Mercy's ER Policy Raises Concerns

In the first 11 days of Mercy Fort Smith’s new emergency room screening procedure, 120 nonemergency patients opted to go elsewhere for care rather than pay a $150 deposit to be treated at the hospital.

Mercy made the policy change on July 16 because emergency room patients were experiencing up to four-hour waits, said Dr. Matthew DuPree, medical director of the emergency department of Mercy Fort Smith. And patients could save hundreds of dollars in medical bills by going to an urgent care clinic or doctor’s office for treatment instead, he said. Nonemergency patients who have insurance pay their co-pay if they want to be seen in the emergency room.

The new policy, which other hospitals around the country and in Arkansas have implemented, is disturbing to Dr. David Seaberg, president of the American College of Emergency Physicians of Irving, Texas.

“No. 1, I think it’s bad for patient care,” he said. “No. 2, this is just purely financially motivated for hospitals.”

Federal law requires hospitals to perform a medical screening exam of people who come into the emergency room to make sure they don’t have a serious condition, Seaberg said. If the patient is deemed not to have an emergency, the hospital is not obligated or mandated to treat him.

Seaberg said that since a patient is seen by a doctor anyway for the screening, it doesn’t take much longer to write a prescription for antibiotics to treat a condition like an ear infection.

“The issue is, these people have nowhere else to go,” Seaberg said. He said the patient would probably just give up on getting treatment instead of traveling to a walk-in clinic and waiting again for treatment.

DuPree said the policy change wasn’t meant to dump sick patients. “The main thing there is, we were having sick people that were just waiting out in the lobby too long to get back into a room,” he said. “We can’t keep operating like this.”

Within the first 11 days of the new policy, the wait time has been slashed to 90 minutes and at the most two hours, DuPree said.

Previously, the wait was so long that patients were leaving without getting treated, he said. In some months, 10 percent of the patients left without seeing a doctor, he said.

“Just after two weeks, our left-without-being-seen [rate] is 4.6 percent,” DuPree said.

DuPree said it was too early to say how much money the policy would save the hospital. For its fiscal year that ended June 30, 2011, the hospital provided more than $8.9 million in uncompensated care, according to a May 1 report from Mercy. DuPree said most of the uncompensated care stemmed from the emergency room.

“We realize that it’s not a perfect system that fixes everything,” he said.

But it would be cheaper for the nonemergency patient to have a bill that’s around $50 from a walk-in clinic as opposed to one that’s $2,000 from an emergency room.

Mercy in Fort Smith sees about 52,000 patients a year in its emergency room.


Other Hospitals Do It

Paul Cunningham, senior vice president of the Arkansas Hospital Association, said the policy is what hospitals are supposed to do.

“If there is no true emergency then … hospitals have the option to treat that patient if they want,” Cunningham said. Medicaid had been working “for years” to get hospitals to refer nonemergency patients to primary care doctors, he said.

The other hospital in Fort Smith, Sparks Regional Medical Center, also has a similar policy in place, said Trevis Walker, a registered nurse and clinical manager of emergency services for the hospital.

Nonemergency patients without insurance have to pay a co-pay of $200 if they want to be treated at Sparks’ emergency room. The co-pay for those with insurance is $150.

Walker said the emergency room sees about 190 to 210 people a day and only four or five of them are regarded as nonemergency. “We are not trying to deter people from coming to the ER,” he said. “We’re just trying to make sure that they use the appropriate place.”