Some Finding No Room at the ER
Screening Out Non-Urgent Cases Stirs Controversy
By Ceci Connolly
Washington Post Staff Writer
“Under the new policy, University hospital demands partial payment up front from non–emergency patients who seek treatment in the ER. For some, including Medicare and Medicaid beneficiaries, the fee is a small cash co–payment; insurance pays the rest. For the uninsured, however, the charge can be a few hundred dollars—money many don’t have. So they leave, toting a list of low–cost clinics in the area.”
“It’s an incredibly mean, nasty time to be in medicine,” said Mark Earnest, a general internist at University and vice president of the Colorado Coalition for the Medically Underserved. “There is not a consensus on how we are going to take care of people, and the result is everybody having to worry about their own survival.”
“In 2002, U.S. hospitals provided $22.3 billion in uncompensated care, up from $18.5 billion in 1997, according to the most recent data from the American Hospital Association. In the past, hospitals have made up some of the deficit by charging insured patients higher fees, a cost–shifting trick that in medical circles is dubbed the Robin Hood model. But that money is disappearing, too.”
“The Emergency Medical Treatment and Active Labor Act, or EMTALA, leaves plenty of room for interpretation, especially on terms such as ’emergency’ and ’treat.’ Cancer may be a killer, for instance, but a cancerous lump in the breast is not, by law, an emergency. Furthermore, EMTALA requires only that the patient be stabilized.”
“In the ideal world, you would not want to do medical screening,” Paradis said. “But when the core mission is at risk, this is an acceptable tradeoff.”