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Editorial: ER costs inspire a letter of frustration

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Posted on April 26, 2018 |
By Angelo Lynn



In today’s Addison Independent, Mr. Kris Diehl of Astoria, N.Y., pens an interesting letter that might be familiar to any of us who have visited the Emergency Room of a hospital seeking medical help. In his case, Mr. Diehl is outraged by charges he received from the ER at UVMHN/Porter Hospital for what was a minor concern: a tick bite.

In reading Mr. Diehl’s letter, the casual reader would be outraged as well, and perhaps indignant by the way Porter staff initially handled Mr. Diehl’s queries. (If you haven’t yet read it, take the time to do so now.) When Mr. Diehl asked whether he should even be there for something as minor as a tick bite, why didn’t the person at the desk refer him to Porter ExpressCare on the other side of the hospital building, for example, potentially saving him hundreds of dollars. And surely for a 5-minute conversation (OK, give or take a few minutes, but we get the point) with the ER doctor on call, and a modest prescription, the cost might be less that $655.56!

Turns out there are reasons for Porter’s seemingly unhelpful initial responses.

Back in 1986, a federal law was passed call EMTALA, which stands for the Emergency Medical Treatment and Labor Act. The law requires “anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.” It was and has always been an unfunded mandate; that is, if the person doesn’t have insurance or the ability to pay, the hospital eats the costs of service. The law is written in such a way as to prevent hospitals from turning away patients and sending them elsewhere — perhaps a lower-performance clinic down the road or the next county over.

Now, it’s unlikely a hospital in Vermont (let alone Porter) would ever turn a patient away from service. That’s just not the Vermont way. But take a hospital in the Deep South in 1986 when faced with providing service to a person of color or issues of gender identity or sexual preference or perhaps a homeless person, and it’s not difficult to understand why the law was written in strict terms. The law was also “referred to as the ‘anti-dumping’ law,” according to the American College of Emergency Physicians, which notes the law “was designed to prevent (private) hospitals from transferring uninsured or Medicaid patients to public hospitals without, at a minimum, providing a medical screening examination to ensure they were stable for transfer.”

The law’s terms, in fact, make it touchy for hospital staff to respond to a patient who has entered the ER for treatment in any way other than to encourage treatment. For an ER staff person at the front desk to suggest a prospective patient go elsewhere opens the hospital to liability if that patient then is either not treated or gets inferior treatment and becomes sicker because of it. Similarly, it’s next to impossible for the front desk staffer to be able to estimate cost of treatment before a medical examination, simply because the extent of any treatment is unknown at that point. It is an unfortunate Catch-22; kind of a damned-if-you-do, damned-if-you-don’t conundrum.

And the law itself is another example of the unintended consequences of well-intentioned legislation.

The burden, then, is for prospective patients to know the options available before making a visit to the hospital’s ER. I asked Porter Hospital officials about all this, and they were sympathetic to Mr. Diehl’s frustration. A call to the hospital first, we’re told, could have better directed Mr. Diehl to Porter’s ExpressCare clinic. They are considering better signage at the ER to alert prospective patients to the clinic, and other ways to make that relatively new service better known.

Porter officials are also acutely aware of the high costs of ER care, and don’t disagree with Mr. Diehl that a better medical care system needs to be devised for the country.

As Mr. Diehl says: “My anger is not necessarily with UVMHN/Porter so much as with our atrocious system that forces patients and providers into such absurd circumstances. A proper socialized healthcare system cannot come soon enough to this country.”

On that, there are many who are in full agreement.

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