More hospitals telling non-emergent ED patients to 'pay first'
Policy aims to curb overuse, reduce costs
Topics: Access to Care, Quality, Performance Improvement, Appropriateness, Outcomes, Service, Capacity, Efficiency, Process Improvement, Throughput, Utilization, Emergency Department, Service Lines
February 22, 2012
In an effort to reduce ED overcrowding, more hospitals are requiring patients who present with non-emergent illnesses to pay upfront before receiving care, Kaiser Health News/Washington Post reports.
At least 50% of U.S. hospitals already have implemented upfront ED fees, which can amount to as much as $350 depending on the facility. The charges are levied once the patient has undergone a federally mandated pre-treatment screening.
According to CDC, roughly 8% of ED visits are considered non-emergent and involve problems that can be addressed in a physician office or clinic, but other studies have suggested a higher rate. For example, a study published in Health Affairs in 2010 found that 27% of ED patients could be more effectively treated in a physician office.
Should pay-first policies be the norm?
ED physician groups have warned against the pay-first policy, noting that some patients might decide to forgo treatment altogether. David Seaberg, president of the American College of Emergency Physicians, notes that 2% to 7% of patients who have been screened at an ED and do not have a serious problem are hospitalized within 24 hours. Patient advocates also warn that the policy could discourage patients with health emergencies from going to the ED.
However, hospital executives say many institutions have enacted the policy in response to lower reimbursement rates and rising bad debt, as more uninsured and underinsured patients seek medical care in EDs. According to hospital officials, the fees have helped reduce ED overcrowding and encourage staff to make appropriate use of scarce resources. For example, after implementing a $150 upfront fee in 2009, Texas-based Midland Memorial Hospital has experienced a 10% drop in non-emergent ED visits (Galewitz, KHN/Post, 2/18).
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