So adding me to the list of people who have never heard of this surcharge, if it is that standard, why did that group suddenly remove that same surcharge after the media? I mean, if it is standard across the nation, why back down?
The reason this surcharge (used by roughly half the EDs) was challenged in the first place was because of a corporate campaign by a union (SEIU) against the hospital. Since they thought the emergency physicians were hospital employees, we were a target.
As this charge was rarely paid for by insurance companies and almost never passed on to the patients, it had little financial impact on patients and little benefit for the physicians. It was billed more out of the principle of supporting night differentials for EM physicians than trying to make money or raise the bar for night access.
Ironically this union that attacked us advocates for shift differentials for their members. However they lobbied aggressively against us and the hospitals we worked at saying this practice was a disgrace. Once this was picked up by the press, it generated a lot of anxiety in the administrative offices of our community hospitals and was being perceived by some of our patients as a reason to delay seeking emergency care at night. A number of the other EDs in town announced to the press (often incorrectly) that they did not use this charge making it appear that this charge was both highly unusual and a recent creation. Some of the public perceived this as greedy doctors trying to take more hard earned dollars from the poor and creating unfair barriers to the people
It was never meant to act as a way to punish patients for seeking care at night, simply a way to have the charges reflect the costs of providing care (night shift differentials make sense for the providers and if you don't bill for them this way, they just get buried in the overall ED charge ).
There is no question that a night shift differential is appropriate (not only are they bad for your health and your family but the number of patients and reimbursement for the same work is worse) and that the cost of doing this is provided in some way or form by the revenue. A lot of people responding to the press articles in posts said that doctors signed up for the life style so should take it without added support or that since there was a right to health care, doctors should just be happy to staff nights for the joy of helping people. I believe that you should be paid for the work you do and that we all need to support the guys who are willing to take the tougher less financially lucrative shifts.
In the end, because all the misinformation in the press, we saw that this charge was now being perceived as a barrier to night access by patients. Also our hospital partners were panicking. The reimbursement from this charge was negligeable and we already had real night differentials built in by taxing all of the clinical revenue. So we gave up and droppped the charge, leaving the real fight to our national organizations.
I do not believe in trying to prevent people with "non emergencies" from seeking care with financial penalties blocks real life threats. I think the recent rise in copay to as high as $200 is a scandal and I've already seen a number of delays in care in patients with life threats. Finally the rise in the ED workload and numbers is not due to non emergent care, it really is rising acuity from the aging of the population and the restricted inpatient access.
Remember that a sore throat is a non emergency until you discover it is epiglottitis and the patient has a respiratory arrest. A toothache is a non emergency until you assess it and find out it really was an epidural hematoma with referred pain or Ludwig's angina. I think we need to start believing that the definition of an emergency is simply someone who feels the need to seek emergency care. If we want to fix the health care costs, then lets look at how we process these lower acuity emergencies and find ways to do it more competitively than the PCPs. People will still see their PCP for BP controls, cholesterol checks, vaccinations, and the rest of the reasons that made me choose emergency medicine rather than general medicine. But a chief complaint is only a non emergency once you've assessed it. Our specialty thrives on the work aversion of other disciplines so let's not make it more difficult for our patients to get to us. In our group we will continue to support night differentials but will find better ways to raise the income to support it than this charge.
