Overcrowding in Emergency Rooms is not really an indication of facilities making more money. Generally, people are coming to the ER because they do not have insurance and/or cannot afford regular healthcare at a doctors office or Urgent Care Center. Most people know that they are supposed to be able to walk into any Emergency Room in the country and be able to receive medical service without having to pay for it upfront. In some cases that is not true. Such as when they are discharged the patients should be asked to pay their ER Copay, a deposit on self-pays or make some kind of payment arrangements for the same. Eventually the patients will receive a bill for services if their insurance company does not pay for the whole bill and if the patient didn’t pay their portion before they left the facility. Some patients will actually contact the billing office to make payment arrangements or fill out a charity form, if they qualify, and that helps with the bottom line. However, a vast majority of self pay patients simply ignore their bills. What can be done to reduce this trend? We, as Emergency Room Registrar’s, Patient Account Reps or whatever you are called, can do about this? Nothing really. It is up to your managers and administrators to decide how or if they are going to curb this trend in their area. Because of the Federal EMTALA rules we are required to give a “Medical Assessment” of anyone who comes in or is brought in for a medical emergency. There is a debate as to what, exactly, constitutes a Medical Assessment. Some feel that only an emergency room doctor can assess a medical emergency. Since, the ER Doctor is usually not the first person the patient sees then the patient will be waiting their turn a while, depending on the diagnosis or symptoms, before they get that far and we can actually do our jobs. What can be done to reduce the wait-time and weed out true medical emergencies from those that can wait?

There are several strategies out there that are receiving some widespread approval and may cost a little more in the beginning but are actually helping the overcrowding of the ER, reducing bad debt to the hospital and increasing collections from patients up-front. Thus, making our jobs a little bit easier. One of them is having a “Qualified Medical Person” in the lobby area assessing patients as they come in to determine if they have a “True Medical Emergency” and should be seen as quickly as possible or are what is considered low priority and can be required to register and pay for their services prior to receiving them. EMTALA only really guarantees that they will be assess and if necessary, to prevent loss of life, limbs or serious bodily damage to be treated as quickly as possible. In other words if you go into an emergency room with a cough, cold, scraps, toothaches, or non-specific abdominal pain then you will have to make payment arrangements prior to seeing the doctor for a prescription and any expensive tests.

Should everyone have access to decent medical care? Absolutely! However, should you go to an expensive Emergency Room just because you have a cough, cold, scrap or bruise. No! Emergency Rooms are for those people who are having a true medical emergency and cannot wait for the doctor’s office to open up. What can you do if you don’t have medical insurance or the wherewithal to pay for medical services? Check the yellow pages for services available in your area. If there are none then check with your local government and see what they are doing about it. Get together with your friends and relatives and start a petition to have the county you live in to create a “Free Clinic” that is opened nights and weekends. If you know any medical personnel such as doctors, nurses, medical lab techs, etc ask them if they can volunteer a few hours a week to help out. Contact local businesses and ask them to donate a small portion each month or once a quarter to help fund the supplies and equipment needed. You can even contact all the local hospitals and ask them to help with supplies, money and personnel. Hey, it is in their best interests to have a FREE clinic to help reduce their bad debt, reduce overcrowding and even get some good press in the bargain! Your community has to pull together if you want solve this problem.

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