This ER in Atlanta is betting that you will.
Taking advantage of worsening patient wait times in emergency departments, the Emory Adventist Hospital is offering a “Hold my place in line” service.
For a fee of $24.99, patients are guaranteed to be see in 15 minutes or less – or the entire visit is free.
It seems to me like shrewd business, and the blatant beginning of tiered emergency service. However, WhiteCoat observes this may be a violation of EMTALA laws, which states that a screening exam needs to be performed in all patients in a non-discriminatory manner: “[It will] be interesting to see whether CMS jumps in if a patient who couldn’t afford the $25 co-pay had to sit longer at the back of the line and experienced a bad outcome.”
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{ 7 comments }
Wow! It will be interesting to see how it all works out establishing a hierarchy at the ER.
What do you bet there is an admission document that by paying acknowledges that they are not going to be seen in the hospital’s emergency department but that they are agreeing to be seen by a separate urgent care service. The would be in effect be voluntarily declining the E.D. service and with that all the EMTALA requirements.
Pay $24.95 for the privilege of being seen in the urgent care clinic within 15 minutes or be triaged and be seen whenever at the E.D.
It screens for those able to pay and allows the hospital to capture them before they leave due to the frustration of the wait. Chances are, if the patient has the $24.95 for express service, they also have insurance.
The last thing the hospital would want is to lose the paying patients who show up but are made to wait with less urgent complaints.
I don’t see the EMTALA issue, as long as they still perform the screening examination for those presenting to the department. EMTALA is not an entitlement to white-glove express service, nor is it a pass to an urgent care center, nor is it really an entitlement not to have to pay anything (except in practice, it so often becomes just that.)
As long as it is optional and does not replace screening, looks good.
I have to disagree with CHenry. It is an EMTALA issue if the fee grants quicker access to any portion of the ED ahead of another, even if it is the express side. So long as it is part of the ED in any way, EMTALA applies. You cannot triage an individual ahead of another based solely on ability to pay.
I think you will see some legal problems when someone ends up requiring more treatment than would have been necessary if they had been triaged by medical as opposed to financial criteria. If being forced to wait longer because someone paid extra leads to a medical complication, there will be a lawsuit that brings that Hospital down, and maybe all the way to bankruptcy. There is nothing people hate more than health care facilities or groups delivering a lower quality of care for purely financial gain.
EMTALA is an entitlement to be seen more quickly if you have a more serious or emergent medical problem.
As someone who has practiced EM, I personally have a problem with someone suffering for a longer period of time, only because another paid to jump ahead of them in line.
If someone wanted to go to an Urgent Care and not an ED, why wouldn’t they just go there in the first place and save the $25 extra fee
24.95 will most likely have you seen by a NP or PA at best, which will be considered as seen! I agree with CHenry’s comment whole heartedly.
If it’s a good idea or proves successful then it’ll be shot down by the bureaucrats. If it bombs (for customers) then the fee will help the income stream a bit.
Chuck Brooks
FutureWare SCG
Keith VanCuran, you might read my post before you disagree with it. If the patient declines the ED service and elects to pay the $24.95 for an alternative service, and it is voluntary, where do you think the violation lies? The ED isn’t refusing its obligations to screen. The patient isn’t being turned away. All the hospital is doing is offering those who are waiting an alternative to waiting under their triage system. If the ED waiting room is near empty, why would you want to pay? I wouldn’t. You probably will get seen just as quickly in the ED.
This is designed to keep the potential urgent care patient from becoming just that after leaving the hospital without being seen because of a perceived long wait for a lower-priority problem. Some people probably reconsider the decision to go to the ER in the first place once they arrive and see a crowd.
EMTALA is a horrible law. It is just forced charity. All these laws assume that hospitals and physicians are simply ‘there’ for government bureaucrats to have and control.
Who can blame hospitals for trying to maneuver outside of this system to actually work to create a solvent business!
If you want to have public hospitals, then have them, and accept transfers from private hospitals when the need arises.
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