When I read this article by Phil Galewitzon Kaiser Health News (in collaboration with the Washington Post) I was amazed, but not for the reason you might think.  Check it out:

Hospitals Demand Payment Upfront From ER Patients With Routine Problems

The gist of the article is that nearly half of the emergency rooms in the nation are now forcing patients who come in with non-emergency complaints to pay a fee upfront or else they are turned away.  $150 and $350 are both noted in the article, so the charges probably range pretty far.

I was amazed by this primarily because I agree with it!  In one way, it seems to go against the grain of what an ER is “supposed to do,” or at least what hospital emergency rooms have always historically done.  But as a medical billing specialist, I can’t argue with the logic behind the policy.

The article notes some startling statistics from HCA (the nation’s largest chain of for-profit hospitals):

 “Last year, about 80,000 emergency-room patients at hospitals owned by HCA left without treatment after being told they would have to first pay $150 because they did not have a true emergency.”

In other words, the upfront fee served as a deterrent to patients who didn’t really require emergency care.  Considering the fact that ER visits by uninsured patients often end up not getting paid, and that many people have actually become experts at “working the system” to use the emergency room to obtain free health care, this can translate to millions of dollars in savings over the course of a year.

It makes great business sense!

Of course, some doctors and patient care advocates are concerned, as the article also notes:

“Physicians worry that sick people will forgo treatment. There is no data on how many who leave the ER without treatment follow up with visits to doctors’ offices or clinics.”

While I understand their concerns, it seems to me that combining this policy with some other measures may work better for everyone.  After all, when hospitals incur bad debt because of things like unnecessary and unpaid ER visits, all of us end up paying for it through higher healthcare costs.

So, here are a few ideas that might work:

• Hospitals could make available a 24-hour walk-in clinic for routine complaints so that anyone showing up at the emergency room without a true emergency can receive the proper care (at the proper price) right on the premesis.
• Maybe the price some of these ER’s are charging is a little high.  Maybe $50 is more reasonable. It could still work to deter those scam artists who are only out to receive services for free, while staying within reach of most patients with legitimate concerns.
• Or, maybe educating patients about what they should expect from the emergency room is sufficient.  The Midland Memorial Hospital in Midland, Texas, has set up a 24-hour hotline where patients can call and speak to a nurse to help determine if they should come into the emergency room or visit a local clinic.  This, in conjunction with a $150 fee for non-emergency complaints resulted in a 10% drop in ER visits and a huge drop in bad debt as well.

I know this subject is going to spark some lively discussion, so let me know what you think: Is charging an upfront fee at the emergency room creative or corrupt?  How would you fix the problem of bad debt at the ER?