ED a safety net that patients should understand better

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