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.
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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.
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Feel better?
“Gorillamycin” Funny!
Interesting post WC.
It is disconcerting to think that there will be a patient purgatory.
Oh brilliant, so now docs can be sued at an even greater rate “you didn’t consider my cough an emergency and it turned out to be ebola”. See if you would have admitted them and run a million dollar workup, you would have known it was ebola. Tsk tsk.
We’ve being a MSE (medical screening exam) at our hospitals for about 5 yrs. I work for HCA. If I triage a level 4 or 5, the midlevel/MD will determine if I am wrong and over-ride or agree and then tell them they don’t have an emergency but will be seen if they want to either pay $150 or their insurance co-pay. Most don’t have $150 and get pissed off and yell and scream and then leave.
However, there are many of our docs who will over-ride a stubbed toe and do an X-ray. The last group of doctors we had who did this were all fired.
Who is doing the MSE for patients that get turned away from Hallifax? Is there a doc out in triage? If not, who is responsible for people who get turned away and turn out to have a real emergency?
For a minute I thought your rant was going to be about the Greet and Street policy, which sounds brilliant to me. I concur on using Raid on dandelions.
I honestly don’t understand why so many docs, who should know better, are still giving in and giving out so many antibiotics. It just doesn’t make sense!
I’d like to personally thank Dr. Gorillamycin for his efforts, my beloved DIL seems to be one of the small percentage who contract C.Diff colitis. She has been sick for months now.
Not OUR fault, neither her family nor my family has EVER been a group to abuse antibiotics, preferring to avoid medicines unless death is the only other option.
We’re starting to give serious thought to fecal transplant.
Anyone know where Dr. G is in practice? I’d like to thank him/her personally.
I like a similar antibiotic, gorillacillin.
I prescribe my favourite thing regularly, “tincture of time”.
“tincture of time”. I like that.
Ha ha, tincture of time-that is like when you thoughtfully say….well Mr. Smith, it will go away in two weeks with antibiotics or 14 days without. The URI mentioned would have gotten flu swabs, CXR, definetly an EKG, probably troponins, a d-dimer and mabe even a pertussis smear in our neck of the woods.
I complained about zeepack on an earlier post here. Naming it Z-Pack was a masterful stroke of marketing, and I passionately hate the person who thought of it.
Patients like saying zeepack. It’s catchy. It sounds cool. It sounds like you know what you’re talking about – “Oh! You know the name and dose of the antibiotic that works? You must really be on top of things, then!”
Dingdongs who can’t remember (and don’t bother to write down) the name of their BP meds or what the huge abdominal surgical scar was from ALWAYS remember that zeepack is what they need.
My solution to reduce the amount of abx seeking is to require that drug companies name their meds something embarrassing.
No one will stride confidently into a waiting room and boldly declare, “I need Zerpes for my sinus infection! It’s the only thing that works!”
Or
“My doctor is an idiot. She won’t give me a prescription for Stankfartulus to cure the tickle in the back of my throat!”
Savage – HUMOROUS point! ZERPES!
Humerus!
I take too many x-rays….
I have honestly heard several people refer to their CPAP machines as “my zpack”.
MC – THAT’s FUNNY!
Our small rural hospital has been inudated with drug seeking trolls lately, overwhelming us. It seems the two nearest hospitals have started screening patients, so the no pay trolls have flooded us.
Tried to explain to our fearless leader that 9 (nine) I-lost-my-norco-for-my-chronic-back-pain patients in a row was a BAD thing !