Posted on 08/02/2006 4:09:53 AM PDT by cbkaty
New fees discourage noncritical patients from using emergency rooms
Larnita Booker sat patiently in the waiting room at Ben Taub General Hospital's emergency room Tuesday morning, as she always does when she needs to renew a prescription.
But when her name was called, she learned the hospital no longer offers that service for free. She could go to one of a dozen community health clinics suggested by Ben Taub counselors, she was told, or she could pay $80 to be seen by a physician at the hospital.
"I'm going to have to go somewhere else because I don't have the money," said Booker, a 45-year-old resident of southwest Houston.
Under a policy that debuted Tuesday, the Harris County Hospital District hopes to reroute nonurgent patients such as Booker away from crowded emergency rooms to local health clinics.
District officials say about half the patients who visit Ben Taub and Lyndon B. Johnson hospitals do not need immediate care, many of them using the emergency rooms for primary care because they don't have health insurance.
Those non-emergency patients now face a choice: They can pay $80 to be seen by a physician in the hospitals' urgent care clinics or $150 to be treated in the emergency room. Or they can go to a primary care clinic, where the fee is $66. The new policy does not apply to children younger than 17.
"This is not about finances," said Kenneth Mattox, Ben Taub's chief of staff, who estimated the diversion policy will cut emergency-room visits by 20 percent. "This is about utilizing the emergency room for emergencies."
Not surprisingly, most of the noncritical patients who visited the hospitals Tuesday, typically a slow day in the emergency room, chose to go to a community care clinic instead of paying to be seen there. Of the 43 patients evaluated between 7:30 a.m. and 4:30 p.m., 20 were deemed to have non-emergency cases. Only three opted to pay to access the hospitals' urgent care clinics.
"We're a little shocked because we didn't think it was gonna cost anything," said Melanie Daigle of Deer Park, who had accompanied a crying friend to the hospital. Her friend, who asked not to be named, had broken her left arm months ago, and it had not healed properly. Daigle opted to pay the $80 fee so her friend, who lives in a homeless shelter, could see a physician at Ben Taub instead of going to a nearby clinic.
Under the new policy, dubbed RightCare, patients with health problems such as back pain, flulike symptoms or prescriptions that need to be refilled consult with a counselor who offers a dozen clinic options.
None of the county's community care clinics is open at night, but hospital administrators said diverted patients have health problems that can wait until the next day. The policy is not expected to overburden primary care centers because patients have a dozen clinics to choose from, administrators said.
The policy, which has applied to patients from outside Harris County for more than a month, already is in place at other Houston-area hospitals.
The emergency rooms at Memorial Hermann Hospital and the University of Texas Medical Branch at Galveston, both Level I trauma centers, adopted similar policies in 2005. Officials at both said they've worked well, relieving stress on staff and shortening the wait times for patients.
A Memorial Hermann official estimated that hospital's emergency room has redirected 10,000 patients to clinics in the past 18 months.
A UTMB official said the new policy has screened out about 10 percent of patients who used to visit the Galveston hospital's emergency room.
"Patients with minor problems used to wait as long as 18 hours," said Dr. Brian Zachariah, UTMB's director of emergency medicine. "Now, they get directed to an appropriate clinic very quickly."
Allen Johnson, chief administrative officer for the Montgomery County Hospital District, said the practice is becoming common, a natural response to years of emergency room overcrowding.
Harris County Hospital District officials said it was not as common for safety net hospitals like Ben Taub and LBJ to adopt such policies. Mattox said he got calls from physicians and politicians around the country this weekend asking how they could do the same.
Anthony Domino, a 42-year-old Humble resident living in a drug-rehabilitation center, visited Ben Taub to get a new prescription for his blood-pressure medication. While frustrated that his Gold Card eligibility had expired, he said he could understand why the hospital wants to divert patients like him to local clinics.
"They've got real emergencies," he said. "A refill ain't an emergency."
alexis.grant@chron.com todd.ackerman@chron.com
I wonder if an INS officer on site would cut it by 50%. (Who am I kidding, it would probably double the load...)
Hospitals that get any kind of Federal Assistance have to provide services to those that cannot afford to. Almost every hospital will keep that quiet.
It would be most unfortunate, but they would have the right to fight this policy if they decided to.
Many Mexicans have the mindset that since ER is free in Mexico, they can take their infants and small kids at every sign of a fever, a slight cough, or maybe loose bowels. It has always been the perception in socialistic political systems that it is the Divine Right for everyone to have free medical help, and gov't assistance to get everyone a piece of land and a house, a scholarship etc. We get calls here in Mexico from undocumented workers that crossed the desert without paying fees, how special the medical services are, that Mr. Welfare in New Jersey is paying for all of their maternity costs at the hospital. Someone needs to fix this.
"They can pay $80 to be seen by a physician in the hospitals' urgent care clinics or $150 to be treated in the emergency room"
Charge the illegals who are the worse offenders of using our hospitals, schools, welfare system!
Can you imagine going to an ER with people actually dieing around you and expect to get a simple prescription refilled? That is insanity to me....
What a novel concept!
I couldn't help but notice how conspiciously absent the article is about mentioning who is crowding ERs for non-emergencies. Wouldn't want to give bad press to those here illegally and those sucking the public assistance teat, I suppose.
The one "homeless" gal who is mentioned has to show up in the dead of night though. I suppose it is because she is working during the day or has some other good reason like needing her sleep.
Not quite correct. ER's must see a patient with a medical complaint regardless of ability to pay, and they must stabilize the complaint.
In the case of a person that shows up every week to fill a prescription, they can send the person away, as there is no medical complaint. If there is a complaint (which they learn very quickly to make) then they can write for one pill, and tell the person to go see their doctor in the morning.
Finally, the services don't have to be provided for free, they just have to be provided. So they can be billed and handed over to a collection agency.
Proper use of discouragement can clean out a lot of the regulars from the waiting room.
Probably half those in the Emergency Room not only are sitting there waiting for a prescription they got a free ride there in an Ambulance.
Ambulance abuse is rampant in Washington DC and I am sure in other cities as well. They get a free ride to the ambulance and a cab chit when they leave for home.
They get sent a bil for the ambulance and one for the emergency room with no intention of paying for either.
We have government free health care in this country now only you have to be a deadbeat to get it.
If you are struggling lower middle class you pay thru the nose in order to make up for those who pay nothing.
Paying for ER care................Priceless ;)
Oh? You want ME to pay for your prescriptions? (taxpayers)
We're disenfranchising the leeches !
Sampleman.....well put! You are so correct.....hats off and a salute to you are due...
I am thankful I have never required an ambulance but I paid $500 for one for my son...which is a reasonable price to pay to save a life.
I understand that faked emergencies account for many ambulance rides to the hospital for those that simply needed a taxi.... For some reason, I doubt if I could get by with this trick.
I would have to be dying to go to an ER...gunshot, stab wound, stroke, heart attack...etc.... Of course, I'd include pregnancy problems for ladies too...
Good - she needs a "primary care provider" (hopefully a doctor) and follow up care. She should be grateful that the Hospital is helping her with her healthcare needs.
Yes, I believe that EMTALA requires the ER to evaluate and stabilize.
I don't think that many people in those ER's do NOT know that they won't be required to pay at the time of service and that the "government" will pick up the check.
The government does NOT pick up the check. The ER is simply mandated to provide service. The ER must just suck up any uncollected bills.
Where did you ever get the idea that the government pays for these visits?
I drove my mom to the ER with a kidney stone once. By that I mean she had a kidney stone, not that I was carrying it in the trunk or something.
If you've never had a kidney stone, or sat with a loved one who had one, it's about as painful as painful gets without being immediately life-threatening. I'm not speaking from personal experience, but both my parents and my sister have had them, so that clock is ticking.
But Mom gave birth twice and had the cartilage removed from both knees, so she knows pain, and she ranked the stone far higher than both combined.
As I'm sitting in triage with my mother, the tough, smart woman who raised me and who is now doubled over in helpless pain and barely able to whimper, a young woman storms up to the attending nurse and loudly demands to know why people who came in after her were admitted before her. She appears to have a minor laceration on one arm.
"Bitch," I said, "this isn't a deli. Unless you're unconscious and bleeding from both eyes, sit the f down and shut the f up before I break both your knees. If it's any consolation, that would probably move you to the front of the line."
Okay, so I actually only said that in my head. But if the duty nurse had decided to bring the beat-down on the loudmouthed twit, I would've held the twit's arms back as a public service.
But I digress.
ERs are clogged with non-emergency cases. No dispute. Moving those patients to community free clinics is compassionate, medically effective and cost effective. Looks to me like Houston has it bang-on right, and I hope the rest of the country follows suit.
You don't have to be dying to use one, just make sure you really need it. My daughter got whacked in the face with a baseball bat. She wasn't dying but she sure as heck needed medical attention ASAP.
Sorry, slurring of thoughts - the 'common wisdom' (overheard comments) is that the government will pay - in fact a mix of the City, County and State government, a bit of Medicare here and there and quite a bit of the hospital's budget - via paying customer's higher costs - pays.
You did notice the quotation marks, right?
In Harris County, Texas, we have a Hospital District Tax.....of 0.19216000................GRIN...and climbing!
Understood.....I stand correct....but I bet you had insurance or a checkbook.....
I didn't infer your point. We're on the same sheet of music.
I stand corrected. As you point out, some local governements to offset some of the costs. I should have limited my statement to state and federal gubments.
Of course she had her Medicaid card with her.
Why bother establishing a rapport with a doctors office? Why bother having to make and keep set appointments? Why not just stroll into an ER whenever you feel like it?
Especially when the taxpayer is footing the bill.
You are quite correct in your statement that government doesn't pay for ER healthcare...WE TAXPAYERS DO.....
It would be more correct to say that WE PAYERS DO. These losses are offset more than anything by adjusting up the cost of healthcare on everyone else. If every fourth set of tires had to be given away, the price of tires would go up.
Maybe from the fact that every major hospital has a hospital social worker that will help nonpaying patients complete an application for Medicaid.
Actually all they need to do is get the patient's signature on the application - the hospital will complete it and submit it to the state's Medicaid system to try to get the person on Medicaid so the hospital will get paid.
There are even private companies now that will pursue Medicaid for non-paying patients. If the person gets approved for Medicaid, the company takes a percentage of the payment and the hospital gets the rest. That money comes out of our pockets.
There are also Hill-Burton funds. The federal government would give a hospital a low interest or no interest loan to expand. In return the hospital is obliged to set aside a certain amount of money every year to pay for indigent patients INSTEAD of paying back the government loan.
That money came right out of our pockets.
That has been common knowledge for the last eon. What this changes, is that the hospitals should not be using the EMERGENCY room to keep from standing in line for a clinic. It' s the same mentality that ended up in the dome in New Orleans.
Yes, we have insurance. However, if we didn't I still would have taken her.
That has been common knowledge for the last eon. What this changes, is that the hospitals should not be using the EMERGENCY room to keep laggards and dullards from standing in line for a clinic.
It' s the same mentality that ended up in the dome in New Orleans.
"Larnita" . . . should have a surcharge tacked on just because we have to endure her wacky name.
You certaily wouldnt get by with it if you have insurance or own a home.
By the way that helicopter that picks folks up at serious auto accidents? $6,000 bucks.
The cure to ER overcrowding is to pay someoen to wear a Border Patrol uniform in the waiting room. Redeploy from the borders to the ER entrances.
I am sure you would and so would I....but being a responsible parent like you, I have always provided insurance for "my" family.....
Vice Cops too......
That homeless gal is probably trying to score some pain meds for the broken arm from months ago. She's probably already tried all the other clinics around.
The freeloaders have ruined it for those people truly in need.
We once had a dispute with our local hospital. We had paid the bill but their records said we had not. It took many phone calls to get this straightened out, but they were merciless in their collection tactics, calling Saturday morning, etc. It amazes me that they can't harass the people who REALLY don't pay their bills!
susie
I believe somewhere back in the caverns and the dark halls behind all emergency rooms there is a litle guy with a stop watch that times visits to be sure no one gets out before at least 4 hours are up.
yeppers! i bet you're right!
oh and our sons helicopter ride from jackson mi to the
u of m mott childrens hospital in ann arbor was $10k!
we still call him our million dollar miracle baby.
helicopter ride, 10 days in nicu, medications,
blood transfusion, specialists, etc. those bills
were astronomical!
thank god for insurance!
I know you're right, but man, it's frustrating.
susie
Hospitals that get any kind of Federal Assistance have to provide services to those that cannot afford to. Almost every hospital will keep that quiet.
You left out an important part of that.....the law says "emergency services". The problem has been who decides what an emergency is. Rather than face lawsuits the hospitals mostly just treat anyone that shows up for whatever reason. If the hospitals can withstand the lawsuits, good for them.
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