About Amy Umble:
Amy Umble is health reporter for The Free Lance-Star

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The ER as front door

Dr. Jody Crane

In talking with Dr. Jody Crane the other day, I was reminded of how a hospital’s emergency department is truly its front door.

Crane has been an ER physician at Mary Washington Hospital since 2000. He said that two-thirds of all admissions at the average hospital come from the ED. At Mary Washington, about 27 percent of the people who walk through the ED door end up getting admitted for further care.   

These percentages become important, Crane said, when you consider the new federal health care legislation. The new law adds millions of people to the Medicaid rolls, beginning in 2014. These people are likely to use the ER for their primary care, he said, and some will become admitted patients. Crane and others have suggested that hospitals get ready for this new surge of patients. “If anybody thinks more volume isn’t coming, they’re nuts,” he said.

A resident of Fredericksburg, Crane, 41, is a graduate of the VCU Medical School. He did his advanced training at the University of Illinois at Chicago. He also got an MBA in 2004 from the University of Tennessee at Knoxville, where he remains an adjunct professor. He owns his own consulting business.

(For more on hospital crowding and the Health Department’s new guidelines on patient boarding, see the story this weekend in the paper.)


  • LarryG

    ” The new law adds millions of people to the Medicaid rolls, beginning in 2014. These people are likely to use the ER for their primary care”

    what are these people doing right now for Health Care?

    this doesn’t make any sense. Usually those without HC – use the ER whereas those who have some kind of insurance, even if Medicare are – in theory – supposed to have access to primary care and not have to use the ER.

    so can you explain this?

    What do these folks do right now when they need health care – and what will change in 2014 ?


  • jhall

    Larryg, As I understand it, the uninsured use the ER for their primary care. These folks will continue to use it, and in fact will use it more when they are enrolled in Medicaid. In the story that I wrote that will probably run this weekend, Dr. Crane says that Medicaid clients are among the highest users of the system. Newly insured people with private health insurance will likely find primary care doctors who will care for them. Medicaid offers such low reimbursements that few doctors will accept new Medicaid patients.

  • LarryG

    so the people who use the ER right now will continue to use it?

    so where were the additional ones come from?

    the article does not make this clear.

    the doc makes an assertion but does not explain how MORE folks will use the ER than are now using it.

    That seems ODD – unless someone is saying that even more people will have to start using the ER – for some reason.

    how about a clarification ?

    I just don’t think making that statement and then repeating it – explains the why behind it.