Upfront payment for non emergent conditions - page 6

by danggirl 8,267 Views | 58 Comments

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... Read More


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    I'm sure it's a liability issue. I'm sure we've all been in situations where our instincts were a little off and as things progressed, we realized it was something else.

    Health and personal care ignorance is huge. Someone could come in for a broken nail. Check their history ect everything looks good. Then you start running tests and find bp 200/110, glucose spilling into their urine, ect ect.

    Happens all the time. I find it's usually the ones with the vague complaints end up being the surprise. Can you imagine what would happen if someone left ER cuz they were expected to pay up front and then something happened? Lawyer lawyer.
    I saw something last night that reminded me again why there is no answer for this problem. Someone on a transplant list who didn't want to pay the copay or the hospital bill.. Who was ill but not 'that' sick but based on the organ that he's waiting on was a super huge deal. The ones who REALLY need the help will not get it because they see the money owed as more serious than the possibility of death.
  2. 1
    Quote from Sassy5d
    I'm sure it's a liability issue. I'm sure we've all been in situations where our instincts were a little off and as things progressed, we realized it was something else.

    Health and personal care ignorance is huge. Someone could come in for a broken nail. Check their history ect everything looks good. Then you start running tests and find bp 200/110, glucose spilling into their urine, ect ect.
    Let's not make things sound unnecessarily scary. The MSE is not simply noting the stated chief complaint -- it includes a basic history and vitals. The SBP > 200 would be the end of consideration of the patient being discharged without being evaluated by a physician. With more normal vitals, there is no reason to check a urine specimen on a patient with a broken nail.
    corky1272RN likes this.
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    I think this is a great idea. I don't see how asking for payment upfront for non life threatening events is going to be cause for a law suit. No one sues the primary care office or urgent care when they require payment upfront and DON'T do any type of MSE. People need to take responsibility for themselves!
    morte likes this.
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    We do it at our hospital. I think it's great- the providers don't love it (since they have to do the screening but don't get reimbursed) but it saves a ton of nursing time (and aside from saving our sanity, hey- we're a valuable resource which should be available to give quality care to the truly emergent, not filling out busywork for those who aren't) and it also means those people stop considering the ED "easier" than the clinic for things that are nonemergent.

    The criteria for who can and can't be Q'd are clear and strict, and PLENTY of stuff that turns out to be nonemergent still makes it back because their presentation isn't cut and dried and triage always errs way far on the side of caution (and plenty of people who are Q'd by triage get un-Q'd by the provider when their assessment reveals something concerning). But if it's something where the focused assessment, history, and vitals reveal nothing emergent, and the providers (who STILL SEES THE PATIENT and signs off on the decision, remember) agrees, then saying that not giving them a full workup for free is somehow wrong or a liability is just goofy. ERs are required to provide assessment to all comers and stabilization for EMERGENT conditions, not all medical care with no upfront costs to anyone who can get themselves there.
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    I work in an emergency department that requirs uninsured pts with non-emergency complaimts pay $250 toward their bill ig they want care or prescription treatment. Most people leave and we refer them to free clinics.
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    Quote from sunshinern04
    I work in an emergency department that requirs uninsured pts with non-emergency complaimts pay $250 toward their bill ig they want care or prescription treatment. Most people leave and we refer them to free clinics.
    Interesting. Are they getting an MSE as part of triage to determine that their complaints aren't emergent?
  7. 0
    Quote from Altra

    Let's not make things sound unnecessarily scary. The MSE is not simply noting the stated chief complaint -- it includes a basic history and vitals. The SBP > 200 would be the end of consideration of the patient being discharged without being evaluated by a physician. With more normal vitals, there is no reason to check a urine specimen on a patient with a broken nail.
    EXACTLY...
  8. 1
    Quote from emmy27
    We do it at our hospital. I think it's great- the providers don't love it (since they have to do the screening but don't get reimbursed) but it saves a ton of nursing time (and aside from saving our sanity, hey- we're a valuable resource which should be available to give quality care to the truly emergent, not filling out busywork for those who aren't) and it also means those people stop considering the ED "easier" than the clinic for things that are nonemergent.

    The criteria for who can and can't be Q'd are clear and strict, and PLENTY of stuff that turns out to be nonemergent still makes it back because their presentation isn't cut and dried and triage always errs way far on the side of caution (and plenty of people who are Q'd by triage get un-Q'd by the provider when their assessment reveals something concerning). But if it's something where the focused assessment, history, and vitals reveal nothing emergent, and the providers (who STILL SEES THE PATIENT and signs off on the decision, remember) agrees, then saying that not giving them a full workup for free is somehow wrong or a liability is just goofy. ERs are required to provide assessment to all comers and stabilization for EMERGENT conditions, not all medical care with no upfront costs to anyone who can get themselves there.
    Ugh... So unbelievably right on the money, no pun intended... Have a guy who has been through almost all of the ERs in Baltimore here getting free dialysis whenever he wants... This guy has no means of payment whatsoever, refuses to get labs drawn, and refuses time and time again to follow-up with our social workers to work on applying for medical assistance programs and refuses to go to scheduled outpatient facilities for dialysis... He is never in acute distress and he is ALWAYS stable, and yet, we admit him and attempt to work him up, taking up a valuable bed... Every other hospital now refuses to treat him except us, people like this absolutely strain my workflow and it is nearly one-third of the people that come in... We have resources for them, but end up caving and admitting them for non-emergent treatment and obs
    corky1272RN likes this.
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    MSE's have been done by many ED's in my area for several years now; hospitals are trying to find a way to stay in business and this is an effective tool.


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