“The DOH’s efforts are unprecedented,” said Jim Brennan, president of the Massachusetts Emergency Medicine Association, a trade group. “The DOH is working to ensure that all patients are aware up front that there are resources available to them outside of the emergency room.”
Brennan said the emergency room is equipped to handle less serious medical emergencies.
“Routine coughs, colds, fevers, stitches, we can handle that,” he said.
Brennan said the average visit time to the roughly 200 urgent care facilities in Massachusetts is an hour, and costs one-fifth as much as an urgent care facility, and he estimates that about 40% to 50% of the urgent care facility’s patient volume could be effectively treated there.
DPH said the initiative is an effort to address the busy summer season.
“With emergency department volumes high during the summer months, this agreement will help reduce congestion and prevent long wait times for treatment,” Department of Health and Human Services spokesperson Olivia James wrote in a letter explaining the policy change.
But officials said the move was driven in part by Steward Healthcare’s ongoing underperformance, which they said has prevented the company from maintaining specialty care at its hospitals, which health officials and the Globe report say are straining nearby hospitals. Steward, the nation’s largest for-profit hospital system, filed for bankruptcy in May, but it remains unclear how that will affect the state’s seven hospitals. If any of its emergency departments were to fail, the influx of displaced patients could be devastating to area hospitals.
“Massachusetts’ emergency medical system is already strained,” Caljoo said, “and we want to ensure that everyone is prepared to handle the continued demands of care through the summer months in the event that Steward is replaced in the future.”
The state’s public health director, Robbie Goldstein, acknowledged at a June meeting of the state’s Public Health Council that Steward was treating fewer patients.
“It’s clear from the data that volumes at Steward facilities are declining,” he said.
Goldstein said at the time that DPH was working to understand how hospitals were handling the transition of patients from Steward to other health care providers.
Dr. Joseph Kopp, an emergency physician at Brigham and Women’s Hospital and Faulkner Hospital, said the transfer of patients from Steward to other Eastern Massachusetts hospitals for specialized inpatient care is already creating a trickle-down effect that exacerbates emergency department congestion. If former Steward patients are taking up hospital beds, emergency department patients may have to wait even longer before being transferred for specialized care.
“All of our hospitals are operating at over 100% capacity,” Kopp said.
Overcrowded emergency departments mean beds line the hallways, agitated and sometimes violent patients push health care workers to their limits.
“The emergency room doesn’t have a solution,” Kopp said. “It’s frustrating for us.”
Kopp said Massachusetts hospitals are seeing an increase in patients suffering in emergency departments (border patients) while waiting to be transferred to other departments or facilities.
A point-in-time tally of emergency department visits collected on Jan. 15, 2024, showed that 54% of emergency department beds in the state were occupied by boarders, the highest number of patients in a single day since 2015. Among those waiting, there were 229 people needing medical or surgical care and 171 people needing behavioral health care.
Those waits can sometimes be deadly: Kopp pointed to statistics showing hospitalized patients have poorer outcomes, are more likely to fall victim to medical errors, and are more likely to die from avoidable complications.
“It’s just going to change the way we actually deliver care,” he said. “Inevitably, it’s not going to be as good as it was before.”
Jason Laughlin can be reached at [email protected] Follow Jasmine Lean.
