Emergency Room Fees For Non Emergent Cases

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

One of the contributors to the rising cost of Healthcare can be attributed to the over use of emergency departments (EDs) for non-emergency needs. In the greater Capitol/First/Beacon Hill area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency rooms and no urgent care centers with the exception of Group Health which is restricted to Group Health insurance members.

Implications on Healthcare System: The general misuse of the Emergency Rooms as a replacement for patient’s primary care can be considered one reason why hospitals on Marcus Island represent the biggest hurdle with regards to healthcare cost containment. Patients are likely to use the ER for primary care because they know they will be seen on the same day at the ER, versus the potential wait time of 2-4 weeks to get an appointment to see their primary care provider. Inappropriate ER use is expensive for hospitals, and prohibits continuity of care for patients.

When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need

The Affordable Care Act will provide health insurance coverage to an expected 32 million people.1 Health care organizations must try to use their current resources competently and capitalize on inpatient bed capacity. Dealing with capacity and high census in hospitals and emergency departments (ED) is a universal problem.1 Hospitals need to enhance their capacity to meet the goal of keeping their doors open at all the times for their patients and community. However, high cost approaches like expanding capacity with more space, staffing, technology and care givers impend the expected bottom line benefits of giving more health services to patients.3

Lakeland Regional Health was number one in America for the most Emergency Room visits March 2015-2016, even so they re-direct on average 260 uninsured and Medicaid patients a month to their Family Health Clinic for non-emergent care. The Affordable Care Act, though providing insurance benefits to many who could not afford insurance in the past, has not changed the quantity of patients utilizing the emergency room for primary care mostly due to the overwhelming need for more clinics that accept Medicaid, Share of Cost, and the uninsured.(2) Patients have often commented that it is cheaper to pay the penalty on their taxes each year over applying for the ACA insurance. The deductible and out-of-pocket for the insurance generally matches but the limits are often well above what the patient can afford to pay, and insurance does not pay until they have met that deductible amount. The question is not about providing care to the patients that arrive in the emergency room, but to offer a screening process to ensure that the emergency room is available for true emergencies, and that the safety of patients are considered and the delay of care is as short as possible.

Sydney Hospital’s policy states that those who achieve assistance status may schedule and appointment, but they may be seen in a case of an emergency without any type of assistance. Sydney Hospital’s policy fails to mention anything about the amounts that will be charged to individuals eligible for assistance. The policy must state that those eligible will not be charged more for emergency care or any necessary care than amounts billed to those who have insurance covering such chargers (Lunder & Liu, 2012). The policy should discuss the method the hospital chooses to use to determine the amounts that are billed to those who have insurance. The basis for calculating patient charges must be included in the policy (Somerville, et al., 2013). An example of what should be included in the policy would be a statement of the percentage of gross charges the hospital considers when they determine the amount that will be billed to the individual that does not have any form of health insurance (Lunder & Liu,

Emergency Department crowding is a cause for great concern. It is costly and responsible for compromising quality of care and community trust (McHugh, VanDyke, McClelland, & Moss, 2011). According to McHugh et al. (2011), improving patient flow can mitigate ED crowding. This paper will describe a plan to implement an ED fast-track area (FTA) as one solution to improve patient flow and reduce ED crowding. The author will describe the approval process, review the problem, discuss the proposal, explain the rationale behind the proposal, examine the evidence, describe the implementation logistics, and determine the necessary resources required for implementation.

Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

Use of emergency room facilities is more costly than visits to doctor’s offices, so this model of care for the indigent contributes to the increasing cost of health care and insurance.

Due to the misdirected cost of care, access to healthcare has impacted through increased demands for medical services and the decrease in medical personnel to provide needed services. Comparatively, estimating by 2021 ten to twenty-one million new direct care workers will be needed in order to cover the projected health care demands (Herman & Rollins, 2003). Nevertheless, the juxtaposition of medical shortcomings and quality of care has also impacted. Henceforth, the current lack of medical personnel such as physicians, nurses, and advanced practitioners have impacted health care quality, causing the majority of Americans to receive health care services through hospital emergency departments and government- subsidized community health centers

It is often wrongly asserted the primary abusers of the ED are uninsured individuals. The ED in the United State is not being flooded by poor, uninsured individuals seeking medical care. Instead, the NEHI (2010) found that the uninsured populace accounts for only a small percentage of the population using the ED inappropriately. Research from the NEHI (2010) states that ED misuse can be contributed to all populations regardless of insurance status, age, demographics, and race (p. 3). The following graphics by the NEHI (2010) offer evidence that the ED use is universal in the State of Massachusetts in 2005; similar studies were found in several other states.

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).