As chair of the ED at Mount Carmel St. Ann’s Hospital in Westerville, OH, Michael B. Weinstock, MD, manages all patient complaints involving ED care. He has noticed a recent uptick in complaints whereby a patient who receives a large bill calls to complain about the ED visit.

“It typically happens months later, which is a clue that billing has factored into their decision to submit a complaint,” says Weinstock, who also is an adjunct professor at The Ohio State University’s department of emergency medicine.

Frequently, the care was acceptable to the patient at the time of the ED visit.

“The patient didn’t complain until they received their bill,” Weinstock explains. “We are seeing that more and more.”

One reason is that many ED patients face higher deductibles or co-pays.

“Patients are more likely to complain about the bill if there was a misdiagnosis or delayed diagnosis,” Weinstock notes.

Weinstock is aware of at least one situation in which an ED bill likely triggered a malpractice lawsuit. The patient stopped breathing and died after receiving a dose of pain medication in an ED.

“It was questionable as to whether this is what caused the patient’s demise,” Weinstock says, noting that the patient’s family sued after receiving a bill from the ED, which included a charge for the dose of pain medication.

“Receiving a bill for medication that they thought might have killed their loved one certainly could have been the tipping point,” Weinstock offers.

In some cases, a family member is the one who calls the ED to complain after the patient receives a large bill. Sometimes he or she is unaware of what actually transpired during the ED visit.

“I tell them what actually happened in the ED, which sometimes differs from the version they were told by the patient,” Weinstock says.

Rarely will Weinstock agree to have the entire ED bill written off.

“If something got missed and the patient had to return, I may call and ask that that portion of the bill be forgiven,” he says.

However, in almost every case, he simply states that he is unable to address the financial aspects of the ED visit.

“I tell them, ‘I am not a billing or insurance expert. I am calling to discuss the medical care you received,’” Weinstock says.

Answer Questions

Weinstock encourages ED providers to inform risk managers if they’re aware of a patient’s or family’s dissatisfaction with ED care. In some cases, the patient or family is invited to the ED to discuss care openly so that all their questions can be addressed.

“We’ve had cases with bad outcomes that couldn’t have been prevented, but the family had all kinds of questions,” Weinstock says. “Why not address those with the family in a collegial way, before there is any threat of litigation?”

Typically, one would carry this out with a phone call, but sometimes a sit-down meeting occurs with the provider, risk management, nursing, and administration.

In Weinstock’s experience, there is no downside to such meetings. Patients appreciate ED providers making themselves available.

“They don’t look at it from the perspective of, ‘You’re trying to cover up malpractice,’” Weinstock explains. “We have done this several times, and it’s worked great each time.”

ED providers occasionally acknowledge that some things could have been done better. It may turn out that the patient or family decides to sue anyway.

“But giving them an explanation is not going to make it more likely for them to sue,” Weinstock warns.

SOURCE

  • Michael B. Weinstock, MD, Adjunct Professor, Department of Emergency Medicine, The Ohio State University College of Medicine/Chairman, Mt. Carmel St. Ann’s Emergency Department, Columbus, OH. Phone: (614) 507-6111. Email: mweinstock@ihainc.org.