ER's Turn Non-Emergencies Away?

[mwboswell]

The below article appeared on the website of a local news station in Rock Hill SC. Some people in the community have varied opinions about this. For those of us "in the business", what do you think about this kind of policy? Do you think it will actually make a difference or is it just bad public relations or giving people a mixed message about a hospital's concern for it's community? What if a patient has no insurance and can't afford a doctor's office visit, where do they go? What do you think?

Local Hospital's New Policy Of Turning Patients Away Upsets Some

Posted: 6:28 pm EDT May 12, 2009

ROCK HILL, S.C. --

Diana Burgess of Rock Hill went to the emergency room at Piedmont Medical Center last month with severe pain in her side."The doctors came in and just basically said they weren't going to do anything for me," she said. The ER doctors determined that the pain Burgess was suffering was not an emergency and didn't require immediate care. President and CEO of Piedmont Medical Center Charlie Miller explained the policy this way: "it is an emergency room, not a primary care clinic." "We think it's had a positive impact on wait times," Miller said. "Two-hundred to 250 people a month are leaving to see their primary care doctor instead." Hospital officials also said patient care is better when they can see a doctor outside of the hospital and form a relationship, rather than using the emergency room as their doctor. However, people like Burgess, who doesn't have any health insurance, said she can't afford to see a regular doctor. "I just left there crying," she said. "I was hurting too. I was really feeling bad. "Miller said the hospital does what is required by law, which means doing a medical screening for every person who comes into the ER. Then doctors determine if their condition requires immediate emergency care.

[Reno1978, BSN, RN]

I think the statement that it's an emergency room and not a primary care clinic sums up my opinion on the matter.

Also, it's frustrating to hear people say they can't afford to see a regular doctor when they don't have insurance. What they can afford to do is bleed the hospital systems dry, though. Personally, if I didn't have insurance, I would must more like to have an outstanding doctor's office visit charge of $90-120 than an outstanding ED visit charge. But I guess when your intention is to get free service, it doesn't matter the amount you're not paying. I just really don't like the mindset that if you have no insurance and can't afford a doctor's visit that it's acceptable to show up at an Emergency Department and screw the hospital out of a payment for the services they provide.

Furthermore, I don't know about her community, but in the places that I've lived, there have always been clinics with sliding scales based on payer ability or free clinics. Prior to becoming an RN I saw a practitioner and was charged $10 because I had no income at the time. For non-emergency cases, patients should be able to make a few phone calls and see what resources are available in their community. Doing a google search for "free clinic rock hill sc" shows a free clinic for medical visits right in the city where this hospital is turning away non-emergent cases in their ED.

[oramar]

If it is not an emergency and I "DO" have insurance will I be treated any differently?

[Katnip, RN]

Of course the media is making the docs in that ED sound totally heartless. But it isn't. The bigger picture will show far too many people using the ED as their primary care giver, clogging the system.

I keep seeing over and over, articles that state that the EDs need to reorganize their system to reduce the huge wait times. But I never see them say that people have to stop going there for non-emergencies. That would probably be the single biggest way to reduce those wait times for real emergencies.

[emtb2rn, BSN, RN, EMT-B]

The piece of the article posted didn't give details on how the docs determined the pain wasn't an emergency. Was it a physical exam & then out the door? Or did she drink contrast for 2 hours, get a ct & then told to hit the road? Kinda reads like the 1st scenario.

I'm simply amazed at how many folks show up for what can be treated by fluids, tylenol & rest. I like the sliding scale concept noted above.

[casi, ASN, RN]

I think that this is a good concept. People need to see a regular doctor or clinic that has their history.

For the patients who can't afford care and/or don't have insurance give them a list of free, sliding scale, and urgent care clinics that may be able to help them.

[icyounurse, BSN, RN]

I have to agree that using an ER for non-emergencies is just plain fiscally irresponsible. If you dont have insurance and cant afford a doctor, how can you afford an ER bill?? Geez.

I do think that in order for this to be successful, there should be a list of urgent care clinics, free clinics, doctors offices that do sliding scales ect in the immediate area to be provided to these folks, with a handy map,as they apparently dont have the resources to research it on their own often times. Many of these people may just need some education.

[HippyGreenPeaceChick]

I think that this is a good concept. People need to see a regular doctor or clinic that has their history.

For the patients who can't afford care and/or don't have insurance give them a list of free, sliding scale, and urgent care clinics that may be able to help them.

There are not enough free or sliding scale clinics around. Then if perchance any workup is needed it is still faster done in an ER no matter how crowded it is. Then there are the local doctors who send their pts to the ER knowing we will get all these tests done quickly regardless of ability to pay. And get these patients admitted for them and they dont have to the work. It is the way our world works untill we get United Health Coverage for all.

[Christina Wright]

To me, this is a difficult issue. I have been on both sides of the fence here. I did not have insurance for about 5 years due to the jobs I was keeping. I have been going to school since 2003 and just finished this year. (I had to wait on a 2 year waiting list for the nursing program.) This caused me to keep a lot of part-time jobs that did not carry insurance. I ended up getting sick on a weekend and did not know where to go. I could not afford to miss time that week due to illness so I did the best thing I could think of and checked into an ER.

The ER I went to for help checked me in and had me wait in the waiting room. I waited there for over 12 hours. I watched the waiting room fill-up and empty out with groups of people 4 times. But I still sat there waiting. By the time I saw the doctor, he was very rude to me and made me feel terrible. This was on top of the fact that I was already not feeling good. He stated to me that they did not even want to see me and that it was not an emergency and that I should not have come. He said I should have went somewhere else. I started to cry because I never meant to upset anyone, I just wanted help. The nurse that was in the room told me to shut-up because my crying would disturb the other patients. I felt ganged-up on, scared, and ashamed like my health was of no concern to anyone. I was also told that is why I waited so long because they were hoping I would just go home.

I told the nurse who told me to shut-up that she had no right to silence me and that I had the right to express my feelings and that I wanted her to leave (I was not crying out loud for Pete's sake). She left and I spoke to the doctor. I told the doctor that if they thought that I should go somewhere else from the beginning that I wished they would have informed me. Instead they checked me in and sent me to triage which is an automatic $500 charge. I told him that I was not aware of my options to clinics in my area that were open on a Sunday that could help me. I thought the free clinics were closed. I informed him that I could not go to the usual walk-in clinic due to the fact that I had no money and no insurance. I then informed him that I had already waited the 12 hours and would be receiving a bill for the triage whether I left or not, so I felt I earned the right to be seen. He agreed, changed his attitude, and helped me. He then gave me information on what I could do in the future should this happen again and who I could contact in my area.

That was a terrible experience for me but now I work in a hospital. I see the other side too. I hear of cases that come in where people state they are having chest pain and it turns out that they came in for other issues not related to the chest pain. Usually, they end up getting treated for the other issue and nothing is found to be wrong with their heart. Then, the bill does not get paid and the hospital suffers. Now, we are having budget cuts and staff cuts due to these unpaid bills because the hospital is non-profit. But what is the answer?

Maybe it would be good if we could have a better referral system? Is it feasible for the hospital to work with the other clinics in the area to refer out non-emergencies instead of refusing care? Maybe give the patients options instead of denials? Why couldn't the community work together and make the information more readily available to the general population to educate them on their options? We have to remember that not everyone is out to take advantage of the health care system. Many are not aware of what they can do or where they can go for care and they are scared. I think we forget when we work in the health care system that not everyone has the knowledge that we do on general health issues. We assume an average person should "know better" than to come to the ER for the issue that they are having. I mean, I know that the hospital is not a charity, but the community does look at the hospital as a huge health resource and expects help of some kind from it. Don't we want the community to have confidence in it's services? What do you think?

[NurseCard, ADN]

Aren't emergency room visits more expensive than visits to a primary care physician????

[UM Review RN, ASN, RN]

Problem is, the ER doesn't make you pay up front, whereas the docs do. Therefore, if someone has no cash and is ill, the ER makes more sense.

However, I do agree, the ER is overused and this will seem like a great idea until one day, a doc gets careless and sends someone home who should've been admitted.

[Christina Wright]

In response to NurseCard:

Yes, of course. But it was easier for me to get billed then pay $150 at the door at a walk-in clinic because I did not have money at that time. I also did not have a primary care physician at the time. I was in school and struggling. Not everyone has money in the bank or an insurance card in their wallets. But I could do payment arrangements.