The face of emergency medicine constantly changes, from a sick child to an injured teenager or an adult patient in need of critical life-saving care. Dr. Sudip Bose is championing efforts to raise awareness about health care issues.  He does so through face-to-face bedside education as well as national level leadership via lectures and media appearances. Dr. Bose is recognized as one of the nation’s leaders of emergency medicine. He has been tapped to serve as a medical expert on a broad spectrum of specialties including trauma, cardiology and public health. Dr. Sudip Bose believes it is important for emergency physicians to not only offer their patients "hope" but to arm them with knowledge to better care for themselves.

 

Submitted Memorandum by Dr. Bose to the President of the United States   Inadequate access to healthcare remains a critical issue for Americans. However, 24 hour access to a physician, staff, imaging and labs already exists in the Emergency Department (ED). The ED serves as the sole health care system and safety net for uninsured, underinsured and those without access to other medical care. Overcrowded and overworked, EDs are perilously close to collapse in many places. Despite these challenges, the ED has created a model in which patients can count on access to care at any time of the day. Expanding the ED model and providing support for that infrastructure will increase accessibility. Treating more patients in the ED seems counterintuitive in an already overcrowded system, but offers a novel and feasible way of building on existing infrastructure to solve a core challenge.   EDs experienced a 32 % increase in patient volume over the last decade, due to: Our aging population of 65+, the largest group seen in the ED, is growing The under/uninsured are multiplying and as stipulated by EMTALA, EDs are obligated to care for every patient regardless of ability to pay or urgency of care The insured cannot be seen by primary doctors due to a shortage of primary care practitioners and an increasing percentage who will not accept Medicare or Medicaid Despite increases in demand, the number of EDs dropped by 7% due to: Low profitability in the setting of low reimbursement by public and private insurance, uncompensated visits and federal EMTALA requirements to treat all-comers National shortages of nurses, primary care and mental health providers to support care High medical liability leading to the loss of physicians to more favorable states, alternate professions, and early retirement and the practice of defensive medicine leading to costly unnecessary tests and procedures Hospital closures also due to similar malpractice issues Shortage of critical "on call" specialists such as neurosurgeons who curtail their services due to high liability and less reimbursements in emergency situations The Anatomy of the Solution: Expand 24 hour care to encompass primary care. The triage process can determine the optimal care path for the patient Provide incentives to attract more primary care and mental health care providers to this "Central Care" system (reduction of student debt or tax relief) Traditional primary care remains in place as an appointment based system to maintain optimal efficiency Medical liability reform to decrease cost and improve inefficiency to both patient and providers Escaping entrenched mentality of job roles - streamlining medical jobs will allow better separation of cognitive and technical aspects of care. Example: nurses not doing jobs that can be automated or done by a tech An electronic medical record to improve quality of care, avoid the costs and side effects of repeating unnecessary tests and procedures These efficiencies added to the economies of scale that would be gained through consolidation will create a strong foundation that would be complemented by future universal health coverage for Americans.

 

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