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

Nurses Activism

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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 room in recent months to ask the least sick of its patients to turn elsewhere for care or face a $100 fee. memorial hospital in jacksonville started the policy in august. both facilities are operated by hospital corporation of america.

florida times-union, nov. 30, 2006

Specializes in NA, Stepdown, L&D, Trauma ICU, ER.

I'm hoping against hope something similar comes my way! I don't work in the ER, but I talk to enough nurses who do to know how abused it is. People come in at all hours of the night for a rash they've had for months, MONTHS! How is that an emergency? People call 911 for things any 10 yr old can tell you aren't serious, and certainly not requiring lights & sirens. Medics respond and are required to transport a primip who has had 3 ctx rated 2/10, they take pts to the ER with hangnails. Meanwhile, last week my coworker did CPR on an MVA for 40 minutes waiting for the squad to respond. He had a pulse and shallow resp when she first saw him, by the time EMTs arrived, he had no signs of life and blown pupils. He was 20 years old. Maybe having a faster response would have made a difference, maybe not. All she knows for sure is that he was technically alive when she first saw him and despite her best efforts, she watched him die over the next 40 minutes.

I know that this bill may not be the best or most effective solution, but something's gotta be done to get the message across that the ER is not a substitute for routine care, either at a PCP or a clinic. The medics and ER are finite, limited resources being taken away from the people who need them by the BS and it has to stop!

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Specializes in NA, Stepdown, L&D, Trauma ICU, ER.
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.

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.

According to the article, the policy says the pts are triaged, and seen by a doctor to determine if they meet the "emergency" definition. They can still come and be seen, without the extra charge. They're also given a list of providers they can see if the ER is not the most appropriate place for them to be.

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Specializes in Hospice.

Along the same lines... has anyone else seen an additional charge for ER visits during certain hours (such as after 10pm), even if the visit is a true medical emergency?

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Specializes in Emergency Room.

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 and the schooling to back them up.

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I think it sounds like a good idea if it works out as planned, which is still uncertain. The people are seen by a doctor no matter what. If their problem isn't emergent, they are given referals to places that could better treat their needs. Many ERs are overrun with nonemergent cases. I think this might lighten the load a little bit. But I'd like to see how this actually turns out before I become an ardent supporter.

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My health insurance won't cover ER visits that aren't "emergency." It is rather unclear then who will pay if you think you might be having a MI, go to the ER, get worked up and find out no MI. I think it would be covered and it's just if you admittedly go there for "routine" medical care, they won't cover it. I think it's the same with this. It's trying to discourage folks who KNOW it's something that could wait, not to discourage folks who are worried that they might be having a serious problem. Not necessarily the best way to go about. Perhaps a better solution is a low cost 24-hour urgent care facility situated right next door to the ER. Well, I can dream, can't I?

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Specializes in Critical Care, Cardiothoracics, VADs.
First, I want to say thank you for this stimulating thread... I am really enjoying this banter...

I will never agree that this law is appropriate, as long as there is a disparity based on a persons ability to pay.

Apparently what this allows is for people to be treated in an emergency room for non-emergent problems if they have the extra 100 bucks

i still say joe citizen should not fear that they will be charged extra in order to seek help...

Cardiologists and others are specialists; emergency rooms are portals into the healthcare system

And I believe its reckless to punish people who may not have the ability to pay and make them feel less important to the healthcare system - and make them feel like they shouldn't bother us unless its something 'important'..

There is no suggestion that they will "punish people who may not have the ability to pay"!!! Only that they will penalize people who DEFINITELY do not have emergent situations.

I don't think it's unreasonable to expect people to pay extra to use the ER as a doctor's office. Obviously if someone turns up with non-specific symptoms and ends up having a true problem, they won't get charged the fee. So it's not denying access to the ER for people without the ability to pay. It's rationing ER access for people without emergencies!

By your examples, those people will a) probably not know the policy until they get to the ER anyhow, so it won't deter them from going and b) Anyone is still welcome to go to the ER and be assessed. They will then have the choice if it's non-emergent of 1. staying and paying an extra fee for treatment or 2. going to their regular doctor.

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Specializes in Emergency.

I just spent the past 12 hours working in our local ED. Mind you during those 12 hours I was able to pee 2x and eat when I could while charting at my computer. We had people stacked in every conceivable corner we had.

It is very difficult to remain compassionate when the ambulance is bringing in a patient who has had an in-grown toenail for 2 months, but couldn't find a ride today, and had nothing better to do. Primary doctor? What primary doctor?

Regarding the $100 additional fee - do you actually think these patients will pay the fee? I seriously doubt it.

While I truly do appreciate the intent of these hospitals, I am not sure if this will work. There is a mind-set within some of our ED patients that we are available for every diagnosis/problem you can think of. It doesn't often cross their mind, that their presenting complaint is not an emergency.

If we want to reserve the ER for "real" emergent cases, we need to provide affordable primary care to all. We are often the doctor they will see.

IMO - the whole system needs overhauled!

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I'm hoping against hope something similar comes my way! I don't work in the ER, but I talk to enough nurses who do to know how abused it is. People come in at all hours of the night for a rash they've had for months, MONTHS! How is that an emergency? People call 911 for things any 10 yr old can tell you aren't serious, and certainly not requiring lights & sirens. Medics respond and are required to transport a primip who has had 3 ctx rated 2/10, they take pts to the ER with hangnails. Meanwhile, last week my coworker did CPR on an MVA for 40 minutes waiting for the squad to respond. He had a pulse and shallow resp when she first saw him, by the time EMTs arrived, he had no signs of life and blown pupils. He was 20 years old. Maybe having a faster response would have made a difference, maybe not. All she knows for sure is that he was technically alive when she first saw him and despite her best efforts, she watched him die over the next 40 minutes.

I know that this bill may not be the best or most effective solution, but something's gotta be done to get the message across that the ER is not a substitute for routine care, either at a PCP or a clinic. The medics and ER are finite, limited resources being taken away from the people who need them by the BS and it has to stop!

How right you are.

Before I started nursing school, I was an EMT on the only ambulance within 50 miles of the hospital. We had people who would call 911 for minor scrapes, children with skinned knees, people whose week old sprained wrist suddenly became an emergency, and drunks just wanting a free ride to the hospital so they could get home from there.

On more than one occassion, critically ill people had to wait for transport because of some selfish idiot. :angryfire The selfish idiot tribe has members from all strata of society, so this isn't a class issue.

I'd like the see the charge go to $1000, which would provide the abusers a real disincentive.

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Specializes in Ante-Intra-Postpartum, Post Gyne.

In my state, you can not even question a person's citizenship in fear you will scare an illegal immigrant away that is having an emergency. Most of the people in my experience that use the ER like that are on Medicaid anyway because they do not have to pay. So the tax payers will pay more for what they already pay for? I know I am not going to the ER with a $5,000 unless I bleeding out my ears. I would go to the doctor if I broke a bone. The ER is so abused.

My brother was dying and some girl kept buzzing the ER window because no one had attended to her cut finger.

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Specializes in NA, Stepdown, L&D, Trauma ICU, ER.
I would go to the doctor if I broke a bone. The ER is so abused. My brother was dying and some girl kept buzzing the ER window because no one had attended to her cut finger.

First off, sorry to hear about your brother and the insensitive snit who thought her finger should be the top priority. Given the state of ERs these days, going to your pcp, being sent out for xray and going back to have the bone set would probably be just as efficient as going to the ER. As sad as that is to say, people who should go sometimes won't simply because they know it will be a 6 hour (on a good day) ordeal before they're done.

The system is broken. This isn't fixing the original issue of people not having or not being able to afford a pcp visit and either a shortage of clinics or the knowledge of them. It's symptomatic management at best, but at least they're doing something:uhoh21:

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That's sad :(

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