According to a report by Kaiser Health News, a trend is catching on for hospitals to require payment upfront for patients seeking care at emergency rooms when serious medical needs are not present. Indeed, 50% of American hospitals now charge upfront fees for ER visits according to the Healthcare Financial Management Association.
This practice accomplishes:
- Reduction to the overcrowding in the emergency rooms
- Rerouting of patients who come to ERs so that they won’t have to wait in clinics during the day
- Limiting those seeking treatment for non-emergent issues due to lack of insurance or payment options
- Relief from time-consumption in bill collections
- Avoidance of rejection from Medicaid and other insurers for reimbursement of services since patients were seen in an inappropriate place in the hospital (non-emergent medical condition which could have been seen in a clinic)
One of the largest hospital chains in this country and the largest private operator of healthcare facilities worldwide, HCA (Hospital Corporation of America, based in Nashville, Tennessee) confirmed that 80,000 patients who did not really need ER treatment though they sought treatment there, left when asked for the $150.00 as mandatory payment upfront.
Patient advocate groups have voiced concern regarding withholding of medical care until payment is issued. Anthony Wright, the executive director of Health Access California which espouses expanded access stated “It seems the point of the policy is to put a financial barrier between the patient and care”.
Officials in the American College of Emergency Physicians are concerned about rejection of patients since 7% of those presenting wind up admitted to hospitals within one day. They have sought to eliminate 700 diagnoses that Washington State view as “non-emergent” for Medicaid recipients. Frightfully, chest pain, shortness of breath and abdominal pain is included in the list.
Dr. Sandra Schneider, president of ACEP (American College of Emergency Physicians) revealed
“the list of conditions was generated solely by the state Medicaid office over objections of physician and hospital task force representatives. The use of discharge diagnoses instead of presenting symptoms/conditions is a clear violation of the prudent lay person standard required for Medicaid managed care organizations. With Washington State having close to 60% of its Medicaid population enrolled in managed care, how will the state comply with the law? Also, what implications does this have for the millions of people who will be added as Medicaid beneficiaries as part of healthcare reform?”
According to Dr. Stephen Anderson, president of Washington ACEP:
“The symptoms of many of these medical conditions indicate life-threatening emergencies and people with these symptoms should seek emergency care. Not doing so could lead to severe illness, disability and even death. Including conditions such as congestive heart failure, kidney stones, miscarriage, chest pain and asthma is outrageous and dangerous”. “We understand the financial stress that states are under and we support efforts at the state and national level to link Medicaid beneficiaries to primary care practitioners, but those resources have to be available and accessible.”
CMS (Centers for Medicaid and Medicare) justify the move by allowing Medicaid patients to have three non-emergency visits to the emergency department each year.
Instituting upfront payment or disallowing emergency visits opens up a myriad of problems. One of the most troubling ones however, as I see it, is that the list of what is covered was decided upon by non-physician panels. Is this a reflection of how all medical care and healthcare options will be structured in the future?
What is your view on this issue?