Nancy Farber, CEO Washington Hospital Healthcare System

(This message will also be included in the Summer 2010 issue of Health Signs.)

An Urgent Message
In an emergency, Washington Hospital wants to make sure you get the care you need

Imagine you knew you could get the same care on either side of the street, but the service on one side was much less expensive than the other. The quality of care is equal, but the wait time is much longer as well. You’d probably choose to go to the less expensive, and quicker option if you were informed about it. But, what if laws were in place to prevent someone from telling you about a less expensive option. Believe it or not, that’s the reality for someone who walks into Washington Hospital’s Emergency Room for treatment of a condition that could just as effectively be treated in an urgent care setting, across the street for a fraction of the cost.

Washington Hospital operates the second busiest Emergency Department in Alameda County. One of the drivers of this high volume of patients are individuals who arrive at our ER for treatment of conditions that don’t require the level of medical care that is offered there. Because of the less emergent nature of the condition for which they are seeking treatment, often they are pushed to the end of the line by patients who arrive at the hospital with immediate, critical health care needs. And, while we have put measures in place to speed the process of care for non-emergent patients, the wait times can still be more excessive than need be, especially when the alternative for care – Washington Urgent Care -- is directly across the street with a shorter wait time to see a physician.

By federal law, hospitals are required to assess anyone who walks into the Emergency Room, even if the services for the patient could be provided in a physician office or urgent care setting. This law, called EMTALA (Emergency Medical Treatment and Active Labor Act) and passed by Congress in 1986, came about as a result of abuse and questionable behavior by a few for-profit hospitals in Texas. One particularly troubling example involved an immigrant whose family brought him to the Emergency Room with symptoms of a heart attack. As soon as the hospital discovered he did not have health insurance and no means to pay, a hospital administrator came to the Emergency Room, offered the patient some juice and sent him on his way. As he left the hospital and walked out to his waiting family, he collapsed and suffered a fatal heart attack.

No one would argue that a story like this should not prompt action by our lawmakers, but as is often the case, good intentions to right the wrongs of hospital operators, has had unintended consequences for the majority of responsible health care providers.

Simply put, EMTALA stipulates that hospitals cannot advise patients who come to the Emergency Room of less expensive alternatives to seek treatment. If we did so, Washington Hospital would risk losing the funding that we receive from Medicare, which for most hospitals constitutes about 40 to 45 percent of the bottom line. That’s a risk no hospital administrator would take.

While much of the debate about health care reform has focused on costs and steps to "bend the cost curve" to provide health care services, providing health care services in an Emergency Room setting is an expensive endeavor. The high costs are the direct result of maintaining a highly educated work force, expensive technology to help save lives and the myriad of supplies that must always be available so that nearly any health care scenario could be treated should it come through the doors.

It’s my belief that many of the patients who come through our Emergency Room doors with non-emergent conditions, would be interested in knowing about a less expensive alternative. But, until the laws are changed, we will continue to be mandated to stay silent on this issue, even if a condition could be just as effectively treated in an urgent care setting. In the meantime, we are in the process of talking to state and federal lawmakers about granting an exemption to the EMTALA rules which would allow Washington Hospital staff to have common sense discussions with patients about the options for less costly care when medically appropriate.

Just as you would want to know about a less expensive care option especially given the economic challenges facing most families today, it is my hope that we can communicate about less expensive -- but equally effective services – for patients when it’s appropriate for them to be seen in a setting other than the Emergency Room. To be able to do so would be a good first step in helping to begin the process of "bending the cost curve" when it comes to providing health care services. This example is not unique in health care, but it’s a very visible example of the kind of change we need to ensure that those who are most vulnerable get the care they need and in a setting that’s most appropriate.

Finally, for an update about national health care reform and how it may affect you, tune into InHealth, Comcast Channel 78, or go to www.inhealth.tv to watch the latest programs and updates about health care reform.

If you have questions about this issue, or any other issue about Washington Hospital Healthcare System, please feel free to contact the Hospital’s Community Relations Department at (510) 791-3417.