Another article that I was going to put in a Healthcare Update that just irked me enough that I had to make it into its own post.

First, the news …

In order to cut down on unpaid health care bills while also complying with federal EMTALA laws, hospitals emergency departments are increasingly engaging in the “greet and street” approach. EMTALA requires that hospitals provide a screening exam to every patient seeking emergency medical care. If that screening exam does not reveal an emergency medical condition, then the hospital has no further duties under EMTALA. Doesn’t have to do any other testing. Doesn’t have to provide treatment. Doesn’t have to give you a prescription. It is only when a hospital discovers an emergency medical definition that the hospital is then obligated to either provide stabilizing treatment or to transfer the patient. If you want to read all of EMTALA’s definitions and requirements, here’s a link.

So if a patient seeks medical care in an emergency department and does not have an emergency medical condition, the hospital is not obligated to provide treatment to the patient. More and more hospitals – especially those with higher volumes of patients – are implementing policies embracing that concept.

One of the latest examples is Halifax Health in Daytona Beach, Florida. If patients go to the Halifax Health emergency department and do not have an emergency medical condition, then those patients now have several options. First, they can either pay their insurance co-pay or pay $350 cash up front, then be seen in the emergency department. Second, they can choose to go to the on-site clinic and pay $48 to be seen. Third, if they don’t want to or can’t afford to pay anything, they are given a list of community resources to follow up with – such as county health departments.

The policy only applies to patients 18-64 years of age. Those 65 and older are covered by Medicare. Those under 18 are likely covered by some form of state insurance for children.

Halifax Health estimates that one third of its bad debt is generated through its emergency department and is trying to cut $5 million from its budget. The hospital system noted that people from neighboring counties generated more than $7 million in unpaid medical care with a large portion of that uncompensated medical care coming through the emergency department.

So, it appears that as financial pressures for hospitals mount and as additional patients enter into a system that does not have sufficient primary care resources, patients will increasingly be left in what will become medical purgatory – a place where patients are not sick enough to warrant emergency medical care and they are unable to find a doctor to treat them in a timely manner.

End of news blurb.

Beginning of rant.

The author of the article interviewed a patient who was told “she would have to pay the entire cost of the visit if she wanted to have her upper respiratory infection with a touch of bronchitis treated.” The patient was upset because this chest cold was an “emergency” to her.
She then had to wait three days to get her emergency antibiotics for the viral infection she was experiencing. Not surprisingly, her emergency “ZeePack” didn’t work.
Then some doctor who obviously hasn’t read my “Don’t Use Raid on Dandelions” post gave the lady a second round of antibiotics. Obviously the first round of antibiotics was much too weak. The patient should have been prescribed Gorillamycin to begin with so that all viable flora in her body could be simultaneously eliminated.
Now, given the natural course of viral illnesses, the patient’s symptoms will begin to wane near the end of her course of Gorillamycin, leading her to the logical conclusion that her cases of bronchitis are much more virulent than other peoples’ cases of bronchitis and can therefore only be treated with Gorillamycin in the future. Any doc who fails to prescribe her Gorillamycin for the next bout of sniffles could potentially cause her to die from untreated bronchitis and will definitely get only negative integers on their Press Ganey surveys.

The good news for you, ma’am is that when you develop clostridium difficile colitis, Stevens Johnson syndrome, invasive MRSA or some form of deadly flesh-eating bacteria infection from all the unnecessary antibiotics you are taking, you’ll be brought right back to the treatment area when you return to Halifax Health’s emergency department.

See? The system really does work.