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What happens when private hospitals avoid treating uninsured patients

Some providers make a policy of referring anyone without insurance to public hospitals, creating duplicate visits and diagnostic testing.

Jeff Lagasse, Associate Editor

The practice of indirect referrals by nonpublic emergency departments and their affiliated physicians are prevalent in communities with a public hospital. Many of these patients are uninsured, with the referrals putting a strain on their finances and that of the public hospital.

These are the primary findings of a study to be published in the January 2018 issue of Academic Emergency Medicine, a journal of the Society for Academic Emergency Medicine.

[Also: Practices seeing fewer uninsured due to Medicaid expansion]

Some private hospitals will go to great lengths to avoid providing care to patients who won't benefit their bottom line, said Harrison Alter, MD, associate chair for research in the Department of Emergency Medicine at Highland Hospital, and executive director of the Andrew Levitt Center for Social Emergency Medicine.

"These hospitals and their doctors have carved out a precise set of loopholes and workarounds to important patient-protection laws dating back 30 years," he said.

The study, led by healthcare consultant and assistant professor of emergency medicine at Baylor College of Medicine, Laura Medford-Davis, MD, found that the majority of patients presenting to a public hospital emergency department after treatment for the same complaint in another local emergency department were indirectly referred to the public emergency department without transferring paperwork or records, incurring duplicate testing and spurring patient anxiety.

The analysis went on to suggest that duplicate visits and diagnostic testing incur additional costs for both the patient and the public and can place an unnecessary resource strain on the public hospital, in addition to increasing radiation exposure to patients.

The findings support the need to increase transparency and align incentives so that efficient, cost-effective, high-quality, definitive patient-centered care can be provided for all patients.

"Laws like EMTALA (the Emergency Medical Treatment and Labor Act) are meant to assure that patients get the care they need no matter their economic situation, or what ER they show up in," Alter said. "Dr. Medford-Davis and her colleagues show that flouting these laws results in duplication and waste, unnecessary radiation exposure, and on occasion, unwarranted and indefensible risk to patients."

Twitter: @JELagasse
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