A Medical Device Daily

President Bush’s FY09 budget request, recently released, eliminates all funding for a children’s hospitals program that trains 4,700 pediatricians and pediatric sub-specialists each year at 60 independent children’s teaching hospitals. Congress has made the Children’s Hospitals Graduate Medical Education (CHGME) program a priority since its inception eight years ago, and it reauthorized the program at $330 million annually in 2006 and appropriated $301 million last year.

Noting that the request to eliminate CHGME funding comes on the heels of the president’s veto of the State Children’s Health Insurance Program,” Lawrence McAndrews, president/CEO of the National Association of Children’s Hospitals (NACH; Alexandria, Virginia), said, “I don’t think the president could be any clearer about his intentions towards children’s healthcare. ‘Wrong’ doesn’t begin to describe his actions.”

Edwin Zechman, CEO of Children’s National Medical Center (Washington) and chairman of the NACH board, said, “Children’s National Medical Center ... is a children’s teaching hospital that has used CHGME funding to place residents in community-based health programs that children from all over this region desperately need. In addition, there are shortages in a handful of pediatric sub-specialties that a cut to CHGME would only worsen.”

The nation’s 60 children’s teaching hospitals train 35% of all pediatricians and half of all pediatric specialists.

CHGME follows the standards of Medicare GME support in order to enable children’s hospitals to receive the same level of federal GME support that adult teaching hospitals receive through Medicare.

“Working with The American Academy of Pediatrics and the Association of Medical School Pediatric Department Chairs, we’re eager to rally our children’s hospital supporters in Congress to fully fund CHGME in FY2009,” said McAndrews. Congress “can set a course to provide all children with appropriate and timely pediatric care that meets their needs.”

NACH is the public policy affiliate of the National Association of Children’s Hospitals and Related Institutions (Alexandria, Virginia).

ED wait times increasing

Waits for emergency treatment are getting longer each year, according to a study just published online by the Journal Health Affairs. The study analyzed the time between a patient’s arrival in the emergency department (ED) and when they were first seen by a doctor and found that the increasing delays affected those with and without health insurance, and all racial and ethnic groups.

Severely ill patients suffered the largest increases in ED waits. Between 1997 and 2004, average waits increased 36% for all patients (from 22 minutes to 30 minutes). However for those, whom a triage nurse classified as needing immediate attention, waits increased by 40% (from 10 to 14 minutes). Waits increased the most for emergency patients suffering heart attacks, who waited only 8 minutes in 1997, but 20 minutes in 2004.

A quarter of heart attack victims in 2004 waited 50 minutes or more before seeing a doctor.

The research, carried out at the Cambridge Health Alliance (Cambridge Massachusetts)/Harvard Medical School (Boston) is the first detailed analysis of national trends in ED waits. Using data from the National Center for Health Statistics, the authors analyzed over ninety thousand ED visits nationwide between 1997 and 2004.

While all demographic groups experienced lengthening ED waits, waits were slightly longer for blacks (13.0% longer than non-Hispanic whites) and Hispanics (14.5% longer). Women also had longer waits (5.6% longer than men), while rural hospitals’ patients had the shortest waits.

The number of ED visits increased from 93.3 million in 1997 to 110.2 million in 2004. Meanwhile, the American Hospital Association (Chicago) reports that the number of hospitals operating 24-hour EDs decreased by 12% between 1994 and 2004. ED crowding in the remaining EDs causes one ambulance to be diverted away from a U.S. ED every minute according to the National Center for Health Statistics (Chicago).

Andrew Wilper, MD lead author of the study said EDs close “because, in our current payment system, emergency patients are money-losers for hospitals. Planned admissions of elective patients who need procedures are usually more lucrative for two reasons. First, elective patients can be scheduled more conveniently and efficiently, and second, they can be pre-screened for health insurance. Our study suggests that these perverse incentives are causing dangerous delays in potentially life-saving emergency care, even for those with insurance.”

Robert Lowe, MD, associate professor of emergency medicine at Oregon Health and Science University (Portland) said the study, “shows how ED overcrowding affects all of us. If a loved one has a heart attack, it doesn’t matter whether he is well insured. He still has a 1-in-4 chance of waiting over 50 minutes, because of ED overcrowding, and this wait will only increase.”

Steffie Woolhandler, MD, associate professor of medicine at Harvard, a study co-author, said, “Some policy makers, including President Bush, claim that everyone in America has access to healthcare through the ED. Our findings counter this notion. We have insurance company CEOs making tens of millions of dollars per year, 47 million uninsured Americans and worsening access to emergency care for everyone. Something is wrong here.”