This commentary is by Marvin Malek, MD MPH, of Berlin. He is an internist, an active member of the Vermont Medical Society and a longstanding member of Vermont Physicians for a National Health Program, which advocates for transforming Medicare into a universally available public insurance program.

Drs. Smith, Vieth, et al, as well as Sydnee Boucher, RN do well to alert us to the problem of ER boarding. Holding patients for hours or days in emergency departments leads to inefficiency within the emergency department, contributes to burnout of ER physicians and other staff and delays proper treatment of patients, in a noisy and uncomfortable setting.

An insufficient number of staffed rehab beds contributes to this problem as does a worsening nursing shortage. Both of these need to be addressed. But even when staff and beds are available, we are often unable to discharge patients whose acute medical issues have resolved: A growing number of Vermonters have signed their Medicare benefit to a Medicare “Advantage” company — now up to 35–40%. And the practices of these companies regularly delay our ability to discharge our patients to rehab facilities.  continue reading