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I was reading this article: http://www.theatlantic.com/health/archive/2015/05/the-agony-of-surprise-medical-bills/393785/ that discusses the increasing spread of free-standing "emergency departments" (I use the scare quotes because I have a hard time seeing how something that is free-standing can, by definition, be a department of anything unless it's a branch office) and the high probability of patients who present to these or hospital EDs receiving out-of-network billing for in-network hospitals.
It got me thinking about the discussions that providers (usually not physicians, but I'm sure sometimes them) have with patients in the ED about the costs of tests-- once you're in the door of course, you're stuck with certain charges, but moving forward with a workup confers additional costs. How many of you ever discuss these costs with patients? If you do, how do you frame these?
I'm heading off to start residency this summer, so this is a question asked from the perspective of a learner. From my vantage point, it seems like in an ideal world you could have these discussions, but if you're ordering tests appropriately it is to rule out or diagnose dangerous conditions in an undifferentiated patient, making worrying about cost less appropriate. In the ED setting, there isn't a huge role for discussions of where one could cut corners or save money on the workup, and discussions of payor status seem like that might be putting at hazard your objectivity or even risk violating some sort of law. Would appreciate the perspectives of any attendings who have figured out a way to strike a balance here, or who have thought about it and decided for reasons x, y, or z that it's not their job and that they shouldn't worry about it.
It got me thinking about the discussions that providers (usually not physicians, but I'm sure sometimes them) have with patients in the ED about the costs of tests-- once you're in the door of course, you're stuck with certain charges, but moving forward with a workup confers additional costs. How many of you ever discuss these costs with patients? If you do, how do you frame these?
I'm heading off to start residency this summer, so this is a question asked from the perspective of a learner. From my vantage point, it seems like in an ideal world you could have these discussions, but if you're ordering tests appropriately it is to rule out or diagnose dangerous conditions in an undifferentiated patient, making worrying about cost less appropriate. In the ED setting, there isn't a huge role for discussions of where one could cut corners or save money on the workup, and discussions of payor status seem like that might be putting at hazard your objectivity or even risk violating some sort of law. Would appreciate the perspectives of any attendings who have figured out a way to strike a balance here, or who have thought about it and decided for reasons x, y, or z that it's not their job and that they shouldn't worry about it.