Emergency rooms could see an increase in non-emergency patients as the economy softens.

It's a growing trend to see more people with non-emergency conditions coming through the emergency room doors.

"It's been happening over the course of the last several years," said Dr. Gordon Leingang at St. Alexius Medical Center.

Medcenter One also has seen an increase in its emergency room visits and walk-in clinic visits. In the last three years, walk-in clinic visits have increased 50 percent and emergency room visits have increased 22 percent, said Medcenter One President Jim Cooper.

The reasons include lack of insurance, inability to pay for medications and fewer primary care physicians, Leingang said. The increases at Medcenter's walk-in clinics could be because of convenience, Cooper said.

It's possible emergency rooms in North Dakota will see the effects of the economy, but not as much as large cities, Leingang said.

"In an ideal world, a person would go to a clinic," Leingang said.

On a recent afternoon, Leingang saw twice as many people with back aches compared to heart attack patients come through the emergency room.

Treating people with non-life-threatening conditions does not distract an emergency room physician. "All emergency physicians would like to say yes, because it is distracting" to treat non-emergency patients, Leingang said.

Studies do not show that it is distracting, he said, and it doesn't take away from the quality of care he provides a patient.

North Dakota emergency rooms are less crowded than major metropolitan cities, which can have wait time measure in hours rather than minutes.

"We're spoiled in Bismarck," Leingang said. "It's highly unusual to wait more than 30 minutes to an hour."

Generally, someone who walks into the St. Alexius waiting room waits seven minutes to be assessed for medical needs and assigned an exam room. It's about 28 minutes to see a doctor from the time they walk in the emergency room door. Medcenter One also has wait time under a half hour, Cooper said.

No North Dakota hospital is treating patients in hallways, either, to improve wait time. For instance, a department could have 30 beds, but only have enough nursing staff to cover 20 patients, Cooper said.

"It's not beds, but staffing," Cooper said, that can lead to a hospital treating in hallways. Staffing is not an issue in this part of the state, he said.

Emergency rooms could see more non-urgent conditions as employees and employers forego benefits or employers lay off workers. So far, this is not an issue in North Dakota. A recent Moody's analysis shows Bismarck's economy expanding, compared to many major metropolitan areas that show signs of a recession or risk of recession.

Most of the changes in health insurance that Medcenter has seen is in increased co-pays. Even Medcenter's employees are paying more for health insurance. At the same time, the hospital is paying more as well.

At an emergency room, everyone is seen, regardless of condition or ability to pay. If a person does not qualify for Medicare or Medicaid, they are responsible for the bill. An exception is if the hospital offers to cover the cost through a charity program. Medcenter does this, and spends about $6.3 million in free care. The hospital carries about $4.3 million in unpaid medical bills beyond what it spends through its charity program, Cooper said.

Achange in state Medicaid reimbursements could effect how much the hospitals receive for its services, which Cooper said is reimbursed below actual cost.

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@;bismarcktribune.com.)