Hurry Up and Wait: Maryland’s Emergency Room Emergency

This article is part of MACo’s Policy Deep Dive series, where expert policy analysts explore and explain the top county policy issues of the day. A new article is added each week – read all of MACo’s Policy Deep Dives.

Maryland has regularly been reported to have the longest hospital room wait times of any state in the U.S., most recently averaging an eight hour wait time. Many reports show evidence of the problem as far back as 2017, well before the pandemic, and potentially having started even earlier. According to a recent WYPR article, studies show long emergency room wait times are correlated with an increased risk of death and higher likelihood of being admitted to the hospital rather than treated and released.

This news comes on the tailwind of other recent articles, including The Washington Post, reporting that harm to patients in Maryland hospitals spiked during the pandemic, resulting in malpractice incidents having tripled over a three year period. Maryland policymakers have been grappling with how to address the systemic failures of Maryland hospitals for years, but are routinely met with a number of interconnected challenges that compound the issue and further constrain progress.

Matrix of Challenges Facing Hospitals in Maryland

According to a Maryland Matters article, the workforce shortages in Maryland hospitals predated the COVID-19 pandemic, but reached crisis level during the federal emergency and still remain an urgent concern. This earlier shortage coincided with the expansion of insurance coverage from the Affordable Care Act, and concurrent mental and behavioral health service needs exploding. This put pressure on the preventative market and started driving patients into emergency rooms.

Additionally, shortly after the pandemic hit, health care workers began leaving their jobs in droves. As staffing vacancies rise, hospitals are often forced to limit the number of beds being serviced, as union protocols protect the existing employees from being over-extended, and this results in leaving open beds unused. Even with the dust having settled and the federal COVID-19 emergency expiring earlier this year, the Center for Disease Control and Prevention released a report this October showing the situation having gone from bad to worse. The findings showed that current health care workers are more likely to report burnout and worse mental health now, and are more likely to seek other opportunities than previous reports found.

This emotional strain is exacerbated by the working conditions when there are not enough staff on hand to share the work in a profession that, even in stable times, already takes a disproportionate emotional and physical toll on workers. But the staffing shortages are only one element of the problem. As foreshadowed by the implementation of the Affordable Care Act, the lack of preventative service access to date has continued driving more and more individuals into the emergency rooms for issues that could be treated more appropriately with a primary care physician or mental health practitioner.

The most recent data from the Maryland Health Care Commission revealed there are only 80 primary care physicians for every 10,000 residents. Mental and behavioral health care in particular has been increasingly difficult for individuals to access, often needing to pay out of network to receive services. Coverage also is sometimes found to account for only a fraction of the costs, which was reported in a number of instances by the Baltimore Banner last year. That same article highlighted that Johns Hopkins Hospital was leaving 30 percent of the beds unused because staff have been diverted to help care for children who needed mental health care and not emergency room services.

“We’d have the capacity if we had the ability to get the kids in and out,” – Rachel Boro-Hernandez, Director of Pediatric Social Work at Johns Hopkins Hospital.

Is Progress Being Made? 

Policymakers have begun putting building blocks in place to resolve some of the health care issues that are driving residents into emergency rooms as a last resort. Legislators passed a handful of bills that could help. Just last month a new law went into effect to speed up the process that would allow qualified immigrants to apply for health care positions. Other bills that passed from the 2023 legislative session include:

Local Efforts to Fill Health Service Gaps for Residents

Counties have been stepping in to fill service needs with mental health facilities having opened recently in both Montgomery and Frederick Counties. MACo’s legislative committee voted to support the authorization of counties to establish assisted-outpatient treatment programs. Local wardens and members of the Maryland Correctional Administrators Association have continued to make their voices heard on state deficiencies and lack of compliance in funding medication-assisted treatment. There is no denying that these efforts and existing changes can help alleviate some of the strain on hospitals and detention centers that are inadvertently caring for individuals who need specific services in the appropriate environments, but that they are not getting now.

Looking Ahead to the 2024 Legislative Session

While the effort to authorize counties to provide assisted-outpatient treatment programs failed in 2023, as previously covered on the Conduit Street blog, the Moore-Miller administration vowed to give it another look following the 2023 legislative session. This effort is likely to come back up during the 2024 legislative session. HB517 from 2022 could also stage a comeback for 2024. In the original version of the bill it would have established a Consumer Health Access Program, or CHAP, to connect Marylanders with mental health and substance use services, and also navigate insurance-related barriers on their behalf — much like a similar program established successfully in New York.

Addressing additional root causes should be a primary focus if lawmakers are serious about solving the current problems. Almost all of the mutual goals within Maryland communities hinge on residents who are healthy and thriving. Incentivizing both health care providers and employees must be the backbone of a successful plan to bolster the necessary levels of market growth that can actually solve problems further upstream, before individuals end up waiting on an emergency.