Lawmakers look to take wide-ranging approach to reducing Maryland’s emergency room wait times

Maryland has some of the longest emergency room wait times in the nation, but state lawmakers want to ensure that Marylanders with dire health needs can receive care as quickly as possible.

The House Health and Government Operation Committee met Wednesday to discuss contributing factors that lead to Maryland’s higher-than-average emergency room wait times and determine if some concerns can be addressed during the 2024 session.

The General Assembly Hospital Throughput Work Group is a group of hospital representatives, lawmakers, state health officials and patient advocates tasked with identifying factors that lead to prolonged wait times in Maryland’s emergency rooms and report it to lawmakers for consideration.

Erin Dorrien, vice president of the Maryland Hospital Association, outlined four areas that the workgroup identified as contributing factors to the state’s long emergency room wait times.

Internal factors include a staffing and workforce shortage among hospitals and emergency departments, particularly when it comes to registered nurses. Other factors include the number of available hospital beds that are staffed with health care workers and the time it takes to process patients from admission to discharge.

Outside factors that play a part in extended wait times include a statewide behavioral health crisis and limited access to primary care.

The work group will soon offer official recommendations to lawmakers that could reduce wait times in emergency rooms, but Dorrien provided a preview to lawmakers. She said that the work group will meet one last time on Friday to finalize a report.

The work group plans to recommend that the state improve data collection systems on wait times, so that they can more have a more accurate idea of when and why longer waits occur. The work group also suggests additional data collection on the emergency department workforce.

To further tackle the workforce issue, the work group urges lawmakers to support recruitment efforts.

According to September data from the Maryland Hospital Association, Maryland hospitals have a 12.1% vacancy rate among registered nurses, 12.3% vacancy rate among nurse practitioners, and 16.8% vacancy rate among licensed practical nurses.

Maryland’s Health Services Cost Review Commission, a state board tasked with overseeing and regulating hospital rates in Maryland, is also concerned about emergency department wait times.

According to an analysis from HSCRC, addressing the issue of hospital capacity and the number of available staffed beds that are ready for patients is not as simple as adding more beds to emergency departments.

Jon Kromm, executive director for the commission, told lawmakers that it can take time to set up new beds in emergency departments, and can also be a costly “Band-Aid” solution.

“That’s not to say there are no new hospital beds across the state…but depending on the region, that may not be necessary,” he said.

“Here in Maryland, we have an opportunity to match our capacity and access to our population needs to ultimately ensure that the right care is being delivered at the right time. If we take a blanket approach of just increasing inpatient beds, it’s essentially amounting to a very expensive Band-Aid solution. That isn’t necessarily what’s best for the patient or what the patient wants,” Kromm said.

The work group also suggests that lawmakers improve access to health care among all Marylanders by expanding insurance access to the uninsured, including Maryland’s undocumented population.

Health and Government Operations Chair Joseline Peña-Melnyk (D-Anne Arundel and Prince George’s) said there will be a renewed effort this year to pass legislation that would require the Maryland Health Benefit Exchange to apply for a federal waiver to allow undocumented residents to purchase an individual health plan from the marketplace.

“There is a bill that is going to be introduced,” she said.

Currently, federal laws say that undocumented residents are “not eligible to enroll in federally funded coverage… or to purchase coverage through the ACA (Affordable Care Act) Marketplaces,” according to KFF, a nonprofit health policy research and polling organization.

A waiver from that law has already been granted to California, Oregon, and Washington, which offer access to health care plans for undocumented residents.

“It simply allows an individual that can pay with their money, no help from the state…to buy insurance on the marketplace,” Peña-Melnyk said.

She said there are other bills in the works to address issues that result in prolonged emergency room wait times, though they are not filed yet.

“We are working on theses. Our members are really committed, all 23 members and myself, on finding solutions,” she said.

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