We’ve all been there. Broken arm, asthma attack, allergic reaction, penny stuck up the nose. Visits to the emergency room usually mean long wait times to see a doctor, to get a diagnosis and, eventually, to be treated.
But what if you had to go there for anything that ailed you, like a cough or a toothache? Many uninsured, Medicaid and Medicare patients are doing just that.
In today’s health care industry, Medicaid and Medicare patients are having a hard time finding primary care doctors that will accept new patients, so they turn to the ER. It seems logical that with health care reform on the horizon, Medicaid and Medicare patients should have more access to primary care.
But Nancy Carswell, who is in charge of insurance billing at Lyndhurst OB-gyn in Winston Salem, said the Affordable Care Act will not fix these patients’ primary care problems.
Carswell said doctor’s offices already struggle with Medicaid and Medicare services due to substantial financial losses, even before 32 million new patients enter the system with the ACA.
A patient usually pays a small co-pay or a deductible to the doctor’s office, and then a fraction of the remaining cost (called a reimbursement) will be paid for by Medicaid or Medicare. For example, a Medicaid patient may pay $20 for a $100 doctor’s visit, and Medicaid may only be able to pay $60 of the remaining $80. So the doctor just lost $20.
She said some doctors won’t be able to stay afloat if they take on any more Medicare and Medicaid patients.“The expenses for the operation of a doctor’s office have increased, but these state-run programs (Medicare and Medicaid) are cutting the reimbursement owed to the physician for taking care of that patient,” Carswell said.
So if these patients can’t find a dentist to treat their toothache and they don’t have a family doctor to treat their cough, many think their only option is to go to the ER.
Dr. Zak Foy, an emergency room physician at Mission Hospitals in Asheville, said he sees this problem every day. “We’re very convenient for people. We are always open and we have to see everyone,” Foy said.
EMTALA is a law that requires every ER in America to give everyone who enters the ER for treatment a medical screening exam. So if someone comes in for something completely asinine, the hospital cannot turn him or her away. The patient’s ability to pay for medical services is irrelevant.
“A lot of patients come in knowing that they don’t intend to pay for that hospital visit,” Foy said. “There are frequent users, high users and then over-users. That’s an expense to the overall system, not an expense to them.”
If patients can’t pay out of pocket for health insurance or for a primary care visit, then they absolutely can’t pay for a hospital visit. “If you’re uninsured and need surgery, there’s no way they can pay a $150,000 hospital bill,” Foy said. “Sometimes we set them up on a payment plan that goes on forever, but most of the time the hospital doesn’t collect.”
Dr. Brian Goldstein, executive vice president and chief operating officer at UNC Hospitals, said that the hospital anticipates that it will not get paid for some of its ER services, and it takes that into account when creating its budget for the year.
Goldstein said there are two major things the hospital anticipates when it comes to the ER serving as primary care:
- Charity care or services that are provided to patients who qualify for financial assistance
- Services provided to patients who are ultimately unable to pay all or part of their hospital and doctor bills
These two services do not come cheap. “This year we did more than $300 million in uncompensated care,” Goldstein said. “That’s the difference between what care costs and what we get reimbursed for from Medicare, Medicaid, TriCare and those patients who are under- or un-insured.”
Goldstein said that regardless of a patient’s inability to pay, UNC Hospitals will continue to provide “high quality and compassionate care to people in need.”
Foy agreed, saying that he loves his job because he is able to treat anyone who walks in the door and never has to worry about costs. “I’m really happy that 30 million patients are going to have insurance that didn’t have it before,” Foy said. “They’ll probably have access to specialty care and many need it now.”
Some experts say that misuse of the ER will only increase with the ACA. Foy said that he is not worried about the ACA’s impact on the ER. “Even though they might use the Emergency Room more, hopefully their chronic conditions will be better managed and they’ll be healthier,” he said.
ER visits may be on the rise, but technology is making treatment more convenient for you. Several health care mobile apps have been created to help you find hospitals, check waiting times, find specialist doctors, and make you a first-aid guru. Below, we’ve shared a few apps that could make your health care experience more agreeable.
Test your knowledge of the Affordable Care Act
