How to reduce emergency room bills

How to reduce emergency room bills

If you had a health condition that required a trip to the emergency room, the last thing you should be thinking about are the medical expenses you will incur.

However, even if you have health insurance, you will likely end up with several substantial bills depending on the type of care you received. Emergency room receipts often contain charges that are either incorrect or excessive. If this is the case, it is important to dispute the bill or negotiate a reduction.

Know What’s In Your Medical Records

If you were a patient in the emergency room, you can only be charged for the treatment you actually received. While this may seem obvious, it often happens that patients are billed for treatment that was not rendered. The first step to take to dispute emergency room bills is to find out what is documented in your medical records.

Receiving different bills from various providers can make it even more confusing to figure out what you are being billed for. Most people think the doctor and hospital bills they receive are the same thing, but they’re not. The treating doctors in emergency rooms are usually subcontractors and will bill separately. The charges on these bills should be carefully compared with what is in your medical records – if you incur a charge for something that isn’t in your records you should dispute it immediately.

Although a hospital bill will be broken down by category, ie. blood work, drugs, supplies, etc., it will not delineate the services that added up to the total amount. In this case, it is necessary to request a detailed itemized bill that will show each and every line item expense. Compare this itemized bill with what is in your records so that you can determine if the bill is accurate.

Be Aware of Out-of-Network Charges

Even if the hospital you visit is in your insurance network, this doesn’t mean all the providers who treat you are. Treatment rendered by out-of-network doctors and specialists can result in unexpected costs for you.

In a medical emergency, you may have no choice other than to be treated at an emergency room where you might receive care from doctors who are out-of-network. However, if your condition is not a true medical emergency, you may consider visiting an urgent care facility first – this will cost you hundreds not thousands of dollars and can demonstrate to the insurance company that you attempted the least costly option and help with negotiating reductions if you end up in an emergency room.

Identify Mistakes in Your Emergency Room Receipt

Emergency room receipts can contain mistakes that result in additional costs to you. For example, the hospital may order tests and cancel them before they are performed. If the ordering physician forgets to take these tests out of your record, they can show up on a bill.

Mistakes in coding levels also commonly appear on emergency room bills. Emergency room bills are coded by levels 1-5, and each level has a different contracted fee. If the level of care you received doesn’t correspond with the code, the bill should be disputed.

Make Sure Your EOBs Correspond With Your Bills

After thoroughly reviewing your bills for accuracy, it is vital to compare them with the Explanation of Benefits (EOB) you receive from your insurance company. When comparing them, take a close look at:

(1) What you were charged

(2) What amount the insurance company allowed

(3) What the insurance company paid or didn’t pay for

Understanding an EOB is not easy. It is necessary to review every line carefully to make sure each amount and service matches that which appear on your bills. If there is a discrepancy, contact the hospital or insurance company for clarification. Additionally, although charges may sometimes get bundled together, it is important to make sure that an in-network provider isn’t “balance billing” you — this occurs when a provider bills for the difference between what they would normally charge and what is allowed by the insurance company.

If you are self-pay, always ask for a reduction. Some hospitals will reduce your bill by as much as 70%. You may also ask whether you qualify for financial assistance.

Contact an Experienced Medical Bill Dispute Advocate

Trying to make sense of complicated and excessive emergency room bills can be overwhelming. If you are trying to dispute emergency room bills, an experienced medical bill dispute advocate can help.

Systemedic is a nationally recognized medical billing advocacy company with decades of experience in helping victims of fraudulent and unethical medical billing practices. If you are experiencing an emergency room bill dispute, contact Systemedic today at (845) 639-0007.

An emergency room visit can cost plenty, even if you’re fully covered by insurance

If the need to go the emergency room suddenly arises, your first instinct is likely to be a phone call to 911—not to wonder how much an emergency room visit may cost you. And in an emergency, getting the right care, and getting it fast, should be the focus.

“If you’re having a heart attack, you’re not going to ask if the doctor treating you takes your insurance,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

But be aware: That potentially lifesaving trip to the emergency room may have a high price tag attached to it. A Kaiser-New York Times survey of insured and uninsured people who had difficulty paying medical bills found that ER bills accounted for the largest portion of what they owed.

Going to a hospital that takes your insurance may not prevent you from getting unexpected big bills. Here’s why: About two-thirds of emergency room doctors are independent contractors, who may not be in your insurance plan, according to the American College of Emergency Physicians. And any out-of-network doctor or laboratory may later bill you for whatever your insurance doesn’t cover, a practice called balance billing. “There can be a whole cast of providers involved, some you never even meet, who send you a bill,” says Pollitz.

In addition, if the ambulance company that transports you to the emergency room doesn’t take your insurance, your out-of-network costs could be over $2,000, depending on factors such as where you live and the level of care you receive before you get to the hospital. A breathing tube, for example, may bump up the price. And if your insurer doesn’t consider the ambulance ride essential, you may be on the hook for even more money

You can’t completely protect yourself from these kinds of surprising medical bills, and you never want to put cost concerns ahead of getting care during an emergency. But these strategies may help.

Has a trip to the ER cost you more than you expected?

Tell us in the comments section below.

Understand Your Insurance Policy

Ask your insurer for documentation on what the plan will and won’t cover if you need emergency care. (The insurer’s website or handbook may not be up to date). For example, get clarity on your ER copay and coinsurance and on what the plan will cover if you’re not admitted. Your insurer can also tell you which area hospitals take your insurance. You can then ask the billing department at your hospital of choice whether the ER doctors participate in your insurance plan.

And because most insurers cover medically necessary ambulance rides, know how your plan defines that—typically, it means you are unconscious, bleeding heavily, or in severe pain.


To find out more on what other states are doing and share your story, go to Consumer Reports’ End Surprise Medical Bills site.

Questions to Ask at the Hospital

When you call 911, a dispatcher will send the closest available ambulance, so there’s no way to know whether it will be in your insurance network. And though you can request a particular hospital, it’s the ambulance staff’s call—and usually they will choose the closest facility that’s properly equipped to treat you, says Scott Moore, President of EMS Resource Advisors and a consultant to the American Ambulance Association.

In certain situations, say you have a head trauma and need a CAT scan, you’ll go to the hospital that the paramedics know has the equipment you need for the appropriate treatment. “If I drive past a hospital, I better have a good reason that I went to another one farther away,” says Moore, who is also an EMT. If someone else calls an ambulance and you don’t need it, you typically won’t be billed unless you get transported, says Moore, though you may be charged for services provided on the scene.

Under the Affordable Care Act, if you need emergency care, your co-pay or co-insurance cannot be higher than your in-network rate, even at out-of-network hospitals. But the law doesn’t prevent out-of-network providers from billing you for the remainder after you’ve received care.

At the hospital, you or the family member or friend who ideally goes with you, will need to fill out admission forms. This is the time, if it’s possible, to request an in-network doctor or other service provider. At discharge, make sure you or your companion requests and keeps all paperwork, including an itemized printout of charges.

What to Do If You Get an Out-of-Network Bill

You’ll probably get separate bills from each out-of-network provider involved in your emergency room care. Pay nothing until you get explanation of benefits (EOB) statements from your insurer; these tell you what the plan has covered and what your portion may be. Then, compare bills and EOBs to make sure you received the services noted and have your insurer confirm that providers who sent bills are indeed not in your plan.

Then, work on getting those bills covered. Ask your insurer whether it’s willing to do so. You can also contact the healthcare providers who billed you and ask them to settle for what insurance has already paid them. “Some doctors will negotiate with you,” says Pat Palmer, founder and CEO of Medical Billing Advocates of America, based in Roanoke, Va. Your insurer may also negotiate with the doctor on your behalf if you request it.

If the insurer and healthcare providers won’t budge, file an appeal with your insurance company. To bolster your case, ask your primary care doctor or specialist for a letter stating that your ER treatment was medically necessary. The Patient Advocate Foundation offers guidance at no charge. Professional claims consultants will also help for a fee or percentage of the amount reimbursed. You can find claims consultants via the National Association of Healthcare Advocacy Consultants or the Alliance of Claims Assistance Professionals.

Finally, be aware that 23 states are working toward or already have some consumer protections against surprise medical bills. For example, in New York, these bills can now go through an independent dispute resolution process if the health plan and provider don’t agree on payment amount. To find out more on what other states are doing, how to file appeals at the state level and share your story, go to Consumer Reports’ End Surprise Medical Bills site.

Self-pay collections don’t have to cost your ED lost revenue. Learn how to work around the biggest obstacles to collect more from self-payers now:

Though the number of self-payers is on the rise, the cost to collect can be up to 3x higher than those paying with insurance.

And just like any balance, the longer these claims go unpaid, the lower your chances of actually collecting on them. That means your emergency medicine (EM) group will suffer from:

  • Longer accounts receivables (AR) days
  • Less working cash flow
  • Mounting bad debt
  • Crippling revenue losses

Self-pay collections will always be higher in the emergency department (ED) than other practices. So the key to winning them is learning how to work around the biggest obstacles to timely reimbursement.

Why Self-Pay Collections are Higher In Emergency Medicine

Understand what you’re up against and you can devise a strategy to overcome these issues:

More Patients on High Deductible Health Plans (HDHP)

According to recent stats, patient responsibility has jumped 29% as more consumers enroll in HDHPs[ * ]. Now self-payers are becoming the new norm.

The bad news is most Americans can’t afford to pay emergency medical bills as quickly as your practice needs the revenue.

Nearly 50% of Americans cannot afford a $400 emergency expense. And there’s been an almost 30% increase in both deductibles and out-of-pocket maximum costs since 2015.

Now, the average American has a deductible between $2,000 and $10,000. And the average out-of-pocket EM expenses total around $4,400.

With one in five working Americans with health insurance admitting they’re struggling to pay off their medical bills, it’s no wonder over 80% of EM practices name the slow payment of patients with high-deductibles their number one challenge.

But dirty claims aren’t too far behind.


More Dirty Claims

An ED isn’t the calm and structured waiting room of a primary physician’s office. Quick patient care tends to come before intake paperwork. And that’s why over half of patient demographic information is lost during an emergency visit.

Your intake team will need to rely on your patient’s friends or family for critical information if the patient is too distressed.

But having an incorrect address, phone number, social security number/Medicare Beneficiary Identifier (MBI), and insurance coverage mean dirty or incomplete claims.

And the fewer clean claims you submit, the more time your staff will spend reworking claims for reimbursement.

Unlike routine visits to a primary physician, sometimes an emergency visit won’t even be covered for the patient, causing them financial hardships which may delay your payment.

Underpayment Or Denial for Non-Emergency Visits

Recent controversial decisions to reduce emergency visits for non-emergent conditions by denying coverage mean your EM physicians may not be reimbursed fairly despite performing their high-level services.

Payers will down-code these claims if the patient’s presenting symptoms or diagnosis don’t qualify as a true emergency. They may even require patient medical records to review claims and approve payment, further delaying your revenue cycle.

A denial in coverage means your patients will be responsible for paying their entire medical bill.

But just because these situations make it more difficult to collect doesn’t mean you can’t improve your self-pay collections.

How to Improve Your Emergency Department Self-Pay Collections Process

Start by implementing these three tips:

#1. Engage Patients Early and Provide Transparency

ED staff often struggle with communicating patient payment accountability. So you’ll want to create a workflow with scripted questions and responses to tackle this situation on the front-end of your revenue cycle.

Rather than frame the experience as how the ED will be paid, have your staff approach patients with their best interests at heart. Alleviate their fears of being in the dark and overcharged by providing as much transparency as possible.

Have your intake staff well-rehearsed on

  • Anticipated financial obligations
  • Estimates for common tests, care, and treatments
  • FAQs about payment and financing options

By being upfront and honest, you’ll reduce patient anxiety and make patients more trusting. And when they understand the emergency medicine billing process, they’ll be much more likely to comply.

Aim to collect at least 50% or more before care even begins and you’ll be in excellent shape.

Providing patients with multiple ways to pay their bills is even better.

#2. Use Technology To Give Patients More Payment and Financing Options

Despite research showing healthcare payments made on phones and mobile devices is trending, only 20% of practices are able to accept payments other than cash, checks, or credit/debit cards.

So just like incorporating more telemedicine , try upgrading to:

Easy Online Bill Pay

More people prefer paying their bills online rather than in-person, by mail, or over the phone.

And stats from the first half of 2017 show[ * ]:

  • Over 60% of medical bills were paid online
  • 95% of patients would pay their medical bills online if they could
  • 71% of patients say mobile pay and billing alerts have improved their satisfaction

That’s why your ED should fall in line with these customer/patient preferences.

Create an intuitive, easy-to-use online portal where patients can:

  • View charges for services and treatment provided
  • See what their insurance has covered
  • Make payments anytime
  • Set up automatic, recurring payments

This will help patients anticipate their future payments and give them more control so their bills don’t fall through the cracks to collections.

This allows spouses, family members, friends, attorneys, and other individuals to pay a patient’s bills without accessing their medical records. This online bill pay option won’t require users to register with a username and password to make a payment.

Payment and Financing Plans

Patients are more likely to clear their debt if they can pay off a bit at a time rather than one lump sum — especially if they can manage their account online.

This is why many EDs have started to implement technology-focused, retail-like payment solutions for their practices.

And it’s also why others are deciding to outsource these new processes to the experts.

#3. Work With a Billing and Coding Partner

If your team follows the first two steps, you should start collecting more from self-pay patients before they ever receive their bill in the mail.

But they’ll most likely leave with a balance owed.

So to maximize revenue and manpower hours, small and large EDs work with a billing and coding partner who actively pursues self-pay collections and ensures the highest levels of collections.

Your team will no longer spend valuable time and resources leaving voicemails, emails, or letters for patients about paying their balance. And you’ll start collecting more.

How to reduce emergency room bills

Some medical charges are expenses that you can prepare for. Medical services like regularly scheduled checkups, vaccines, and dental cleanings rarely sneak up on us. However, some medical bills, like the one you might get for an ambulance ride to the hospital, can come as a huge surprise.

This surprise can also come as a shock to your finances. If you don’t have a hefty emergency fund sitting around for exactly this sort of situation, then you could end up in serious medical debt. Instead of drowning in hospital bills, figure out how to pay your ambulance bill or negotiate down to a price point that you can meet.

Table of Contents

How Much Does an Ambulance Cost?

Not all ambulance rides are created equal. When you’re taken to the hospital in an ambulance, your bill is the result of a few things:

  • The base cost for the ambulance’s time. This ambulance took the time to drive you to the hospital, taking out of its usual patrol routine and making it unavailable in case of another emergency.
  • The cost of services that you’re given onboard the ambulance. Just riding in the back of an ambulance is one thing, but many people need treatment of some sort in the ambulance. Drugs or other life support tools can jack the price up even higher.
  • The location of your medical emergency. Ambulance costs can vary widely from city to city. As it is with most things, your ambulance bill will probably be higher if you live in a big city.

Ultimately, there is no single cost that you can assign to an ambulance ride. However, a U.S. Government Accountability Office study found that ambulance rides across the United States could range from $224 to $2,204, with the median cost hovering around $429. No matter where you live or exactly what you get from an ambulance ride, one thing is clear: ambulance bills are not cheap.

Tips for Paying an Ambulance Bill

Do You Really Need an Ambulance?

If you don’t actually need an ambulance, it would be a shame to end up having to pay a three or four figure bill because of your mistake. The Thousand Island Emergency Rescue Service recommends this checklist to see if you should call an ambulance.

  • Are you (or is someone else) in immediate danger of losing your life?
  • Could your condition worsen on on your way to the hospital?
  • Could movement lead to additional complications or injuries?
  • Do you need skilled treatment immediately?
  • Would an ambulance ride be significantly faster than your other means of getting to the hospital?

Ask Your Insurance to Cover the Bill

Depending on your exact health insurance plan, you may be able to get help from your insurance company in covering an ambulance ride for emergency medical care. The important thing to note is the presence of an emergency threat. Going through the checklist from above will help you make your case to the insurance company to get their help with the bill. You should also check out your individual health insurance plan to see other stipulations and requirements on ambulance bill coverage.

How to Negotiate an Ambulance Bill

If your ambulance bill has arrived and you’re not getting the kind of help that you’d like from your insurance, then don’t fret. It may still be possible to negotiate for a lower ambulance bill that’s more within the range of what you are able to pay.

  • Make sure that you’ve been billed with the correct insurance codes. Like we said above, insurance companies will usually only cover emergency trips to the hospital in an ambulance. If the ambulance provider sends a bill with non-emergency codes, ask if they can change it so that your insurance can step in. You will be able to make a better case here if you can go through the checklist from above to explain why you were in an emergency situation.
  • Get an itemized bill and check for errors. Just like if you were disputing a medical bill, you should get an itemized bill from your ambulance provider. Double check to make sure that you actually received all of the services that you’re being charged for.
  • Try to settle at a lower amount. If you can’t pay the amount that you’re being charged, you may be able to convince the ambulance provider to go a little lower. They want to get paid, so try to find an amount that will satisfy the ambulance company and that you will be able to pay.
  • Negotiate a payment plan for your ambulance bill. As with most large bills, an ambulance bill doesn’t have to be paid all-at-once. Try to negotiate a payment plan with the ambulance provider that will leave you with smaller monthly charges that fit more easily into your budget.

An ambulance ride doesn’t have to destroy your financial health. Make sure that you really need an ambulance and be prepared to make the case for your emergency situation to your insurance provider. Once you have a bill, double check for any errors and negotiate it down to a price point that you can meet.

How to reduce emergency room bills

Some medical charges are expenses that you can prepare for. Medical services like regularly scheduled checkups, vaccines, and dental cleanings rarely sneak up on us. However, some medical bills, like the one you might get for an ambulance ride to the hospital, can come as a huge surprise.

This surprise can also come as a shock to your finances. If you don’t have a hefty emergency fund sitting around for exactly this sort of situation, then you could end up in serious medical debt. Instead of drowning in hospital bills, figure out how to pay your ambulance bill or negotiate down to a price point that you can meet.

Table of Contents

How Much Does an Ambulance Cost?

Not all ambulance rides are created equal. When you’re taken to the hospital in an ambulance, your bill is the result of a few things:

  • The base cost for the ambulance’s time. This ambulance took the time to drive you to the hospital, taking out of its usual patrol routine and making it unavailable in case of another emergency.
  • The cost of services that you’re given onboard the ambulance. Just riding in the back of an ambulance is one thing, but many people need treatment of some sort in the ambulance. Drugs or other life support tools can jack the price up even higher.
  • The location of your medical emergency. Ambulance costs can vary widely from city to city. As it is with most things, your ambulance bill will probably be higher if you live in a big city.

Ultimately, there is no single cost that you can assign to an ambulance ride. However, a U.S. Government Accountability Office study found that ambulance rides across the United States could range from $224 to $2,204, with the median cost hovering around $429. No matter where you live or exactly what you get from an ambulance ride, one thing is clear: ambulance bills are not cheap.

Tips for Paying an Ambulance Bill

Do You Really Need an Ambulance?

If you don’t actually need an ambulance, it would be a shame to end up having to pay a three or four figure bill because of your mistake. The Thousand Island Emergency Rescue Service recommends this checklist to see if you should call an ambulance.

  • Are you (or is someone else) in immediate danger of losing your life?
  • Could your condition worsen on on your way to the hospital?
  • Could movement lead to additional complications or injuries?
  • Do you need skilled treatment immediately?
  • Would an ambulance ride be significantly faster than your other means of getting to the hospital?

Ask Your Insurance to Cover the Bill

Depending on your exact health insurance plan, you may be able to get help from your insurance company in covering an ambulance ride for emergency medical care. The important thing to note is the presence of an emergency threat. Going through the checklist from above will help you make your case to the insurance company to get their help with the bill. You should also check out your individual health insurance plan to see other stipulations and requirements on ambulance bill coverage.

How to Negotiate an Ambulance Bill

If your ambulance bill has arrived and you’re not getting the kind of help that you’d like from your insurance, then don’t fret. It may still be possible to negotiate for a lower ambulance bill that’s more within the range of what you are able to pay.

  • Make sure that you’ve been billed with the correct insurance codes. Like we said above, insurance companies will usually only cover emergency trips to the hospital in an ambulance. If the ambulance provider sends a bill with non-emergency codes, ask if they can change it so that your insurance can step in. You will be able to make a better case here if you can go through the checklist from above to explain why you were in an emergency situation.
  • Get an itemized bill and check for errors. Just like if you were disputing a medical bill, you should get an itemized bill from your ambulance provider. Double check to make sure that you actually received all of the services that you’re being charged for.
  • Try to settle at a lower amount. If you can’t pay the amount that you’re being charged, you may be able to convince the ambulance provider to go a little lower. They want to get paid, so try to find an amount that will satisfy the ambulance company and that you will be able to pay.
  • Negotiate a payment plan for your ambulance bill. As with most large bills, an ambulance bill doesn’t have to be paid all-at-once. Try to negotiate a payment plan with the ambulance provider that will leave you with smaller monthly charges that fit more easily into your budget.

An ambulance ride doesn’t have to destroy your financial health. Make sure that you really need an ambulance and be prepared to make the case for your emergency situation to your insurance provider. Once you have a bill, double check for any errors and negotiate it down to a price point that you can meet.

Affiliations

  • 1 Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA. Electronic address: [email protected]
  • 2 Department of Family Medicine, Oregon Health & Science University, Portland, OR.
  • 3 Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
  • 4 Department of Emergency Medicine, Wright State Physicians, Dayton, OH.
  • 5 Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC.
  • 6 Department of Medicine, Johns Hopkins University, Baltimore, MD.
  • 7 Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR.
  • 8 Departments of Emergency Medicine and Health Policy and Management, George Washington University, Washington, DC.
  • 9 Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
  • PMID: 28844764
  • PMCID: PMC5828915
  • DOI: 10.1016/j.annemergmed.2017.07.022

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Authors

Affiliations

  • 1 Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA. Electronic address: [email protected]
  • 2 Department of Family Medicine, Oregon Health & Science University, Portland, OR.
  • 3 Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
  • 4 Department of Emergency Medicine, Wright State Physicians, Dayton, OH.
  • 5 Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC.
  • 6 Department of Medicine, Johns Hopkins University, Baltimore, MD.
  • 7 Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR.
  • 8 Departments of Emergency Medicine and Health Policy and Management, George Washington University, Washington, DC.
  • 9 Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
  • PMID: 28844764
  • PMCID: PMC5828915
  • DOI: 10.1016/j.annemergmed.2017.07.022

Abstract

Study objective: Emergency department (ED) crowding and patient boarding are associated with increased mortality and decreased patient satisfaction. This study uses a positive deviance methodology to identify strategies among high-performing, low-performing, and high-performance improving hospitals to reduce ED crowding.

Methods: In this mixed-methods comparative case study, we purposively selected and recruited hospitals that were within the top and bottom 5% of Centers for Medicare & Medicaid Services case-mix-adjusted ED length of stay and boarding times for admitted patients for 2012. We also recruited hospitals that showed the highest performance improvement in metrics between 2012 and 2013. Interviews were conducted with 60 key leaders (physicians, nurses, quality improvement specialists, and administrators).

Results: We engaged 4 high-performing, 4 low-performing, and 4 high-performing improving hospitals, matched on hospital characteristics including geographic designation (urban versus rural), region, hospital occupancy, and ED volume. Across all hospitals, ED crowding was recognized as a hospitalwide issue. The strategies for addressing ED crowding varied widely. No specific interventions were associated with performance in length-of-stay metrics. The presence of 4 organizational domains was associated with hospital performance: executive leadership involvement, hospitalwide coordinated strategies, data-driven management, and performance accountability.

Conclusion: There are organizational characteristics associated with ED decreased length of stay. Specific interventions targeted to reduce ED crowding were more likely to be successfully executed at hospitals with these characteristics. These organizational domains represent identifiable and actionable changes that other hospitals may incorporate to build awareness of ED crowding.

Conflict of interest statement

Conflicts of Interest:

Eric Howell receives salary support from the Society of Hospital Medicine in his role as QI officer

How would you say your emergency department’s operations are running?

Because according to a recent report from Yale scholars, “Hospitals are struggling to provide emergency and trauma care effectively.”

Despite the fact that most emergency departments are equipped with the latest in technological advances, many still can’t get past their fundamental operational inefficiencies.

So we’re taking a deep look at what this report says today to uncover what’s really to blame for your low numbers. Then we’ll discuss a few emergency department operations strategies to help you fix things.

To start, you should understand why these problems keep happening in the first place.

Why Are Emergency Departments Struggling With Efficiency These Days?

One reason for inefficiency and low patient satisfaction scores could be the lack of beds to go around.

Though there’s been a 120% increase in the population, the number of patient beds has gone down significantly.

The amount of hospital beds available in 1975 was 1.5 million. Now compare this to today’s 900,000 and a glaring issue quickly surfaces.

And this is just the beginning.

“Over 90% of Emergency Departments report overcrowding at some point during the day.”

Without enough beds, emergency departments just like yours are forced to resort to boarding patients in hallways.

While this may not seem like a big deal, according to the report , this actually leads to:

    Longer patient stays

Patients in hallways “are often missed” or unintentionally neglected. Because of that, “mortality increases with the duration of ED boarding.”

The report also mentioned specifically that “stroke patients have poorer management and outcomes when emergency departments are crowded.”

The problem isn’t just an internal nightmare; these issues are affecting patients — and may even be putting them in danger.

Without a solution, it will continue to spiral out of control, skyrocket costs, put more patients at risk, and push talented staff out the door.

Downsizing nurses and doctors, poor bed management, and logistical inefficiencies are also an issue here.

If your emergency doctors can’t do what they’re trained to do because they’re too busy filling out paperwork, they may leave for another independent ED group that functions better.

Fortunately, there are a few ways you can improve your efficiency and combat all these issues at the same time.

Emergency Department Operations Strategies To Fix This

Today’s emergency departments have become a one-stop-shop where patients can get all sorts of testing and diagnostic work done fairly quickly without an appointment.

What used to take several weeks now happens in just a few short hours and patients simply need to bounce between examination rooms instead of having to visit multiple doctors individually.

This makes emergency departments an attractive option for people, including those who are under-insured or not insured at all, since they can get everything they need done in one place.

This increase in demand comes at a cost: operational inefficiency.

Because of that, it’s important to consider the following strategies so your emergency department can spend more time and energy on true emergencies and less time dealing with things that don’t have as much of an impact, which leads to your first step:

#1. Work With All Team Members To Improve Door To Doc Times

Improving your emergency department’s operational efficiency should be everyone’s goal, not just stakeholders and board members.

This means you’ll need to create a comprehensive plan detailing what should happen during both peak hours and slower periods.

Having the right amount of staff members at the right time ensures your door-to-doctor times are as low as possible while still being able to provide exceptional care.

This one improvement has a huge impact on patient satisfaction scores, as does this next reminder.

#2. Have Compassion In All Situations

During busy times, it’s far too easy for team members to feel frustrated and rushed. Unfortunately, patients can see this negativity all too clearly; or worse, have their healthcare impacted by it.

While proper planning can drastically reduce this (see the previous tip), there may still be times when your team is short-staffed.

Here’s where an extra dose of compassion goes a long way — for both patients and team members.

Instead of letting tempers flare, encourage your team members to take a more compassionate approach to delays, issues, interpersonal conflicts, and other bumps in the road.

It’s essential to help your team nip negative emotions in the bud so everyone can operate with a clear, level head and provide the level of care your patients need.

This step can lead to greater awareness, fewer rushed and pressured decisions, and increased patient and team member satisfaction scores.

Your EM group will operate more efficiently as a team all while improving customer service.

And this last strategy can also help you do just that.

How to reduce emergency room bills

The Balance / Ellen Lindner

The thought of an ER visit can be scary, not only because you need emergency health care, but out of a sense of worry that you’ll be charged too much for services. Health care costs for ER services seem to be rising each year.

Findings from researchers at John Hopkins Bloomberg School of Public Health and Washington and Lee University suggest that these charges can exceed approved Medicare rates for the same services by as much as 10 times. That’s a 1,000% markup.

Average ER Costs

The average cost of an ER visit can be as much as a mortgage payment. Hospitals know that our first priority is receiving care. There’s little to stop them from charging steep prices for the care they provide. Rates can be even higher for minorities and patients who don’t have health insurance.

The John Hopkins study reported that hospitals in the Southeast were the greatest culprits in charging too much for ER services.

The average cost for an ER visit will vary based on whether you have insurance. A copay for an insured person is around $250. This may or may not be waived if you’re admitted to the hospital. Even insured patients may have to foot the whole bill if they haven’t met the plan’s annual deductible.

An ER visit can cost several thousand dollars if you don’t have health insurance. It can depend on the level of care you need.

Health plans must meet the IRS 2021 minimums of $1,400 for a single person, or $2,800 for a family, to be considered a high deductible health plan. It could be even higher depending on your plan.

Charges could run into the tens of thousands of dollars in extreme cases when critical care is needed. Ambulance fees can be more than $1,000. Charges for air ambulances can be even worse. It’s hard to know what kind of bill you can expect when you’re going to an ER for treatment.

ER Visits and Your Insurance

You might receive a very high bill if you’re away from home when you need care, or if you must visit an out-of-network provider for any reason. Seven out of 10 patients didn’t know they were using an out-of-network healthcare provider at the time they sought care, according to a Kaiser Family Foundation report.

Some insurers are putting ER charges under the microscope to determine whether the visit was for a true emergency. some are refusing to pay full charges for visits if they decide that the hospital is charging too much. This can leave a patient with an unpaid bill for ER charges that aren’t covered by the insurer.

Anthem Blue Cross Blue Shield of Georgia was sued by the American College of Emergency Physicians and the Medical Association of Georgia in 2018 for refusing to pay for ER visits that were deemed not to have been emergencies.

Affordable Care Act Changes

Your health insurance company will require a co-pay for ER treatment if you’re insured. It will vary based on your health insurance plan.

Under the Affordable Care Act (ACA) Patient’s Bill of Rights, insurers haven’t been allowed to charge higher copays for out-of-network hospitals since Sept. 23, 2010. Patients aren’t required to get preapproval for ER care. But plans that are grandfathered in before this date are exempt from this rule.

What Does the Future Hold?

Don’t look for ER charges to go down in the near future. A New York Times report cites Yale University research that shows that many hospitals are outsourcing ER care to out-of-network providers that are aggressively overpricing services. Always go to the nearest ER if you have a choice.

A tool from Medicare.gov will provide you with a list of the nearest hospitals in your zip code, city, or state.

You Have Options

You may have some options for lower ER charges. They include coverage through your state if your family is low-income and if yours is one of the Medicaid expansion states that receives ACA subsidies. Go to the HealthCare.gov website to find out if you qualify for Medicaid in your state based on your income.

Some hospitals also offer assistance programs. Charges are limited under these programs, usually to the Medicare allowance for specific services. The ACA limits ER charges for those who are eligible for financial assistance. This provision is only for non-profit hospitals.

Ask to speak with a financial counselor at the hospital. Review all your options if you’re not sure about the coverage that’s available to you for ER treatment. Some hospitals may even reduce the charges if you dispute them. At the very least, they may offer you a payment plan based on a lesser charge.

It doesn’t hurt for low-income patients to ask to be billed based on a Medicare or Medicaid rate for services. Some hospitals offer to discount ER services by as much as 50% for self-pay or uninsured patients.

Frequently Asked Questions (FAQs)

What is the average cost of an emergency room visit?

The average cost of an emergency room visit was $530, according to the Agency for Healthcare Research and Quality. Costs also vary by age. Visits for those ages 18-44 average $490, while visits for those age 65 and older average $690. Those in rural areas paid an average of $560, while those in small metropolitan areas paid $500.

What happens if you go to the ER without insurance?

If you don’t have insurance, you have the right to be treated in an emergency. Emergencies are defined as severe or life-threatening incidents, having bodily functions or organs severely impaired, or being in active delivery. Any Medicare-participating hospital must provide emergency care to people regardless of their ability to pay. After your visit, you’ll receive a bill. Contact the billing department to see if you qualify for financial assistance and arrange a payment plan.