State officials say a concrete fix is coming by the end of the year. The commission’s own numbers point to a shortage of nursing home beds, not a shortage of studying, but lawmakers are still waiting on the recommendations.
By Michael Phillips | MDBayNews
ANNAPOLIS, Md. — Maryland patients have waited longer in hospital emergency rooms than patients in nearly every other state, and they’ve been waiting that long for a very long time. The state’s own hospital rate regulator says Maryland’s emergency department length of stay has trailed the national average for more than 20 years, a gap that predates Maryland’s unique all-payer hospital payment system entirely.
The Maryland General Assembly tried to do something about it in 2024, passing House Bill 1143 to create the Emergency Department Wait Time Reduction Commission. That was more than two years ago. The commission’s only public report so far, an interim filing, landed in November 2025. Stripped of the charts and acronyms, its conclusion was that Maryland still didn’t fully understand why its ERs run this slow, and needed better data before it could say what would actually fix it.
A second, more substantive report is due under the law by Nov. 1. HSCRC Executive Director Jonathan Kromm told a joint legislative committee in January that the commission would have a list of “concrete recommendations” ready for hospitals by the end of 2026. As of this writing, the commission’s own public reports page still lists only the November interim filing. Its next milestone is a “Legislative Report Review” meeting scheduled for Sept. 23, about five weeks before the statutory deadline.
What the interim data actually shows
To its credit, the November report doesn’t just restate the “Maryland is worst in America” headline that’s circulated for years. It complicates it, in ways that cut against a simple story:
- Marylanders visit the ER at a lower rate per capita than the rest of the country. The state’s hospital payment model, which steers patients toward primary and community care, is linked to a nearly 6 percent drop in Medicare ER visits, according to a federal evaluation cited in the report.
- When researchers adjust for hospital size, teaching status, and how sick incoming patients are, Maryland’s ER performance moves much closer to the national average. Much of the raw gap traces to the fact that Maryland hospitals are, on average, bigger, more complex, and more likely to be academic medical centers.
- The real bottleneck isn’t the ER waiting room. It’s what happens after a doctor decides to admit someone. Patients discharged to a skilled nursing facility stay in the hospital six to 6.4 days longer than average. Patients bound for long-term care hospitals stay eleven to twelve days longer. Those patients back up hospital beds, which backs up the ER, a cycle the report calls “boarding.”
- Maryland ranks 30th nationally for post-acute bed capacity and would need 1,688 additional nursing-home and long-term care beds just to match the national average, according to the commission’s citation of July 2025 federal nursing home data.
- Between 2019 and 2022, Maryland hospitals’ risk-adjusted length of stay rose 4.26 percent. The commission’s own math translates that into the rough equivalent of 246 missing staffed hospital beds statewide, more than the average Maryland hospital’s entire bed count.
“The real bottleneck isn’t the ER waiting room. It’s what happens after a doctor decides to admit someone.”
“Maryland would need 1,688 additional nursing-home and long-term care beds just to match the national average.”
None of that is a defense of the status quo. It’s an argument that the fix sits further upstream than the ER doors, in a shortage of nursing home and rehab beds the state hasn’t built.
Half the hospitals are already improving on their own
Lawmakers got a progress check at a joint Senate Finance and House Health committee briefing on Jan. 21. Kromm told the panel that 22 of Maryland’s 41 hospitals cut their emergency department length of stay over calendar year 2025, just over half. He pointed to ED boarding as one of the main remaining drivers: patients who have already been seen and diagnosed but are stuck waiting on an inpatient bed, a transfer, or a discharge, and said hospitals have been working to free up beds faster.
“Twenty-two of Maryland’s 41 hospitals cut their emergency department length of stay over calendar year 2025.”
State Sen. Clarence Lam, a Democrat who represents Anne Arundel and Howard counties, pushed back on the pace at that same hearing. “We really need to move this quickly,” he said. It had been a year and a half since the commission was created, he noted, and hospitals still didn’t have formal recommendations to act on.
Del. Aaron Kaufman, a Montgomery County Democrat, raised a separate worry at the hearing: that new federal Medicaid work requirements under the 2025 budget reconciliation law could push uninsured patients back into emergency rooms for care they’d otherwise get elsewhere, eroding whatever gains the state has made.
“The fix may sit further upstream than the ER doors, in a shortage of nursing home and rehab beds the state hasn’t built.”
A track record of studying the problem
This isn’t Maryland’s first attempt. The Health Services Cost Review Commission ran a two-year public quality-improvement push called EDDIE that wrapped up in July 2025. The Maryland Hospital Association led its own legislative work group in 2023 that filed recommendations in March 2024, around the same time an MHA-backed study confirmed Maryland’s ranking using 2021 data. State Sen. Pam Beidle, who chairs the Senate Finance Committee, put it bluntly to CBS Baltimore at the time: “We were the only state that was 50th in the country in the ED.”
The regulator has also spent real money. Between January 2021 and December 2025, HSCRC put $79.1 million into expanding behavioral health crisis centers across 24 hospitals, aimed at keeping psychiatric patients out of the ER when a crisis center would do. That funding predates the current commission by more than three years. Whether it’s moved the needle on ER wait times specifically isn’t something the November report quantifies.
It isn’t even statewide
Wait times vary sharply by hospital and region, which is part of why a single statewide number can mislead as much as it informs. A December 2025 report from The BayNet found Calvert County’s ER running about six-hour waits, Luminis in Anne Arundel County and UM Charles both near nine hours, and MedStar St. Mary’s around seven. Calvert and Luminis improved from the prior year. UM Charles and MedStar St. Mary’s got worse. Prince George’s County, meanwhile, stood up its own local task force on the issue rather than wait on Annapolis.
What to Watch
- The commission’s “Legislative Report Review” meeting on Sept. 23, the last scheduled checkpoint before its Nov. 1 statutory deadline for a second annual report.
- Whether that report contains the “concrete recommendations” Kromm promised lawmakers in January, or another round of subgroup findings.
- Whether the General Assembly ties any new funding to the post-acute bed shortage the commission’s own data points to as a major driver of ED delays.
- Whether the federal Medicaid work-requirement changes flagged by Del. Kaufman show up in 2026 hospital data as more uninsured patients turn to the ER.
Sources: This story draws on the Maryland Emergency Department Wait Times Reduction Commission’s interim report, filed with the Maryland General Assembly in November 2025 by the Health Services Cost Review Commission, and the commission’s public meeting schedule as posted on hscrc.maryland.gov as of early September 2026; a Jan. 21, 2026 Maryland Matters report on a joint Senate Finance and House Health committee briefing; a March 2024 Maryland Hospital Association study on emergency department wait times as reported by CBS News Baltimore; and a December 2025 report by The BayNet on hospital-level wait times in Southern Maryland.
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