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Tuesday, February 15, 2011

rich ER, poor ER


Another "free standing ER" has open in our metro area. This one is owned by a hospital in the area but is not affiliated with this hospital. Another place opened in the last 6 months but it is only open 12 hours a day. This one will be open 24 hours a day.

I am fascinated by all of this. Is the move to a two tier medical system? These places are in the suburbs where people tend to have insurance. Because they are freestanding they are not subject to EMTALA regulations, in other words they can refuse to see you or they can make you pay up front. These places make more money than the other ERs because insurance pays more than medicaid/medicare.

The thing is if this is the future of emergency medicine, will hospital ERs become the place for the poor to get care and the free standing places for those with insurance?

Shouldn't these kind of developments be a sign to legislators that EMTALA needs to be revamped?

5 comments:

soontobe said...

great point!! I work in an ED and like many others a huge percentage of our clientle are the poor - which from the aspect of care means nothing - all treated equal. However from the financial stand point those stand alone centers will be wildly more finacially successful since they can say "no insurance? no help for you!" EMTALA needs to be looked at for those centers also. If someone is there, for what they deem emergent care they should not be refused.

Rachedy said...

The name is confusing. Around here we have a lot of walk in clinics that only take cash or insurance. They can do minor stuff but will call an ambulance for big stuff. What makes these stand alone ED's any different than that?

GB, RN said...

I figured that medical care would come to this. This article describes it perfectly: http://www.msnbc.msn.com/id/33863680/ns/health-health_care/

Hell, I even got to experience the two-tiered mentality myself when I had knee surgery. I worked at a particular hospital, which is where my orthopod practiced out of. He, and a bunch of other ortho docs opened up their own specialty hospital in town. So, he still worked at both. When I had my procedure, I mentioned that I wanted it done at my hospital (knew the staff, liked them a lot). He opted to do my procedure at his specialty hospital. It turned out okay, but I later realized that he did this because his hospital skimmed the patients with the best insurance. Everyone else had to go the main hospital for their procedures.

I think they are called Boutique Hospitals, and they are here to stay. I personally don't like the idea of being in one specialized area, and having something go wrong that they don't know how to manage.

Nurse K said...

I teased Scalpel about this back in the day (remember Scalpel?). A "freestanding ER" is really a 24-hour urgent care in my humble opinion. The urgent care attached to my clinic fixed my kid's broken arm, sewed a lac, etc. If I'd have walked in with SOB and chest pain, they'd just put in an IV, give me oxygen, and call 9-1-1, same as the freestanding ER.

Anonymous said...

There is a hugh difference in a Stand alone Emergency Room and a Urgent Care center. First of all, the ER's have Board Certified Physicians and experienced ER nurses.Your Urgent care cinics are ran by generalist. ER Physicians set fractures, repair complex lacerations,determine whether or not chest pain is a STEMI or NSTEMI, as most patients with chest pain are sent home,for out patient follow-up. You get what you pay for! I bet your FP or specialist will not see you for free! Why should Emergency specialist not charge for the critical care they render? Dr.A