Wall Street Journal Examines ‘Divisive Internal Debate’ Over University of Chicago Medical Center Plan To Reduce ED Beds

The Wall Street Journal on Saturday examined a plan to limit the number of emergency department beds at the University of Chicago Medical Center, which has "spurred a divisive internal debate that is being closely watched by hospital physicians across the country." According to the Journal, "The dispute touches on one of the most critical questions facing hospitals that serve low-income populations:" how many Medicaid and Medicare patients a hospital can afford to serve. Many U.S. emergency physicians believe limiting beds in EDs "could become a means of economizing that might spread to other hospitals," the Journal reports. According to the Journal, emergency physicians note that emergency medicine is typically less profitable than other treatments, including surgery.

The controversy at UCMC, which estimates show admits a higher percentage of lower-income Medicaid patients -- 35.6% -- than other hospitals in the Chicago area, began when the facility proposed a plan to eliminate 10 of the 31 beds in the ED. James Madara, CEO and dean of medicine at UCMC, said the administration's intent is to allocate more beds for specialties including oncology, gastroenterology and neurosurgery that attract patients from across the country.

The plan prompted two high-ranking physicians at UCMC last month to quit their administrative jobs in protest. In addition, about 12 other physicians from the ED and other departments signed a letter of protest. Terry Vanden Hoek, who stepped down as interim chief of emergency medicine, wrote in a letter to the university's dean of medical education, "The current plans to cut our bed number further will make it more likely that only the poorest of the poor will be waiting prolonged hours for care, longer than will be safe." Internal hospital reports from the last two years, as well as interviews with five physicians at the hospital, indicate UCMC's ED patients often wait eight hours or more before seeing a physician. Vanden Hoek also suggested in the letter that the plan could favor patients with private insurance. He wrote, "Some patients will have rapid access to an ICU or private bed," but lower-income patients "will not be so lucky."

Madara said UCMC is not trying to drive ED patients away. "As you can see from our waiting times and the number of people who have left without being seen, we need to make significant changes," Madara said. Hospital officials said they hope to lower wait times by transferring some ED patients to other hospitals. John Easton, a spokesperson for UCMC, last week said the proposed reduction was no longer part of the plan, but the hospital continues to evaluate its placement of beds (Burton, Wall Street Journal, 2/28).