ED's nonemergent patients must pay first or be referred
ED's nonemergent patients must pay first or be referred
New policy opens up 50 new 'slots' per week
Under a new policy instituted in May 2008, patients in the ED at Metro Health Medical Center in Cleveland who have minor ailments must now pay part of their bill before being treated or be referred to one of MetroHealth's 16 clinics in the area. They are guaranteed an appointment within 72 hours.
Already, this policy has made a big difference at the overburdened ED. "What we hoped to achieve by getting these patients to a primary care provider was to create capacity for patients who might have a medical emergency, and we do have about 50 more slots available per week," says Charles L. Emerman, MD, chairman of MetroHealth's department of emergency medicine. "Obviously, some costs will be avoided as well in terms of supplies [not used] and staff time."
What's more, the patients like the new system, too, says Karen Smith, RN, MSN, the ED's director of nursing. "During the first 30 days we followed anyone we referred out," she notes. "We had a greater than 35% response, and they were very pleased with the new process."
Most patients, she adds, receive a follow-up appointment within 24 hours.
When a patient presents in the waiting room, he or she is greeted by a medic at the desk window. He or she then is triaged by an RN who is specially trained in conducting medical screening exams. If he or she has one of 15 conditions spelled out in the department protocols, and if he or she has a high-risk feature, he or she goes to the ED. (For example, if a patient presents with a primary complaint of vaginal discharge but also has abdominal pain, the abdominal pain would be considered a high-risk feature.) If not, the patient goes to the registration desk, and the clerk determines if he or she has insurance. (See the list of conditions, below.)
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"If they have insurance, they are asked for their co-pay," says Smith. "If not, they are asked to pay a point-of-service payment of $75, or they are given the option of having an appointment in one of our clinics." The ED, she adds, is directly connected to the clinics' electronic scheduling system.
In the past, notes Emerman, all such patients would have been seen in the ED.
The ED staff, says Smith, are "very pleased" with this new policy. "Our sicker patients are cared for the way they should be," she notes. Smith says the ED is trying to educate the community, along with primary care physicians, about this new policy for patients with minor complaints or who need prescriptions refilled. "We have printed out cards for the patients. On one side is a list of [medical] resources in the county, and on the other is a list of where they can get prescriptions filled," she explains.
The cards, which are given directly to the patient, also tell the patient what to expect in the triage process and what typical wait times are. If patients live outside the county, they are given a special card for the county in which they live that tells where they can get free medical care and inexpensive prescriptions.
To help spread the word about the program, the hospital CEO went to the mayor's office and discussed it with public officials. Hospital representatives also made themselves available for media interviews.
Under a new policy instituted in May 2008, patients in the ED at Metro Health Medical Center in Cleveland who have minor ailments must now pay part of their bill before being treated or be referred to one of MetroHealth's 16 clinics in the area. They are guaranteed an appointment within 72 hours.Subscribe Now for Access
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