes, heart attacks and other related conditions leading to more hospitalizations.
Also, many Americans don’t take advantage of free basic health care precautions. For example, more than 90% of patients admitted to Carroll Hospital for COVID infections are unvaccinated and most patients admitted for complications related to the flu have not received a flu vaccine. These are preventable hospitalizations.
Another significant issue is a provider shortage across America, especially in rural settings, meaning fewer doctors, nurses and other providers to care for an increasingly older and sicker population. Because of these shortages, people must wait longer to secure a doctor’s appointment and, sometimes, seek emergency care instead.
Through better pay and other incentives we need to encourage medical students to select a career in primary care and family medicine instead of specialties that pay significantly more.
LifeBridge Health and Carroll Hospital have partnered with Carroll Community College, McDaniel College and other educational institutions to graduate more healthcare providers. These institutions have invested millions of dollars in infrastructure and new academic programs to help with provider shortages in Carroll County and beyond.
There are no short-term solutions to this multi-layered challenge. However, America has finally started to address these issues. Healthcare systems are thinking of more efficient healthcare delivery models that provide non-hospital-centered care. These include additional telehealth opportunities and the expansion of community-based, preventative care services that reduce emergency room visits.
Tom Zirpoli is the Laurence J. Adams Distinguished Chair in Special Education Emeritus at McDaniel College. He writes from Westminster. His column appears on Wednesdays. Email him at tzirpoli@mcdaniel.edu.
