The Expensive ER

This beats the $700 Air Force toilet seat!

Some rural communities have a built-in healthcare expense for which there seems to be little hope for control. This is the cost of a visit to an ER (if the community has one) for non-emergent illnesses when all of the doctors' offices are closed.

Because of demand for the service in large communities and cities, urgent care facilities have sprung up to provide a "next-to-last" resort for patients with after-hours problems. These aren't exactly cheap - a visit to an "urgi-center" usually costs about twice as much as the same service in a physician's office. But it is certainly less expensive than the hospital ER. A general perception is that urgi-centers are not financially viable endeavors in small towns.

The idea for this column was generated by a patient's horror story concerning ER costs. This man, self insured up to $5000, had a bad cold and "sinus" trouble, and went to the ER on a weekend day. He was seen by a physician, examined briefly, and a medicine was prescribed. Passing through the business office on his way out, he was presented with a bill for (it's a good thing you're sitting down) $802. That's eight hundred and two dollars, in case you think there was a mistake in the numbers.

Now there's an interesting coda to this story. The patient complained during regular hours to the hospital's financial representative, and his bill was reduced by one-half!

Wait a minute! If the $802 bill was too high, why did he get it in the first place? And, if it was the "norm" for this service, why should it be cut in half? If the plan is to gouge people who happen to be able to pay, let's at the very least be consistent.

It must be assumed that similar stories are being played out in every community where there is an ER but no other after-hours care facility. Small town doctors used to "cover" the extra hours by telephone, house call, or by seeing a patient at the office. (If there were enough doctors, they took this late call in rotation.) There may still be small towns where this happens. But the pattern now is for most of the doctors to close their offices at roughly 5PM, and put a message on the phone answering machine that says: "If you have an emergency or need any care, dial 911 or go to the emergency room. Otherwise, we'll be open tomorrow at 9 AM. Good luck!"

We will not soon return to the good old days when your doc was available after hours because physicians are different now (they actually believe in a life after medicine). They may also be afraid of going out alone at night to see someone they don't really know very well. And, there is the malpractice threat. Lawsuits are more likely to be generated by urgent care than by that which is provided in a nicely run office.

Small town hospital ERs are money losers. There isn't enough business for them to make it, even by charging big amounts for their services. They exist primarily because they evolved and somehow managed to survive the general closure of the other parts of the hospital. Citizens in the community like the idea that an ER will be there for them when they really need it. They don't like the idea of dying due to some condition which could have been fixed in the good old ER. The truth is that if they're indeed sick enough to die perhaps, they really need to be in a bigger, fancier place. And, most of the time, even if they go first to the little guy, they end up being transferred to a larger facility.

The small community ER can be replaced with three things: 1. A good urgent care center. 2. Good ground ambulance service. 3. Rapidly available air-transport.

Then, outrageous bills for treating bad colds would be a thing of the past.