The hospital edifice complex


My father-in-law had a lousy weekend. He couldn't pull himself out of bed, canceling our plans to take him out for his birthday. Then his field of vision constricted--very scary given his history of strokes. Paramedics were called, and I rushed over to meet them. My primary task was to make sure he wasn't taken to the closest hospital, a for-profit whose shortcomings I cannot describe using family-friendly vocabulary.

I was relieved to learn they were taking him to the best hospital nearby, a not-for-profit affiliated with a major religious order.

I've been to this hospital several times in the past. It had recently undergone a major rebuild. It now features a soaring lobby with wood paneling, chandeliers and a volunteer tickling a baby grand piano. The names of celebrities grace its cancer center and other wings. Gourmet food trucks pull into its parking court every day to fete employees.

But I had never visited the emergency room, which is located in the rear. I can only assume the planners built front to back and ran out of money or craftsmanship sometime before completion.

The ER waiting room was cramped, low-ceilinged and packed with potential patients and their families in various states of daze and distress. The color scheme was gray and off-white. A couple of vending machines and a tiny television were the only diversions, aside from a list of patient rights and responsibilities printed in microscopic print and posted on the wall.

Patients have the right to emergency medical care. They have the responsibility to be polite to hospital staff and not to interfere with facility operations. Nothing was posted about charity care policies, or the fact that even middle income families are eligible for a discount as part of an agreement reached years ago with the state's main hospital lobby. Based on my state's demographics, probably about a third of the people sitting in that room were going to have to pay their ER bill on their own, and at least half were looking at steep co-payments. I am certain I was the only one there who knew they could get a discount if they asked.

However, this is not a place where questions are encouraged. Whereas the lobby features a huge open-air desk, receptionists here sit behind thick glass. I had to raise my voice so they could hear me.

This seems to square with a recent NPR/Thomson-Reuters poll on price transparency. Only 16 percent of those polled said they had sought out price information, even though 80 percent of those polled or their family members had recently received a healthcare service. That's up from the 11 percent in the 2010 poll, but still a nominal figure.

A little more than 35 percent of the respondents said they obtained price information from a hospital, compared to 50 percent who obtained it at their doctor's office. Among those under the age of 35, less than 27 percent got pricing data from their hospital, down from nearly 39 percent in 2010.

I'm not questioning the quality of this particular hospital; it is one of the best facilities for miles around. But it is of a piece with many other hospitals I've visited over the past decade: Fancy edifice for a public entrance, but a rabbit warren ER entrance intended to suggest that those who enter have no bargaining power and shouldn't bother to ask for some. Whether that's by accident or design, hospital finance and other executives are going to have to rethink that particular layout.

My father-in-law is okay, by the way. He was told to consult an ophthalmologist.

And given the ever-growing number of people who lack insurance or who have huge out-of-pocket costs whenever they enter the ER, he may not be the only one in need of an eye doctor. - Ron (@FierceHealth)

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