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Hospital's plan — a bridge too far?
While it's true that many hospitals and EDs have instituted policies that seek to encourage nonurgent patients to find other medical "homes," the policy recently adopted at the University of Chicago Medical Center goes a bit farther than most, says Sandra Schneider, MD, vice president of the American College of Emergency Physicians.
"Many hospitals are doing something similar, but perhaps not as overt or as obvious," says Schneider, who also is a professor of emergency medicine at the University of Rochester (NY) and an attending ED physician at Strong Memorial Hospital in Rochester. "Many, for example, will choose to admit patients who have surgical needs to the OR over those from the ED, if there is one bed left in the hospital." She also has seen hospitals continue to take transfer patients even when the facility is full and patients are waiting in the ED, "because transfers usually pay better, have insurance more often, and have more complex issues," Schneider says.
Where the University of Chicago was a bit more overt about it, she asserts, is they began to shrink beds available to patients and the size of the ED, "which artificially reduces your ability to take in patients who cannot pay. It's one way to make sure you do not get those types of patients." What's more, such an approach is based on a misconception, says Michael Frank, MD, JD, FACEP, FCLM, general counsel and director of risk management for Emergency Medicine Physicians Management Group, in Canton, OH. "Editorial in the Chicago Tribune to support this policy cited average costs of $1,200 for an ED visit to demonstrate that the hospital can't afford nonurgent visits," he notes. "That may be what they charge, but that's not what the visit costs the hospital."
Hospitals, he notes, have many fixed costs, including utilities and salaries. "What it costs to treat someone with a sore throat is trivial," Frank says. "If you divert that patient, you may save $20, not $1,200."