Up front

Two hospital emergency rooms in Palm Beach County will start charging patients who visit the ER with non-emergency related illnesses. From today's Palm Beach Post-

Starting Tuesday, St. Lucie Medical Center in Port St. Lucie and JFK Medical Center in Atlantis will require ER patients with non-emergencies to either pay upfront for care or be directed to an outpatient health clinic.

"This is another step to deal with the overcrowding in the ER," said Jim Kruger, St. Lucie Medical's director of emergency services. "There's nothing worse than coming to the ER and having to wait a couple hours or more to be seen."

JFK CEO Gina Melby said she hoped the new policy would have a dramatic effect on the overcrowding of county ERs.

"Our goal with this initiative is to make sure those patients who are sickest get prompt medical care and those who do not have a medical emergency receive information on how to get more effective and less costly treatment," she said.

Critics worry the new weeding-out system won't fix the overcrowding problem; it will merely put doctors in the awkward position of turning away patients they are trained to help. Further, it might cause patients to hesitate to get help when they really do have an emergency.

About 12 percent of St. Lucie's patients would be affected by the new policy, which excludes children under 5 and seniors, Kruger said.

JFK and St. Lucie Medical are owned by HCA Inc., the nation's largest hospital chain, which is instituting the ER policy at several of its 189 U.S. hospitals. HCA's Lawnwood Regional Medical Center & Heart Institute in Fort Pierce plans to adopt the policy in December.

Doctors say patients come into ERs daily for routine matters such as prescription refills, scrapes, toothaches and mild sore throats. These problems clog the ER and run up costs, they say, because high overhead makes it the most expensive place to deliver care.

JFK and St. Lucie Medical will join a small but growing number of hospitals across the nation in trying to divert patients with non-emergencies.
*****

Nationwide, hospitals are reconsidering their legal and ethical obligations to treat everyone in the emergency room as the rolls of the uninsured rise and hospitals face more pressure to control costs.

St. Lucie and JFK say they meet their legal obligations because all patients will be
triaged by a nurse and their condition will be assessed by a physician. But if the doctor deems a patient's condition as not an emergency, the patient will be told to pay upfront for care or will be directed to an outpatient clinic.

For those without insurance, non-emergency patients will have to pay
$140 to be treated at St. Lucie Medical or JFK.

Dr. Jean Malecki, director of the Palm Beach County Health Department, which runs five health centers for low-income residents, said she had no problem with the new policy.

"Emergency rooms should be used for emergencies," she said.

But the approach has its detractors.

"I don't like it," said Dr. Michael Collins, director of the emergency department at Jupiter Medical Center. He said the policy may leave a doctor susceptible to a lawsuit if a turned-away patient is later found to be seriously ill.

"I don't want to be the doctor to look someone in the eye and say, 'I can't treat you unless you pay me,' " he said.

Ok before I get started, I have to disclose HCA is a former employer of mine.

I see several problems with this policy. The first of which is stated by Dr. Collins. While patients will get triaged and probably seen by a Physician Assistant, alot of the small problems they list are sometimes warning signs of much more serious problems. Does a ER want to take that risk if the patient can't afford to pay?

If you want proof of what can go wrong, read this. Eric Dolch is still in a coma a year later. Some of the symptoms mentioned in today's article can be signs of meningitis.

How strictly will a hospital enforce this? Doctors are more likely to err on the side of caution for fear of a malpractice lawsuit.

By the way, how much will the hospital charge? I can tell from past experience, how hospitals or medical facility can wrongly charge a patient. My wife had an MRI in April, JFK had my wife pay $130 upfront, but our portion of the bill came out to $70. The wife charged it, when I got notification of benefits I immediately called JFK's billing center only to get a run around. Then I called the local business office and had my credit card immediately refunded the difference.

I was lucky, because I paid by credit card. If you pay by cash or check, you'll wait and wait and wait..... for any reimbursement from the hospital. Trust me, been there and done that too with a medical provider.

Emergency rooms should be for emergencies or off hours medical help. The trouble is, not all emergencies can be immediately diagnosed. What do you think?

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