opinion

ED a safety net that patients should understand better

LETTER — Posted Jan. 21, 2013

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Regarding “New ED drama? Hospitals demand upfront fee for nonemergencies” (Article, Dec. 3, 2012):

If there are alternative places for nonemergent care, I am strongly in favor of redirecting nonemergent care to a more cost-effective location. I mention this because large numbers of reported “urgent” conditions actually do not require ED treatment.

Our current practice of acting like an urgent care or drop-in clinic was historically motivated not by need but by hospital and physicians’ profits. Our system has neglected to develop the primary care capacity needed in our country, and ED physicians now wonder if we have not contributed by our willingness to take all comers. We all know we like this work for the trauma and the high acuity but have to face the fact that much of the minor work is what pays the bills. We pat ourselves on the back and take pride in being part of the “safety net.”

Acuities are increasing and are likely to go up even more as reimbursements decline and the population ages — it will help our patients to start planning. Being a “safety net” does not require ignoring our obligation to educate patients and save them some of their or the government’s health care dollars if possible.

I have practiced emergency medicine for nearly 30 years and remember when COBRA was passed, containing the Emergency Medical Treatment and Active Labor Act. We realized then that it might require “slave labor” on the part of the nation’s emergency physicians, but then it seemed the moral high ground.

We all need to take a second look at what this statute is really costing our system. Costs for uncompensated care are shifted elsewhere, accelerating overall cost growth. Who has even heard of a “private hospital” anymore? They were the target.

EMTALA may be archaic, another example of our government inadvertently facilitating irresponsibility on the part of our citizens. This is particularly timely with Obamacare and the current resistance to the individual mandate. Choosing to be uninsured is only a real choice when we let uninsured motorcyclists die on the side of the road.

Jeffrey B. Stieglitz, MD, Firth, Idaho

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story