When it comes to ED costs, nobody wins


As we all know, things can get pretty tense in the emergency department, particularly for patients who come in because they have no health insurance and can't go anywhere else.

Given the price of emergency services, it's hardly surprising that patients blanch--and possibly even check themselves out--when they find out just how expensive their care will be. Apparently, that's just what happened in one unnamed ED, where a patient with a serious hand injury walked out when a surgeon candidly shared the estimated cost of care (about $10,000 to $20,000). It's worth noting that despite the likelihood that the patient would never pay up, the surgeon didn't deny the patient care, and didn't insist on any form of upfront payment either. He only gave the patient bad news--the truth.

Still, when the patient went to a different emergency room, that hospital didn't discuss fees, but rather told the man that he'd work things out with the facility later. Now it seems the first surgeon is facing costly EMTALA charges. The second hospital has accused that surgeon of committing an EMTALA violation, arguing that quoting prices constituted a "barrier" to care.

Wow. Talk about a no-win situation. The surgeon, who may have merely been of a literal turn of mind, simply answered a question with the facts--which, realistically, were probably more than a sick, frightened patient could handle. The man, who probably wasn't uninsured for his own jollies, did what he felt he had to do. Meanwhile, the other hospital most likely absorbed the bill, which wasn't great for them, of course.

I'm not sure there's a big lesson here, other than that in the world of uninsured, injured patients, pretty much nobody wins. Until there's a nationally-implemented, reliable source of funding for people without coverage--perhaps even just those with catastrophic needs--otherwise well-meaning people will continue to be caught in this bind.

I'd love to think that the next election will be change on this front, but honestly, I doubt it. What do you think the solution is here? Have you come up with any middle ground on this front? - Anne

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