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SPECIAL REPORT: Non-emergency visits to the ER can raise costs for other patients

WSBT 22 photo

Some people go to the Emergency Room for everything, including a pregnancy test or the common cold.

These non-emergency visits are costing you a lot of money, especially when the patients don’t have health insurance.

How can someone else’s ER visit cost us?

Unfortunately when someone goes to the ER without health insurance or refuses to pay their bill, that means higher prices for everyone -- even if you don’t ever use the ER yourself.

“Many, many sore throats, and many, many things that could have been seen by a physician’s office,” said Lori Pajakowski, former ER nurse.

There were almost 137 million ER visits in 2015; about 30 percent of those cases could have been treated at an Urgent Care or by a family doctor.

“One of the misconceptions people have is that if you work in an emergency department, it’s always emergency patients,” said Pajakowski. “Like a very serious trauma patient or a patient whose had a heart attack or a massive stroke. The reality is, that’s a small percentage of our day.”

People using the ER for non-emergent situations can cause frustration for everyone.

“I discourage people from going to the emergency room for a cold," said said Dr. Dan Nafziger, chief medical officer Goshen Hospital. "That’s one of the things that actually contributes to the problems of wait times."

To improve wait times, patients are triaged by an Emergency Severity Index. Level 5 being non-urgent, up to a Level 1 being the most severe.

“Even though it seems like you’re waiting and waiting and waiting for an ankle sprain that you’ve had and it’s very painful, we have to take the chest pain, the shortness of breath, obviously those go first," said said Dr. Bruce Hughes, emergency medicine physician.

Wait times aren’t the only issue. ER doctors say they spend a lot of their time trying to direct patients to the appropriate course of care.

“That’s become more challenging over the past 19 years, and that becomes more of our job, this positioning patients or helping them access the healthcare system,” said Hughes.

Why do doctors have to try to educate patients?

“Under insured and uninsured often can’t get healthcare," said Pajakowski. "The emergency room becomes their primary source of healthcare."

In 2015, more than 13 million people were treated at the ER without insurance. That number continues to rise because of the EMTALA Act.

“That requires ER’s to receive all patients regardless of whether they are a one or a five, so with that you are entitled to care," said Caren Rossow, who's retired from hospital management.

Rossow was in hospital management for over two decades. She says if the hospital can’t get money from the patient, it ultimately affects your pocketbook.

“Ultimately if you can’t pay the bill, it becomes bad debt, and bad debt they end up writing off," said Rossow. "It affects everyone when you think about it."

Services at the hospital become more expensive to cover the cost. Even if you never need treatment there, it eventually catches up with you through your own insurance provider.

“Hospitals will contract through insurance companies. And ultimately that cost is passed on to everybody through higher insurance premiums. Or other things like that, it does impact everybody,” said Rossow.

As for ER doctors, they continue to do their part in treating the sickest and trying to educate those that aren’t.

“Educating the community that ‘Hey, the dollar store sells pregnancy tests for a dollar and it’s silly to come in,'” said Hughes.

Health officials told WSBT that ultimately hospitals have to make money to keep their doors open.

When they have a percentage of people not paying their bills or are uninsured, they have no choice but to raise costs for the people that do pay.

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