Next time you go to an emergency room, you should be prepared for this: If your problem isn't urgent, you may have to pay up front.
Last year, about 80,000 emergency-room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency. Under federal law, hospitals with emergency rooms must treat all comers, but the care isn't free.
HCA officials declined to say which of its hospitals use the practice, but the company owns more than 160 hospitals in 20 states. In the Tampa Bay area, it owns hospitals in Pinellas, Hillsborough, Pasco, Hernando and Manatee counties. Led by HCA, a growing number of hospitals have implemented the pay-first policy to divert patients with routine illnesses from the ER after they undergo a federally required screening. At least half of all hospitals nationwide now charge up-front ER fees, said Rick Gundling, vice president of the Healthcare Financial Management Association, which represents health care finance executives.
"It has been a successful part of helping to reduce crowding in emergency rooms and to encourage appropriate use of scarce resources," HCA spokesman Ed Fishbough said. The HCA payment policy excludes children 5 and younger, pregnant women and those 65 and older.
But emergency-room doctors and patient advocates blast the policy as potentially harmful to patients.
Kim Bailey, research director for the consumer group Families USA, said the tactic lets hospitals turn away uninsured patients who often fail to pay their bills and are a drag on profits.
Physicians worry that sick people who do not have private physicians will forgo treatment.
"This is a real problem," said David Seaberg, president of the American College of Emergency Physicians, who estimated that 2 to 7 percent of patients screened in ERs and found not to have serious problems are admitted to hospitals within 24 hours.
"After you've done the medical screening, it makes little sense to not go ahead and write a patient a prescription," said Michael Zappa, a Boca Raton hospital consultant and former president of the Florida College of Emergency Physicians.
"It seems the point of the policy is to put a financial barrier between the patient and care," said Anthony Wright, executive director of Health Access California, a consumer advocacy group,
The U.S. Centers for Disease Control and Prevention says that about 8 percent of ER visits are for non-urgent problems that could be treated less expensively in a doctor's office or clinic; others put figure much higher. A 2010 Health Affairs study found that 27 percent of those visiting ERs could be treated more cost-effectively at doctors' offices or clinics.
Florida legislators are considering joining states that limit Medicaid reimbursements for non-urgent ER visits.