Two Florida hospitals now charge extra for non-emergency ER visits - page 3

found at healthleadersmedia.com: two florida hospitals now charge extra for non-emergency er visits in mid-november, orange park medical center became the second northeast florida emergency... Read More

  1. by   Gromit
    Quote from hfdguy
    I am an EMT and in LPN school (due to graduate in Jan!).. I just have one thing to say:

    Shame on all of you who support this... you should be ashamed!

    In Connecticut, its a law that anyone who feels the need can go to an emergency room.

    What they are asking the average person in Florida to do is diagnose their illness and determine if they are 'sick enough' to go to the Emergency Room. That is absolutely against everything we have ever been taught in medicine.

    I hope you all remember that the most important thing about being a nurse is to be an advocate for your patient - you are the one with the knowledge, the average person has no clue, and trusts us to do what we can to help them.

    I hope two things happen: One, that everyone in Florida in healthcare write their representatives to have this outlawed, and two, that everyone charged in this manner sue the two hospitals as a class action, stating that the patient has a reasonable expectation of treatment and that they are not equiped to diagnose whether certain signs and symptoms are 'true' emergencies or not.

    How many CVA patients wake up with just a headache? What are the major signs and symptoms of a MI? AAA? Would we consider 'diffuse pain, lethergy, flu like symptoms' to be minor or indicitive of a serious life threatening condition? I know ERs are overcrowded. Most hospitals in CT now have primary care clinics associated with the ER so those deemed non-emergent can still be seen. But I also know that they have sent people to the clinic with a 'non-life threatening' condition, only to find out they are minutes away from a catastrophic event.
    You OBVIOUSLY don't have a whole lot of experience in this department. I spent a lot of time working on ambulances before I began working in the hospital. FULLY 85% of our "emergencies" were not. MOST of them were rediculous reasons for going to an emergency room (usually because people had the silly notion that they would be seen quicker -and even chose to ride an ambulance because they thought they would get in quicker still -not that it helped 'em. If they were non-emegent, I put 'em in triage/waiting area along with the walk-ins, as protocol demanded.) This is designed to get folks to considder the walk-in clinic or their primary care doc, before jumping into the ER with the idea of rapid care. By clogging up the ER, they slow down care for EVERYONE -including the more emegent folks.
    Shame on US? Shame on you. Don't presume to dictate to my state when you have no experience with the problems that plague it.
  2. by   JRapha'sRN
    The first thing they consider is age. The rule doesn't apply to people younger than 5 or older than 65.

    Nurses then screen the patients, gathering information on the reason for their visit and information such as the person's blood pressure and temperature, Rounds said. The patient's need for care is assigned a number from one to five.

    The fives, those with minor illnesses or with no need for further tests or X-rays, also see a doctor who ensures they don't need emergency care. They then are given a list of 30 to 40 alternate providers, from urgent care centers to after-hours dental clinics, who would be able to help them.

    Those who still want to be treated in the emergency room can be, so long as they pay the extra $100.
    I work in an ED that uses a 5 level triage system. After reading the article, it seems like the hospital has developed a good system. They are only sending away those who truly don't need to be there. In my triage protocols a level 5 is someone who doesn't need anything invasive or need lab/radiology studies. A sports physical is a level 5 triage. I think that the hospital has "CYA" in that an RN and MD see the pt and then offer alternatives ("a list of 30-40 providers") for care. A level 5 really doesn't need emergency care. In actuality, a level 4 doesn't either. Our ED has two "sides" one for walk-in care (triage levels 4 & 5) and the other for emergent care (triage levels 1-3). Having our WIC designation frees up beds on the ED side. If we didn't have the WIC, I would think that this plan would sound very appealing.

    I also believe that every ED should have a vending machine stocked with pregnancy tests. This could cut down on some of our visits! A lot of our level 3 "abdominal pain" work-ups end up to be a girl who just wanted a free pregnancy test. They have to be a level 3 due to our triage protocols, and get it free due to their reliance on the government...
    Last edit by JRapha'sRN on Mar 27, '07
  3. by   Gromit
    Quote from JRapha'sRN
    I also believe that every ED should have a vending machine stocked with pregnancy tests. This could cut down on some of our visits! A lot of our level 3 "abdominal pain" work-ups end up to be a girl who just wanted a free pregnancy test. They have to be a level 3 due to our triage protocols, and get it free due to their reliance on the government...
    Hehehe. I heard that!
    Get it free? Oh, you mean get it on the backs of other folks
    Last time I went into the ER as a patient (wife drove me there) I was tachycardic, had been for a number of hours. Short of breath, in general I was exhausted (have an LVEF of 25%) and when they finally called me in to head 'upstairs' some lady who had been griping that her foot hurt, started talking loudly about how >I< came in after her, but was going before her -and made comments that it was racial or even gender related
    Sorry, but I think cardiac condition SHOULD trump 'sore foot'. But what do I know? I'm only saying it because I was the cardiac patient (?)
    Still, my favorites are those who are claim their problem IS emergent, yet they get annoyed and leave the facility.
  4. by   lorita
    I work at one of those hospitals in the ER and there are 2 things you need to keep in mind 1. These are not emergencies! 2. They ARE NOT being charged $100 extra. They are charged $100 total no mater what the actual cost is. the differene is it must be paid prior to service rather than after but there are NO EXTRA CHARGES. The pt pays upfront and does not receive any other bill. For poor people it is difficult for most mod income it is a blessing!
  5. by   naskippy
    On one had I agree, on the other hand I see potential problems. The problem we have in our "I'm too busy" world is that we have WAY too many people who struggle all day to remain at work and not take time off to go to the doctor or take their kids to the doctor...when they get off work the doctors office is closed so they high tail to the local ER for that stuffy nose, sore throat, head ache, and various other illnesses and symptoms that could easily be treated at their physicians office. These people clogging up ER beds needed for more seriously or critically ill patients that could walk in or be brought in by ambulance at any unknown time. They drive up the cost of our healthcare and insurance premiums with their abuse of services and insurance benefits, costing you and me more money for our healthcare and insurance when we need it due to their abuse of emergency healthcare.

    Problems I see...well first off 2 hospitals implimenting charges like this will not make a difference in our rising healthcare costs and sky rocketing insurance premiums. But if we had the overwhelming majority of hospitals across the country charging similar fees, well it certainly might.

    The other problem I see is that of borderline decissions. The triage nurse is making pretty much a subjective call based on a few vital signs and what the patient tells them. In this day and age, better to be safe than sorry or you and the hospital will without a doubt find yourself in a lawsuit if you make a questionable call or a mistake.

    Also, I just read lorita's posting who works at one of these hospitals. If what she says is in fact true and I have no reason to doubt her...well what is the issue here? You pay a flat fee of $100.00 For many people that would be getting off the hook easy when the typical ER visit is like double that in most places. What's wrong with paying your bill up front too? There is no law that says a hospital HAS to give you credit now is there?
    Last edit by naskippy on May 13, '07
  6. by   DarrenWright
    Quote from RunnerRN
    I think the big issue with this policy is that people are going to sit at home, thinking...."gosh, I could barely afford my Rx's this month, is this feeling I'm having an emergency? If I think it is, will the ppl at the ER think so? And if they don't, I don't know if I can afford to pay the $100." Regardless of how it is implemented, once the word gets out I think it will cause problems like that.
    I am the first to complain about all the nonemergent pts I see in my ED. I'm all for the implementation of SOMETHING to decrease the number of idiots (and children of idiots) I see, but scaring people (essentially threatening them) is not my first choice.
    And when we say that "pain" is considered an emergency, the majority of ppl presenting with BS complaints are presenting because of pain of some degree. Ear pain, tooth pain, foot pain, ingrown nail pain, etc.
    There is a thread that just started today regarding a policy several hospitals are implementing with a team of a doctor and nurse in the WR who "treat and street" as ppl come in. Kid has an earache? Doc does an assessment, determines if the kid needs to be seen in a bed, or if they can write the Rx right there. UTI sxs? Send off urine, make sure no fevers or low back pn, write Rx. Interesting idea.
    Oh, and I would NEVER feel comfortable providing an EMTALA medical screen. I leave that to the docs who have the malpractice insurance and the schooling to back them up.
    Rather irrelevant.

    The hospital is obligated to screen them regardless of their ability to pay. If it's not and emergency, then they are expected to pay, and if they are deemed non-emergent and don't want to pay, they leave. They don't become a captured population suddenly saddled with an unwanted bill.

    I would be fine conducting an EMTALA screen given the proper training; there's a reason why ER's are staffed with a Triage RN and not a Triage MD.
  7. by   gradRN2007
    and that's why i work for a hospital that turns no one away and if they don't have the ability to pay so be it!
    Memorial Healthcare!!
    I think that's horrible and must be a hospital that's "for profit" or private system..
  8. by   gradRN2007
    about florida, there are not for profit hospitals that are top notch and profit hospitals that are well not so top notch
    please don't lump them all together
    thanks
  9. by   HeartsOpenWide
    And how is this going to effect those on medicaid? Not at all, the hospital can not charge them anymore because they only pay so much. But they can charge the paying man more. At first this sounded like a good idea because I know abused the ER can , but I know this is not the answer
  10. by   RunnerRN
    Quote from DarrenWright

    I would be fine conducting an EMTALA screen given the proper training; there's a reason why ER's are staffed with a Triage RN and not a Triage MD.

    Proper training? I believe that is called NP/PA/Med school. And the reason triage is staffed with RNs and not MDs is all about resource allocation. Why would an ED want to take a doc away from the back where they can see pts and get them out of the department to just triage people? I do not do an EMTALA screen in triage. I use my nursing judgment to determine if this patient can wait for the MD eval, or if they need to be seen emergently.
  11. by   DarrenWright
    Quote from RunnerRN
    Proper training? I believe that is called NP/PA/Med school. And the reason triage is staffed with RNs and not MDs is all about resource allocation. Why would an ED want to take a doc away from the back where they can see pts and get them out of the department to just triage people? I do not do an EMTALA screen in triage. I use my nursing judgment to determine if this patient can wait for the MD eval, or if they need to be seen emergently.
    Sheeesh...you missed the point, and you cannot make your opinion an absolute.

    EMTALA, as it's written, allows nurses to conduct the screening for an emergency as defined by EMTALA as long as it's hospital policy, and before you focus on the "hospital policy" bit, you need to realize that EMTALA defers to 'hospital policy' on many issues.

    You didn't have to explain why a physician doesn't do triage, but you obviously didn't understand what I was saying.
  12. by   JessicRN
    My insurance you have to call your if it is not a code you have to call your PCP they decide if you need to go to the ED. When you get to the ED if you are not admitted you pay $100 copay if you are admitted you pay nothing.

    Why should everyone else be treated differently. Seems to me I am the one currently being disrcriminated against because I pay for my insurance. I do work in the ED and the number of missed diagnoses are few and far between. We have become a primary care ED where patients come in with a multitude of non emergent problems and we have to tend to address them all . (i.e we had a 24 year old come in with Chest pain for 3 months, in her visit not only did we work her up for that she also had vaginal drainage which she developed later and had a pelvic exam and she had a sore knee from an MVA she had a month ago and got xrays for that as well) she went home happy as a clam, she got a complete physical for nothing and did not have to make an appt with her PCP.

    There had to be more policing after the fact. A child with a fever for one hour with no change in the childs behavior without taking the temperature or giving them anything or calling their own pediatrician because they "don't want to bother them"should be addressed and yes if they went to the doctors, the doctor would have charged them a copay at the office they should get the same copay in the ED.
    In our hospital we are a public health hospital we provide free care to any indigent or illegal pt. That includes PCP's that take free care or you pay by sliding scale. There is no excuse anymore. It is simply using the ED because there is only a wait of hours instead of days (except these are usually the biggest complainers when they have to wait extended periods of time), you can get your lab and xray results immediatley instead of waiting of course it is more convenient because you can come anytime. You can also lie about your name and address and not get any bill at all or use your cousins free care or medicare without anyone checking.
    It is true many places don't have the benefit we have provided but our place proves giving a person everything will not stop them from coming to the ED for non emergent things, we make it too easy to abuse we have made an express care where the non emergent get seen before the true emergencies. Something has to be done.
    What people do not realize is ED's are closing because there is so much loss of money from non payers. EMTALA and COBRA is killing them and us. Also just think when you have people on medicare (paid for by the taxpayers) who go to the emergency for non emergencies and what should have costed $50 dollars at a doctors office now costs us $1000's. Calculate the savings. When you or your family member have a true emergency and find your hospital ED is closed or you or someone close has to wait 8 hours for a bed in severe abd pain or you get stuck in the hall with true cardiac pain because that 24 yr old I spoke of earlier is occupying a bed you will feel differently I am sure
  13. by   jjjoy
    JessicRN - You seem quite passionate about this and I agree with much of it. I think you're preaching to the choir for the most part here. There's got to be some good campaigns out there that you can join up with in order to have your voice heard in wider society. It can be painfully slow to try to change things, but any effort beats no effort. Even just signing petitions can make a difference. There ARE things we can do influence change, little by little.

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