One evening in February 2017, Joseph, Sarah Dudley’s husband, began to feel sick.
He had a high fever, head and body aches, and seemed confused. Go to a hospital emergency room or an urgent care clinic near your home in Des Moines, Iowa.
“The ER takes five, six, seven hours to see a doctor, depending on how many people are there,” Sarah said. I know I can see a doctor at
At the clinic, a doctor’s assistant misdiagnosed Joseph with the flu, according to court filings. his condition worsened. A few days later, he was hospitalized with bacterial meningitis and fell into a medically-induced coma. He has had multiple strokes, lost hearing in one ear, and now has problems processing his information. The Dudleys sued over the error, and a jury ruled him $27 million, but the defendants asked for a new trial.
Their stories reflect challenges in America’s healthcare system. Injured and ill people are asked to carefully decide which medical facility is the best place to seek help in moments of stress. must be
Landing with the wrong settings can lead to unexpectedly high medical bills and increased frustration. Patients often do not understand the types of services different settings offer or the level of care needed, and uninformed choices are a ‘recipe for bad outcomes’. Kaitlyn DonovanSenior Director of the National Patient Advocacy Foundation, a patient rights non-profit organization.
“We created this labyrinthine healthcare system that works to maximize profits,” said Donovan. “It does it by creating an obscure system that’s hard to navigate. It’s always pushing more costs to the patient.”
But revenue-driven, risk-averse operators of sites that serve as alternatives to hospital emergency rooms have little incentive to make the process easier for patients.
“We live in a world of paid services, so the more patients we see, the more money we make. Vivian Ho, a health economist at Rice University. “If you open one of these facilities, even if it’s not for profit, you have to get an income.”
According to the Emergency Medicine Association, the number of emergency medicine clinics in the United States will grow by about 8% each year from 2018 to 2021. However, the level of services and care provided varies greatly between clinics. In the current strategic planthe industry group says it is working to help more viewers understand what is considered emergency care.
Concentraoperates emergency care clinics in the eastern and central United States and advertises its ability to treat allergies, minor injuries, colds and flu. Keanowanother major emergency care player, says its clinic can treat similar problems, but services may vary by location. According to the American College of Emergency Medicine, some clinics offer labs and x-rays. Others have “more advanced diagnostic equipment.”
Urgent care clinics can provide quick access to cheap treatment, Ho said. Meanwhile, independent emergency departments tend to charge significantly higher fees Of similar services, she said.
independent emergency department increasingly common, although the data on the exact number are ambiguous. Some are owned by hospitals, others are independent. Some are open 24/7, some are not. Often staffed by doctors trained in emergency medicine, Many do not offer trauma services and do not have operating rooms on site, like them Saddle the patient with high bills.
Patients didn’t always have many options, he said. Dr. Ative Melotra, Professor of Health Policy at Harvard Medical School. Despite all the options, the healthcare industry tends to direct patients to the most expensive and highest level of care, he said.
“If you call your family doctor while you’re waiting, what would you probably hear? ‘If this is a life-threatening emergency, call 911,'” Mehrotra said. “Risk aversion is always pushing people to the emergency department.”
Federal law requires emergency departments of hospitals participating in Medicare to treat people who show up. Known as EMTALAwas created in 1986 to prevent hospitals from transferring uninsured or Medicaid-eligible patients to other facilities before they were stabilized.
But the lack of clear guidelines for enforcing the law may prevent emergency department doctors from directing patients to better facilities, doctors said. The law does not apply to emergency clinics and does not consistently apply to independent emergency departments.
Law says it worries hospital-based ER doctors Dr. Ryan Stanton, an emergency physician in Lexington, Kentucky. We are concerned that EMTALA may be violated by those wishing to refer patients to lower-level care settings when appropriate.
“It’s about protecting consumers,” Stanton said. “But it has downstream implications, such as: There are some things I want to tell you, but federal law says I can’t.”
Stanton updated EMTALA to allow hospital emergency room physicians to ask patients about the level of care they need and whether the ER is the best and most affordable place to receive them. said they could be more open to
The Centers for Medicare and Medicaid Services, the federal agency that enforces the law, said it was open to working with hospitals on how to communicate with patients, but did not elaborate on specific initiatives.
Efforts to educate patients before seeking treatment do not always clear up confusion.
For example, consider the emergency care chain med expresswhich provides a list of states it handles, and A guide to when to go to intensive care.
Karolina Levesque, a nurse practitioner at MedExpress in Kingston, Pennsylvania, said she still sees patients with serious health warning signs, such as chest pain, that require referral to the emergency room. Even those patients get frustrated when they are sent to another location.
“Some patients will say, ‘I want my copay back, you didn’t do anything for me,'” Dr. Levesque said.
Some patients, like Edith Eastman of Decatur, Georgia, say they appreciate when health care providers recognize their limitations. When she got the call that she had injured her throat, her first thought was to take 13-year-old Maia to an urgent care center.
A local clinic was treating Maia when she broke her arm earlier. Instead, worried that the fracture was more complicated, they referred Maia to the emergency room and charged $35 for the visit.
“Emergency care said, ‘Look, this is beyond our pay scale.’ We didn’t just patch it up and send it home,” Eastman said.
All parts of the health care system need to play a role in clearing up chaos, proponents say. Insurers can better educate their policyholders. Urgent care clinics and separate emergency rooms can be more transparent about the types of services they provide. Patients can better educate themselves to make more empowered decisions.
Otherwise the solution will be piecemeal, like a short-lived advertising campaign Operated by Baycare, operates hospitals and emergency care centers around Tampa, Florida. Efforts to educate patients launched in 2019 I caught a virus.
“I have the flu. Urgent care. I have the plague. Urgent care,” read one ad.
Helping patients self-triage means BayCare can reserve more expensive ER resources for patients who really need them, said Ed Rafalski, chief strategy and marketing officer for the system.
But in other hospitals, competition is the only other player entering the market, he said.
“If you have an independent emergency care facility open across the street from the ER, you lose a certain part of your business just by the fact that it’s there,” he said.
Donovan, a patient advocate, said such thinking perpetuates confusion and is ultimately harmful to patients.
“If you break your leg, it’s not reasonable to say, ‘Did you google if emergency care or ER is right for you?’ No, you just need to get treatment ASAP.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.
You can republish this story for free (detail).
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.
apply To KHN’s free morning briefing.
