Re-routing ED patients: A recipe for trouble?


As you'll see in today's issue, the University of Chicago is taking some heat for allegedly discriminating against Medicaid patients in its ED. Specifically, the mother of a 12-year-old boy is telling the world that her pit-bull-savaged son got turned away for inpatient care because the hospital didn't like their Medicaid coverage.

This comes in the wake of U of C's recent announcement that it would begin turning away patients who weren't acutely ill and sending them to community clinics or neighboring hospitals, a move that it says is designed to help it focus on high-end care.

As readers of this publication know, U of Chicago's move is far from unusual. In fact, a steadily growing number of hospitals in markets around the country have instituted programs that connect patients with community clinics rather than treat them in overburdened EDs.

When done right, such programs can actually be beneficial for everyone concerned. After all, people with low-level illnesses or chronic conditions need a regular medical provider, not a stressed-out ED doc whose attention is on the critically ill and injured. And of course, the hospital needs to make sure its ED can fulfill its mission without keeping people waiting too long for care or boarding too many patients in the hallways.

That being said, it's easy to be suspicious of the U of C's motives, even if executives there aren't at fault. When you make a move that pushes largely the poor and uninsured out of your ED, however well-intended it might be, there are consequences that extend far beyond your doors. In this case, the hospital has effectively disenfranchised the many Medicaid patients in its neighborhood who have few other options nearby. Maybe that's how it has to be, but the impact of that decision can't be understated either.

The bottom line is that if your hospital is going to join the growing corps of facilities turning away less-ill patients, it would be smart to bear in mind that these decisions don't happen in a vacuum. You're almost certainly going to face a PR hit at first, and you're going to need to bend over backward to demonstrate that you're basing your decisions to treat or refer on carefully-chosen clinical standards. You'd also be well-advised to do some education and marketing outreach to assure patients that they're going to get what they need no matter where they get treated.

Otherwise, fairly or not, your facility will come off a ruthless provider going wallet biopsies on all comers. And that's the last thing you want in an era of accountability for charity care, transparency and major health reforms. Come off as the bad guy, and things will get ugly. - Anne

P.S.:  FierceHealthcare won't be published on Monday, February 16 in honor of President's Day. We look forward to seeing you again on Tuesday!

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