Upfront payment for non emergent conditions

Specialties Emergency

Published

So just curious to hear some other opinions of this. Our hospital is considering a serious overhaul of its ER practices due to the upcoming reductions in Medicaid. All patients presenting with any complaint are to have a medical screening exam (as per EMTALA) performed by the mid-level provider stationed out in the triage area. If, according to the medical screening, the person does not have an emergent condition, an appointed person (new "care finder" position) will give the person a choice of either being seen in the ER but they will have to pay upfront for the care OR they will be provided with the names of clinics where they can go to be treated. According to EMTALA, the ER is not required to treat anyone other than those presenting with emergent conditions or in active labor. I work in an inner city not for profit hospital where it seems the majority of the patients are uninsured or on Medicaid. It is also a rather poor area and of course people frequently use the ER for routine medical problems. I was just wondering what anyone else thought of this idea.

Specializes in icu/er.

thia idea has been looked at a few times at my full time er job. we have had several consultants come through explaining things to the head bean counters about the pro and cons of this. there are a few er's in my state that have started this and has impressed a few folks here. things are going to have to change here in mississippi, there is no easy answer..govt reimbursements are going down the toilet and hospitals are losing services cause of the high number of indigent care we give. from what ive been exposed to, i think pay up front could help off set some waste and abuse from the public.

Specializes in Emergency, Case Management, Informatics.

Again, I think a few of you are missing the point here.

Anything ambiguous is not going to be streeted. NP/PA is not going to street the 30-year-old with indigestion. NP/PA is not going to street the abdominal pain, even though it could be Taco Bellitis.

These NP/PA's are going to prove the patients right before they prove them wrong in this scenario. It's too much of a liability for the NP/PA to dismiss ambiguous complaints.

What WILL be dismissed/streeted will be trivial complaints with no danger of being a life-threatening illness/injury. This is where the EMTALA MSE comes in. These mid-levels will do a proper MSE in triage. MSE is a SCREENING exam, not a full work-up.

Therefore, if the NP/PA finds in the MSE that the patient is just asking for a preg test, uncomplicated STD complaint, has a cold/sore throat with no sx/sx of meningitis/pneumonia, or other non-urgent types of complaints, they will ask for payment up front. Think about your triage level 5 patients. This is who will be targeted.

This is no different than presenting to your doctor's office with these types of complaints and the office asking for your co-pay up front. The only difference is that EMTALA requires an MSE to determine this non-urgent condition prior to asking for payment. EMTALA does NOT require your ED to treat non-urgent conditions.

This is not "selfish". This is proper utilization of resources. The ED is NOT a primary care office. If you think it's okay for people to come to the ED for primary care, then you need additional education on what the ED is and what it is not.

Do I hear multi-million dollar lawsuits here? What if they were wrong? What if you were triaged incorrectly? Is the US following the healthcare practices of some developing countries now? Came from a third world country before.....and things were done a little similar to this. Patient comes in and needs treatment. Before he is seen, a deposit is needed. No deposit=minimal to no treatment. Is this where America is heading to? I seriously hope not! There is a gray area here because if they discover that you don't have any means to pay your bills, then they might just say you are "stable".

Specializes in Critical Care.

They already do this where I work, you are required to make an upfront payment, also they have people from finance approach patients for their deductible before they are discharged from the hospital.

Personally I think this is in poor taste, but it is a fact of life in many urban hospitals due to the poverty, uninsured and medicaid patients. If it were me I would just say I don't have a check or credit card and they can bill me!

I know a lot of coworkers who have unpaid bills at the hospital due to low pay and high out of pockets and then they are barred from seeing their doctor and getting any preventive care until they pay up or go on a payment plan. People are being refused mammograms, colonoscopies etc and having to fight to be seen in the ER and they are coworkers.

I can afford the medical bills but it seems like all your money goes for medical instead of retirement, no wonder Americans lack savings! Hospitals have the worse insurance and I don't understand how they expect their workers especially low paid and families to be able to afford all the out of pockets that can potentially run into over $10,000 a year. On one insurance plan you could be hit with $38,000 year for family coverage if a disaster hit. What recourse would a person have other than to declare bankruptcy. Then they have the nerve to hit their workers up for United Way charitible contributions when they nickel and dime them to death and begrudge them a raise or a living wage! Many of my coworkers need charity themselves to make ends meet!

Specializes in Emergency, Case Management, Informatics.
Do I hear multi-million dollar lawsuits here? What if they were wrong? What if you were triaged incorrectly? Is the US following the healthcare practices of some developing countries now? Came from a third world country before.....and things were done a little similar to this. Patient comes in and needs treatment. Before he is seen, a deposit is needed. No deposit=minimal to no treatment. Is this where America is heading to? I seriously hope not! There is a gray area here because if they discover that you don't have any means to pay your bills, then they might just say you are "stable".

The mid-level is in the triage area performing the MSE. Insurance information is not available to the provider until after the MSE per EMTALA.

:rolleyes:

What about having a sepret urgent care inside the hospital or er ? All the Medicare ,drug refills , minor stuff can go there and you will still have the er next door if ivs or other test are needed .

They already do this where I work, you are required to make an upfront payment, also they have people from finance approach patients for their deductible before they are discharged from the hospital.

Personally I think this is in poor taste, but it is a fact of life in many urban hospitals due to the poverty, uninsured and medicaid patients. If it were me I would just say I don't have a check or credit card and they can bill me!

I know a lot of coworkers who have unpaid bills at the hospital due to low pay and high out of pockets and then they are barred from seeing their doctor and getting any preventive care until they pay up or go on a payment plan. People are being refused mammograms, colonoscopies etc and having to fight to be seen in the ER and they are coworkers.

I can afford the medical bills but it seems like all your money goes for medical instead of retirement, no wonder Americans lack savings! Hospitals have the worse insurance and I don't understand how they expect their workers especially low paid and families to be able to afford all the out of pockets that can potentially run into over $10,000 a year. On one insurance plan you could be hit with $38,000 year for family coverage if a disaster hit. What recourse would a person have other than to declare bankruptcy. Then they have the nerve to hit their workers up for United Way charitible contributions when they nickel and dime them to death and begrudge them a raise or a living wage! Many of my coworkers need charity themselves to make ends meet!

The hospital where I was addmented did this and I thought at lest in my case it was nuts and I have an all out fight with the man. For one I had been brought from the doctors office by ems and was being addmented and olney being held in the er till they got me a room . I told his there was no in hell was going to pay an er charge up front when I just waiting for a room and they even had my info wrong :devil:

they already do this where i work, you are required to make an upfront payment, also they have people from finance approach patients for their deductible before they are discharged from the hospital.

personally i think this is in poor taste, but it is a fact of life in many urban hospitals due to the poverty, uninsured and medicaid patients. if it were me i would just say i don't have a check or credit card and they can bill me!

i know a lot of coworkers who have unpaid bills at the hospital due to low pay and high out of pockets and then they are barred from seeing their doctor and getting any preventive care until they pay up or go on a payment plan. people are being refused mammograms, colonoscopies etc and having to fight to be seen in the er and they are coworkers.

i can afford the medical bills but it seems like all your money goes for medical instead of retirement, no wonder americans lack savings! hospitals have the worse insurance and i don't understand how they expect their workers especially low paid and families to be able to afford all the out of pockets that can potentially run into over $10,000 a year. on one insurance plan you could be hit with $38,000 year for family coverage if a disaster hit. what recourse would a person have other than to declare bankruptcy. then they have the nerve to hit their workers up for united way charitible contributions when they nickel and dime them to death and begrudge them a raise or a living wage! many of my coworkers need charity themselves to make ends meet!

that's just wrong

I will owe $1000.00s on my hospital bill ! I hope I will not be bared from seeing my doctor ? How can they leagly do that ?

Specializes in ED, Telemetry,Hospice, ICU, Supervisor.
my thoughts exactly. ed is for emergencies. unfortunately, not every community has community resources or free health clinics, or reasonable transportation to these places. I volunteer at a free clinic, and we constantly have people calling trying to get transportation to us.

here's hoping that more free clinics pop up.

I agree the ER should be for emergencies. My family moved to the city I am living in back in 1995. I was gone for a few years but I moved back. In all the years I have been here since 1995 I only recently found out about free clinics in the city. They provide services like check ups everyday. Different physicians come in and treat patients and prescribe meds when needed. Meds here are also given for free. Funding doesn't come from the county/city at all but form private donations and mostly from a for profit hospital. The best part is you do not even have to be from the city to get treated, we have patients that drive from 2 hours away for free insulin.

Point is there are places where you can be seen for free. You just have to look for it.

Specializes in ED, Telemetry,Hospice, ICU, Supervisor.
I have heard of hospital here that does what you are talking about they have a np in the waiting room . I have never been to this hospital so I do not know how they work it but my understanding the np makes the call if you are alould to go back or not . The person I knew said they try to avoid this er because they do not what to waist there time if they get sent home .

Isn't that the whole point. People with life/limb emergencies get seen in the ER. Those with sore throats get sent home and told to see their primary.

Specializes in ED, Telemetry,Hospice, ICU, Supervisor.
Do I hear multi-million dollar lawsuits here? What if they were wrong? What if you were triaged incorrectly? Is the US following the healthcare practices of some developing countries now? Came from a third world country before.....and things were done a little similar to this. Patient comes in and needs treatment. Before he is seen, a deposit is needed. No deposit=minimal to no treatment. Is this where America is heading to? I seriously hope not! There is a gray area here because if they discover that you don't have any means to pay your bills, then they might just say you are "stable".

If the case is an emergency like a GSW to your chest, I believe that you will get treated then they bill you.

If you come in to the ER complaining of a sore throat then I believe they refer you to the PA/NP who will perform an assessment as to what category of treatment you need. If you wish to be seen at the ER now then yes you will pay up front. If you choose to go home and make an appointment with your primary care, then I do not think the ER will bill you.

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