When a patient with a sore throat, earache or other minor ailment heads to the emergency department for treatment, there are a raft of negative consequences: longer waits for patients with more serious conditions, higher costs for both the patient and the hospital, and the challenge of treating a patient in a less-than-ideal setting.
While hospitals legally are required to take care of all ED patients regardless of their ability to pay, Presbyterian Hospital in Albuquerque, N.M., now sends many patients to primary care appointments for less serious ailments after an initial screening.
Incoming ED patients are triaged by a nurse who decides if the patient should be directed to a less-urgent setting. The patients then are brought back to be seen by a physician or nurse practitioner who discusses the hospital's new policy and determines the best course of treatment. Finally, a patient navigator arranges a primary care appointment within the system or with another provider of their choice; the appointments are made within 24 hours of the ED visit.
Hospital leaders say the screening fulfills requirements from the 1986 Emergency Medical Treatment and Active Labor Act that hospitals offer emergency services to all patients. Before implementing the policy, staff met with officials from the Centers for Medicare & Medicaid Services, local advocacy groups and state officials to assuage concerns. CMS representatives worried that patients would complain, but none have done so.
Presbyterian leaders say they are able to balance the reductions in acute care payments — estimated at $70,000 to $100,000 in gross charges a month — with the increased revenue to primary care physicians and lower costs to the system's health plan. But some concerns remain, notes Jim Hinton, CEO of Presbyterian Healthcare Services, the hospital's parent system, pointing out that the hospital refers patients to other providers even if they aren't affiliated with Presbyterian, without receiving compensation. And the system shoulders the cost of referring patients without the ability to pay their own primary care practices.
Presbyterian leaders say the program's success will be measured by whether patients stop showing up in the ED with nonemergent conditions. Since the program was launched, less than 5 percent of patients have returned to the ED with a similar problem within the next few days.