Transcripts

"Bill of Health"-ER's Critical Condition

JEFF YASTINE: If you have been to a hospital emergency room recently, you know the situation. Overcrowding is common and if you don`t have a true emergency, you could wait hours before seeing a doctor. But as we`ll see in my latest "Bill of Health" report, that problem is being solved by a building boom in ER`s around the country.

It`s a familiar scene, a hospital emergency room and lots of patients with non-emergency medical problems waiting to get in. The reasons are varied -- rising numbers of the uninsured, the closing of ERs in some cities, fewer primary care doctors, and an unwillingness of many physicians to take high-risk medical cases that may result in a lawsuit. Managers at Baptist Hospital of Miami responded in creative ways. Hallways were marked off with assigned parking spaces for patients on gurneys during busy times. The ER was divided up so that those needing non-acute care didn`t have to wait quite so long to see a doctor. But as the work going on outside the existing ER shows, executives here eventually decided they needed a new emergency room which will be more than four and a half times as large.

BO BOULENGER, CEO, BAPTIST HOSPITAL OF MIAMI: Margins are really shrinking in hospitals across the nation. They`re very tight, and as we were talking about, there`s a lot of competition for capital. So we`ve got to make sure we make the right investments. We`ve got to still be prudent business people with these investments. But we`re convinced that investing in the emergency department and expansion of in-patient beds is the right way to go in order to better serve our community.

YASTINE: It`s a decision many other hospitals around the country are making. The amount of hospital square footage under construction nearly doubled over the past six years and the new ERs look nothing like the old ones, plusher with open floor plans and a so-called race track design for faster access by doctors and nurses.

between 1999 and 2005, with much of that going to either expand existing ERs or build brand-new facilities. And the new ones look nothing like the old. With open floor plans and a so- called "racetrack" design for faster access to patients by doctors and nurses.

BECKY MONTESINO, ASST. VP, BAPTIST HOSPITAL OF MIAMI: They can flexibly expand or contract the department, and they can see everything going on everywhere. There were no solid walls. And we saw those as the best functioning emergency centers around the country and we copied that.

YASTINE: But there are downsides. With many hospital systems barely breaking even, they run the risk of a downgrade in their credit rating when they try to borrow tens of millions for an ER expansion.

ALAN LEVINE, PRESIDENT & CEO, NORTH BROWARD HOSPITAL DISTRICT: If we go out and embark upon building a $40 of $50 million emergency department and you`re expanding capacity for people who are uninsured, you`re not going to recover that investment. The net result of that is that that has an impact on your bond ratings. As a non-profit system, that`s important for us. For a for-profit system, clearly that has an impact on their value on Wall Street. So, these huge investments do have an impact financially and it`s important for hospitals to consider that before they engage in spending that kind of capital.

YASTINE: For additional help, many hospitals now have neighborhood clinics where they try to see the non-emergency medical cases that might otherwise wind up in their ERs. But administrators warm that many of the new emergency departments run the risk of becoming as overcrowded as the old ones, without broader reforms in the nation`s healthcare system.