One evening in February 2017, Joseph, Sarah Dudley’s husband, began to feel sick.
He had a high fever, head and body aches, and seemed confused. Go to a hospital emergency room or an urgent care clinic near your home in Des Moines, Iowa.
“The ER takes five, six, seven hours to see a doctor, depending on how many people are there,” Sarah said. I know I can see a doctor at
At the clinic, a doctor’s assistant misdiagnosed Joseph with the flu, according to court filings. his condition worsened. A few days later, he was hospitalized with bacterial meningitis and fell into a medically-induced coma. He has had multiple strokes, lost hearing in one ear, and now has problems processing his information. The Dudleys filed a lawsuit over the error, and a jury ruled him $27 million, but the defendants asked for a new trial.
Their stories reflect challenges in America’s healthcare system. Injured and ill people are asked to carefully decide which medical facility is the best place to seek help in moments of stress. must be
Landing with the wrong settings can lead to unexpectedly high medical bills and increased frustration. Patients often do not understand the types of services offered or the level of care needed in different settings, and uninformed choices are a ‘recipe for bad outcomes’.Rights nonprofit.
“We created this labyrinthine healthcare system that works to maximize profits,” said Donovan. “It does it by creating an obscure system that’s hard to navigate. It’s always pushing more costs to the patient.”
But revenue-driven, risk-averse operators of sites that serve as alternatives to hospital emergency rooms have little incentive to make the process easier for patients.
“We live in a reimbursement world, so the more patients we see, the more money we make,” said Vivian Ho, a health economist at Rice University. If you open one of your facilities, even if it’s non-profit, you need to make an income.”
According to the Emergency Medicine Association, the number of emergency medicine clinics in the United States will grow by about 8% each year from 2018 to 2021. However, the level of services and care provided varies greatly between clinics. In its current strategic plan, the industry group says it is working to help a wider audience understand what is considered emergency care.
Concentra, which operates emergency clinics in the eastern and central United States, advertises that it can treat allergies, minor injuries, colds and flu. CareNow, another major emergency care player, says its clinics can treat similar problems, but services may vary by location. Some clinics offer labs and his x-rays, according to the American Academy of Urgent Care Medicine. Others have “more advanced diagnostic equipment.”
Urgent care clinics can provide quick access to cheap treatment, Ho said. Independent emergency departments, on the other hand, tend to charge significantly higher rates for similar services, she said.
Independent emergency departments are becoming increasingly common, but data on their exact numbers are unknown. Some are owned by hospitals, others are independent. Some are open 24/7, some are not. Often staffed by physicians trained in emergency medicine, they often provide trauma services or perform surgeries on-site despite imposing large bills on patients. i don’t have a room
According to Dr. Ateev Mehrotra, a professor of health policy at Harvard Medical School, patients didn’t always have many options. Despite all the options, the healthcare industry tends to direct patients to the most expensive and highest level of care, he said.
“If you call your family doctor while you’re waiting, what would you probably hear? ‘If this is a life-threatening emergency, call 911,'” Mehrotra said. “Risk aversion is always pushing people to the emergency department.”
Federal law requires emergency departments of hospitals participating in Medicare to treat people who show up. or to prevent transfers of patients eligible for Medicaid to other facilities before they have been stabilized.
But the lack of clear guidelines for enforcing the law may prevent emergency department doctors from directing patients to better facilities, doctors said. The law does not apply to emergency clinics and does not consistently apply to independent emergency departments.
Ryan Stanton, M.D., an emergency physician in Lexington, Kentucky, said the law is making hospital-based ER doctors nervous. We are concerned that EMTALA may be violated by those wishing to refer patients to lower-level care settings when appropriate.
“It’s there to protect consumers,” Stanton said. “But it has downstream implications, such as: There are some things I want to tell you, but federal law says I can’t.”
Stanton updated EMTALA to allow hospital emergency room physicians to ask patients about the level of care they need and whether the ER is the best and most affordable place to receive them. said they could be more open to
The Centers for Medicare and Medicaid Services, the federal agency that enforces the law, said it was open to working with hospitals on how to communicate with patients, but did not elaborate on specific initiatives.
Efforts to educate patients before seeking treatment do not always clear up confusion.
Take MedExpress for the emergency care chain, for example. MedExpress provides a list of conditions to treat and a guide to when to seek more intensive care.
Karolina Levesque, a nurse practitioner at MedExpress in Kingston, Pennsylvania, said she still sees patients with serious health warning signs, such as chest pain, that require referral to the emergency room. Even those patients get frustrated when they are sent to another location.
“Some patients will say, ‘I want my copay back, you didn’t do anything for me,'” Dr. Levesque said.
Some patients, like Edith Eastman of Decatur, Georgia, say they appreciate when their providers recognize their limitations. When she got the call that she had injured her throat, her first thought was to take 13-year-old Maia to an urgent care center.
A local clinic was treating Maia when she broke her arm earlier. Instead, worried that the fracture was more complicated, they referred Maia to the emergency room and charged $35 for the visit.
“Emergency care said, ‘Look, this is beyond our pay scale.’ We didn’t just patch it up and send it home,” Eastman said.
All parts of the health care system need to play a role in clearing up chaos, proponents say. Insurers can better educate their policyholders. Urgent care clinics and separate emergency rooms can be more transparent about the types of services they provide. Patients can better educate themselves to make more empowered decisions.
Otherwise, the solutions will be piecemeal – like a short-lived advertising campaign run by BayCare, which operates hospitals and emergency care centers around Tampa, Florida. The patient education initiative launched in 2019 has spread rapidly.
“I have the flu. Urgent care. I have the plague. Urgent care,” read one ad.
Helping patients self-triage means BayCare can reserve more expensive ER resources for patients who really need them, said Ed Rafalski, chief strategy and marketing officer for the system.
But in other hospitals, competition is the only other player entering the market, he said.
“If you have an independent emergency care facility open across the street from the ER, you lose a certain part of your business just by the fact that it’s there,” he said.
Donovan, a patient advocate, said such thinking perpetuates confusion and is ultimately harmful to patients.
“If you break your leg, it’s not reasonable to say, ‘Did you google if emergency care or ER is right for you?’ No, you just need to get treatment ASAP.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.
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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.
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