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.
The way this was presented, it sounds like she just showed up, was screened and shown the door. It doesn't address if or how many times she has been seen in that department for the same or similar complaints. If she has been evaluated for "severe pain in her side" a dozen times in the past month with no significant findings, then there isn't a great deal more that will be served by yet another workup. The ED can keep prescribing narcotic analgesics, but long term drug therapy should be overseen by a PMD. It's not medically appropriate for long term therapy to be overseen by an emergency department. The continuity of care just doesn't exist. No emergency department physician who plans to stay out of court and keep practicing medicine will medically screen and boot someone with "severe pain in her side" who hasn't ever been seen in that department in the past. It's just not going to happen. They'll at least get lab work done and radiology studies as appropriate. There's more to this story than was presented.
I saw one of my regulars lately (chronic pain). As I was triaging him, I asked if he had seen his doctor at the local community health center recently. He stated that those people were all idiots and he "fired" them as his doctor and he couldn't go back there. This is a patient with multiple comorbidities that requires ongoing lab evaluation for dosage adjustments. Basically, he expected us to manage his multiple conditions from now on since he fired the only doctors in town that would see him.
We have a system coming down that I expect to start rolling out in the next year. We'll be building an interdisciplinary team that will review ED records and look for our major offenders and attempt to get them tied into more appropriate resources including PMD coverage. Part of it will be holding the line on narcotics and more aggressive use of medical screening exams for frequent fliers. Partly it's being diven by the state, as our state pubic aid department has started tracking use of ED vs PMD and we're getting letters about specific patients (the patient also gets a copy) that state that they are overusing the ED (costing the state too much money) and that they must go to their PMD for non-emergent issues. We'll see how it works.
Oh, and Oramar - most of our docs wouldn't have the first clue where to look to determine if a patient has insurance or not. I don't see it as an issue, and woe be to the facility that gets caught doing such.
Aren't emergency room visits more expensive than visits to a primary care physician????
Sure but can you always get into see a PCP. More often than not if you call they cant get you in for at least a few days. That leaves urgent care if you have insurance or money. BTW most urgent cares do not accept medicaid or medicaire. They want good insurance and cash up front. Free care clinics are scarce enough. They see people usually on a first come first serve basis, some have appointments. But when it is time for them to close at the end of the day, they close. And say try again or go to the ER.
Medical care outside of the ER is even more so now than ever before for the haves, not those without. I know several doctors outside of work. They do not accept any charity, medicaid, or medicaire work.
Specializes in Med Surg, Home Health, Dialysis, Tele.
I didn't have insurance as well before I became an RN. I just prayed I didn't get sick. I surely didn't go to the ER( I didn't have any money either), now there are various clinics, some that are staffed with nurse practitioners, that are about $60-70 for an offc visit where I live. So it is attainable now for people. A lot of times the ER is used not only for primary care but also a free ride. :zzzzz
If it is not an emergency and I "DO" have insurance will I be treated any differently?
Actually, yes. If you have insurance you can keep coming to an ER, and be seen for whatever. If you are a drug seeker and have insurance then you wont be turned away. But if you do not have insurance then a MSE will give give the option of paying up front in cash, not check. Or you have the option of going elsewhere.
Specializes in Critical Care, Emergency, Education, Informatics.
There is more to it than the haves and the have nots. The medical screening exam has been around for a long time and if you search there are other threads here on the subject. Most hospitals who utilize the MSE usually have set protocols. The old and young are excluded, preg issues are excluded, out of range vital signs are excluded. In one facility I worked at if a female showed up for STD check we had to see her, but if a male showed up, he was refered to the county health dept.
In some cases it's not the policy that is the problem, in some cases it's the provider that is teh problem. Some providers are just jerks.
If it is not an emergency and I "DO" have insurance will I be treated any differently?
If it's not an emergency your insurance may not pay. My husband recently went to the ER for dizziness and we got a letter from our insurance company saying it was not deemed an emergency and they would not cover the bill.
This ticked me off because I am an ER nurse and I see all these freeloaders that come in for minor complaints and never pay a penny. My husband who was too dizzy to walk and has insurance couldn't get covered. I've never been so mad. I tried to appeal it but didn't get anywhere.
my mom used to say, "one bad apple spoils the whole bunch". basically all of the people who abuse the system whether it be by getting "free" service, or wasting valuable ER time, those are the people who ruined it for those who really need to go to the ER.. Imagine being turned away and it turns out to be more serious because the person had waited until the next morning to go to a doctor if at all.
i don't think there will ever be anyone happy with the ER policy no matter what. it is kind of sad that it had to get like this
the whole health care system seems a mess to me...
I've been on both sides of the fence on this issue as well. Actually I've been on the unisured part for quite a while, though I do have a PCP. She only charges $60 or less for a visit, but the trick is having that $60 sometimes. I recently had to go to the ER because I was wheezing for over a week and was starting to get worse. Waited in the ER for a complete shift, but was seen. Turns out I was in the middle of an asthma exacerbation that could have gotten much, much worse...but I didn't have the money to see my PCP. I qualified for the medassist program as far as the actual ER bill goes, but I still have bills for the Dr. and Radiologist separately. I hated having to go to the ER and our Urgent Care does have a payment plan, but you still have the money up front. We do have a free clinic for the tri-county area, but they are only open twice a week and if you end up far back in the line you won't get seen. The last time I went I stood outside for over 3 hrs to get a good place in line only to be told that I couldn't be seen because of my previous year's income. Now, I do think ER's should not be used for non-emergencies....but honestly where do you go when there are no other options. I personally hate going to the ER because I feel they seem me as a freeloader or worse just because I don't have insurance. I also know from personal experience if you don't have insurance PAC's get diagnosed as an anxiety attack, same with hypoglycemia since it wasn't "hypo" by the time I got seen. That last one, my PCP at the time told me to go straight to the ER after I told him what my BS read at. I guess I shouldn't have self treated it before going to the ER huh?
It's a no win situation for all involved IMHO and my
Crocuta, RN
172 Posts
Working in an ED, I think of a couple things:
The way this was presented, it sounds like she just showed up, was screened and shown the door. It doesn't address if or how many times she has been seen in that department for the same or similar complaints. If she has been evaluated for "severe pain in her side" a dozen times in the past month with no significant findings, then there isn't a great deal more that will be served by yet another workup. The ED can keep prescribing narcotic analgesics, but long term drug therapy should be overseen by a PMD. It's not medically appropriate for long term therapy to be overseen by an emergency department. The continuity of care just doesn't exist. No emergency department physician who plans to stay out of court and keep practicing medicine will medically screen and boot someone with "severe pain in her side" who hasn't ever been seen in that department in the past. It's just not going to happen. They'll at least get lab work done and radiology studies as appropriate. There's more to this story than was presented.
I saw one of my regulars lately (chronic pain). As I was triaging him, I asked if he had seen his doctor at the local community health center recently. He stated that those people were all idiots and he "fired" them as his doctor and he couldn't go back there. This is a patient with multiple comorbidities that requires ongoing lab evaluation for dosage adjustments. Basically, he expected us to manage his multiple conditions from now on since he fired the only doctors in town that would see him.
We have a system coming down that I expect to start rolling out in the next year. We'll be building an interdisciplinary team that will review ED records and look for our major offenders and attempt to get them tied into more appropriate resources including PMD coverage. Part of it will be holding the line on narcotics and more aggressive use of medical screening exams for frequent fliers. Partly it's being diven by the state, as our state pubic aid department has started tracking use of ED vs PMD and we're getting letters about specific patients (the patient also gets a copy) that state that they are overusing the ED (costing the state too much money) and that they must go to their PMD for non-emergent issues. We'll see how it works.
Oh, and Oramar - most of our docs wouldn't have the first clue where to look to determine if a patient has insurance or not. I don't see it as an issue, and woe be to the facility that gets caught doing such.