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

SharpknifeRN · Dec 16, 2006

Hello all. I agree that telling who is who is going to be difficult, but I think that I can explain how this law came to be. I have worked in Orlando and now work in St. Pete, both places have the same problem, they have a reputation for being places that people can get drugs. Yes I know saying this will make me unpopular, so be it. I don't know why having been in both ER's there is nothing about it that would make the casual observer believe it. Orlando is not the only place this is going on, because it is currently happening in the ER in the hospital I work in. It is happening because it works. They just put up a sign that says if you do not have insurance then you pay before tx up front or if you need to be made stable, then so be it for transport to a public facility. It was either do this or close the doors.

Just prior to this I sat in our ER for about four and ahalf hours waiting for tx. The dozen or so people ahead of me were increadable. They brought their friends with them and had a party in the waiting room. This included drinking, and line dancing. Then suddenly when they were called back to be seen they could not get up out of their chairs faining back injury. I wish I could have taken pictures. My feeling is they didn't pay for the tx they got either. These people are why you can't get timely tx for your kid at 11 at night and why you pay what you do for the tx you get.

lorita · Mar 27, 2007

The way this works is The doctor decides if it is an emergency or not if it is determined that it is not an emergency the patient is given the option to stay and be treated at a cost of $100.00 or leave. there will be no other bill this is not $100.00 additional it is the total cost and must be paid before care is provided. It is actually cheeper than what the real cost is but since most people who come to ER for non emergencies have no money they leave.

Gromit · Mar 27, 2007

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.

JRapha'sRN · Mar 27, 2007

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...

Gromit · Mar 27, 2007

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...[/quote']
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
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.

lorita · May 1, 2007

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!

naskippy · May 13, 2007

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?

DarrenWright · May 23, 2007

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.

gradRN2007, BSN, RN · May 23, 2007

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..

gradRN2007, BSN, RN · May 23, 2007

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

HeartsOpenWide, RN · May 23, 2007

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

RunnerRN, BSN, RN · May 23, 2007

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.