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Non-emergency ER patients to pay
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Newton Medical Center will begin charging a $150 deposit to patients who don't have a true emergency condition yet still request care from the hospital's emergency room. Patients with insurance will be required to pay their co-pay or deductible.

The move is being made to deter people, particularly the uninsured, who would otherwise abuse the ER by treating it as a primary care facility, according to hospital officials. The hope is to reduce unpaid medical bills and streamline the ER for true emergency patients, said Newton Medical spokeswoman Linda Moseley.

So far in 2012, 12.5 percent of visitors to Newton Medical's ER were not truly emergency cases, according to chief financial officer Troy Brooks. About a quarter of all ER visitors are uninsured, according to previous numbers provided by officials.

The hospital operated at a loss of $2.9 million during the 2011 calendar year, largely due to people and insurance companies, not paying for the full cost of healthcare.

Newton Medical has seen emergency visits grow rapidly in recent years. The hospital had 46,246 total ER visits in 2011 (up 3,000 from 2010) and is on pace to see 50,500 in 2012, according to Brooks. Patients with true emergencies will continue to be treated without having to pay up front.

"We have been discussing this for a while. It takes a coordinated effort of the ER doctors, the nurses and the patient accounts personnel to get the procedures identified and ready to go," Brooks said in an email. "We are aware that other hospitals in our region are using similar programs."

Rockdale Medical Center also charges a $150 deposit for non-emergent (the medical term for a case that's not a true emergency) patients who want to receive care from the ER, while Clearview Regional Medical Center (formerly Walton Regional) charges around a $180 deposit for those patients, according to spokeswomen for both hospitals. Both hospitals are private, while Newton Medical is still overseen by a public hospital authority.

"The system overall does work well for us, because the ideal situation is when someone comes to the ER (for a non-emergency) that we're able to refer them to a primary care physician that they can build that continuum of care with and that long-standing relationship with," said Clearview Regional spokeswoman Emily Russell.

"So, by being able to triage the patient and then asses the situation and give the choice back to the patient, we're able to further have that relationship and create those (primary care) relationships in our community."

Newton Medical spokeswoman Moseley said the hospital's triage process (a medical term for an initial evaluation of a patient) will not change.

Hospitals are required to examine and offer treatment to any patient who comes to the emergency department under the Emergency Medical Treatment and Labor Act. She said there are populations that are exempt, including the very young and the very old.

According to the American College of Emergency Physicians, the law, known as the "anti-dumping" law, was designed to prevent private hospitals from transferring uninsured or Medicaid patients to public hospitals without, at a minimum, providing a medical screening examination to ensure they were stable for transfer.

According to a Feb. 20 story by Kaiser Health News, "At least half of all hospitals nationwide now charge upfront ER fees," said Rick Gundling, vice president of the Healthcare Financial Management Association, which represents health-care finance executives.

However, the same article said some ER doctors worried that the policy would turn away people, particularly the uninsured, who would then not seek medical attention elsewhere and become sicker.

Newton Medical is expecting 13,000 uninsured people to use the ER in 2012, based on projections made in September. Non-emergent patients who choose not to receive care at the ER will receive a guide of various community resources that they can visit.

Brooks said the average charge for a non-emergent visit is around $200 to $300, though he noted that, "Even within the non-emergent category, there is often variation in the level of work-up and diagnostic testing that is required to arrive at that non-emergent decision."

Therefore, charging a $150 deposit up front "equates to a discounted self-pay rate for the non-emergent service and is in the range of what others are charging for their similar programs," Brooks said.

"Financial considerations were a big part of this decision, but there is also a very significant and growing issue regarding overcrowding in the ER and the proper utilization of that service," Brook said. "We will be better able to project the economic impact with the actual experience that we see in the balance of November. It is tough to predict how many patients will choose to stay and pursue their non-emergent care here in the ER, but we are prepared to provide those services to them."