ERAll hospitals are challenged by increased emergency-room visits from the uninsured or under insured. The result of this dilemma is more self-pay bills being written off to bad debt and charity.

The emergency room sits at the pinnacle of all hospital departments producing hospital charges ultimately going unpaid. Hospital’s struggle to cope with rising emergency-room visits and the unpaid hospital bills associated with them. Some hospitals are now instituting new policies that require patients to pay upfront for emergency-room care.

The following article taken from the Wilkes-Barre Citizens’ Voice offers a great synopsis of the issues faced by our nation’s hospital emergency rooms and what some hospitals are doing about it.

Emergency Room Patients Across Country Paying Upfront For Non-urgent Care

As hospitals across the country struggle to cope with rising emergency room visits and more unpaid hospital bills, some are instituting new policies that require patients to pay upfront for non-emergency care.

The number of emergency room visits have risen by 11 percent in the past five years, according to statistics kept by the state Department of Health. In the same time frame, the number of emergency rooms across the state has shrunk by 10 percent, according to Martin Ciccocioppo, vice president of research for the Hospital & Healthsystem Association of Pennsylvania.
The U.S. Centers for Disease Control and Prevention estimate that 8 percent of emergency room visits across the country are for problems that could be handled at a primary care physician’s office or walk-in clinic. Local estimates are not available.

Experts locally said there is anecdotal evidence a growing number of patients are seeking emergency room care for routine complaints, from coughs and colds to sprained ankles, cuts and burns.
“The population is getting older and the population is getting sicker. People want their care quickly,” said Ronald Strony, M.D., director of emergency medicine at Geisinger Northeast. “Because of this, the use of the emergency department has gone up exponentially.”

In fiscal year 2010, uncompensated care levels at hospitals across the state grew 8 percent, equaling $891 million in fiscal 2010, according to independent state agency Pennsylvania Health Care Cost Containment Council. About 46 percent of that was categorized as charity care. The rest was written off as bad debt, according to the council’s report.

Because of these pressures, hospitals across the country are focusing on getting patients the right treatment in the right place, Strony said. The Emergency Medical Treatment and Active Labor Act passed in 1986 requires hospitals to provide an appropriate medical screening examination for any patient seeking treatment in the emergency room. Through those exams, medical staff ascertain whether the patient’s complaint is an emergency. A number of hospitals, both for-profit and nonprofit, around the country have implemented policies requiring patients to pay upfront for care that is deemed to be non-urgent.

For-profit Community Health Systems Inc., which owns eight hospitals across the region and more than 130 hospitals around the nation, screens emergency room patients as required.
“For those who decide to request non-emergency care in the ER, the hospital may collect a fee or the patient’s co-pay for the service provided, just as is done in a physician’s office or outpatient clinic,” CHS spokeswoman Tomi Galin wrote in an email. “These policies have been implemented at CHS-affiliated hospitals at various times over the past few years.”

Prior to their acquisitions, Wilkes-Barre General Hospital, Regional Hospital of Scranton and Moses Taylor Hospital each made some effort to secure patient payments in the emergency room for the services provided, according to Jim McGuire, spokesman for umbrella group Commonwealth Health. “The ownership change of these hospitals has not resulted in a change of process at this time,” he said. “It is always the patient’s choice whether to continue care in our emergency department or seek care in an alternate setting, such as their physician’s office or an urgent care clinic.”

While there are no policies requiring upfront payment at Geisinger hospitals, emergency room staff there also will have discussions with patients about options for non-emergency care, Dr. Strony said, including an on-site urgent care clinic.

Moving non-emergency cases to clinics and doctors’ offices makes sense on a number of levels, the doctor said. It frees up emergency room beds for sicker patients and gets non-urgent cases treated faster. In addition to reducing costs at hospitals, receiving care at clinics or doctor’s offices is often less costly than emergency room care. “A co-pay at the (emergency room) is $75 to $100. At an urgent care clinic, it’s $10,” he said. “That’s a no-brainer for the patients.”

For more information about how you can improve emergency rooms cash collections, contact Phil C. Solomon at 404-849-8065 or

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