LITTLE ROCK — A Fort Smith hospital has begun requiring nonemergency patients to pay $150 if they insist on being treated in the emergency room rather than accepting the hospital’s referral elsewhere for medical treatment.
Federal law requires hospitals to screen all patients who come to their emergency rooms, regardless of their medical conditions.
On July 16, Mercy Fort Smith began giving nonemergency patients in its emergency room two options: pay what it calls a $150 “deposit” to obtain treatment or take a referral to another hospital or clinic, spokesman Laura Keep said Wednesday morning.
“This is something that’s been done across the country to make emergency departments more efficient for patients in need of emergency care,” the hospital wrote Tuesday in an explanation of the policy change that took effect the day before.
Spokesmen for the American Hospital Association and the Arkansas Hospital Association said Wednesday that they have not noticed such a trend.
“I checked with the policy folks here, and this is not something the AHA tracks,” the national association’s representative, Carly Moore, wrote in an e-mail Wednesday morning.
Paul Cunningham of the Arkansas association said he knew of no organization implementing such a change among its 101 member hospitals.
“I haven’t heard of any wholesale turn that way,” Cunningham said Wednesday.
Under the Emergency Medical Treatment and Active Labor Act of 1986, hospitals cannot turn away anyone who comes through an emergency room door. As interpreted previously, hospitals must offer an “appropriate” medical screening examination as well as stabilization of all medical conditions. It is sometimes called the patient “anti-dumping” law.
In the years since the law was passed, hospitals across the country have said the law affects them financially, as they write off indigent care as a charity expense. Also, hospital operations are hindered when low-income and uninsured patients without a permanent primary-care doctor use emergency rooms for minor health issues such as colds and intermediate problems such as deep cuts.
In Arkansas, many hospital emergency rooms have created a nonemergency area, sometimes called an “urgent care” area, to separate patients whose lives are not in danger from those with life-threatening illnesses and injuries.
In doing so, it appeared hospitals weren’t making a distinction between emergency and nonemergency patients when it came to the federal law’s mandate.
In Tuesday’s written explanation from Mercy Fort Smith, the hospital touted the change as key to its promise of a 10-minute average wait time from arrival in the emergency room with chest pain to having “an EKG [electrocardiogram] completed and read by the physician.”
Starting July 16, patients who arrived in the Mercy hospital’s emergency room found a nurse waiting to triage them on a scale from 1 to 5, with the top three levels representing emergency patients and bottom two levels representing nonemergency patients.
The nonemergency patients then would see an advanced practitioner for a screening exam before being seen by a physician to make a final determination if the emergency room is the appropriate place to receive care.
“If no immediate care is needed, they will then meet with a counselor to discuss the best place to receive medical care,” the memo explains.
That’s when patients are offered a choice to pay $150 for care or be given a referral to another facility - an urgent-care clinic or a primary-care office.
Mercy said its urgent-care clinics can see patients for things like “simple cuts, puncture wounds or abscesses,” as well as for things like sprains, strains, fractures, cold or flu symptoms, ear pain, fever, urinary-tract infections, rashes, minor burns and insect bites.
The hospital also cautioned people not to use the urgent care clinics in instances where they truly need emergency care.
“Remember, urgent care is not a substitute for the emergency department,” Mercy wrote. “If your symptoms are life-threatening, call 911 immediately.” Such symptoms include chest pain, fainting or loss of consciousness, severe abdominal cramps, head injuries or serious injuries from auto accidents.
Arkansas, Pages 9 on 07/23/2012