My point was that a normal EM attending would know the difference between someone who would have a serious problem and would be seen even if they can't pay vs. someone who is just there for a non emergent reason, and for those cases, they should be forced to pay. You can't simply go into a store and take merchandise without paying can you? You can't walk into a dentist's office and say hey treat me and I'll see if I can pay you. Medicine is the only field where people can decide whether they'll pay or not for services provided. It's completely out of line. If people had more responsibility and liability (ie-being charged like you would at any other normal establishment for getting care) then maybe our system would not be in the shambles taht it is
Oh they're all charged, and they're all sent to bill collectors and have their credit ruined if they don't pay. Don't worry about that. For me it's 17-18% of my patients that don't pay.
But it's almost never as cut and dried as you suggest. Most patients who come to the ED do so with a complaint that could represent an emergent condition- an acute injury, abdominal pain, chest pain, dyspnea, altered mental status etc. Of course, after evaluation, sometimes including tests, most of them don't have an emergent condition. But how are they supposed to know that sitting at home if it took me 4 years of college, 4 years of medical school, 3 years of residency, $3000 in tests, and 2-4 hours to figure it out?
Yes, some are obvious when I walk in the room. Nope, your toe pain isn't an emergency. At my shop, those cases get billed if they have insurance and if they don't I offer them a "medical screen-out", which they all take, since it means they won't get a bill from me or the hospital.
But if I have to do labs and a chest x-ray, sorry, you're getting a bill. Don't pay it and you're going to have a tough time getting a mortgage.
ACEP says less than 10% of ED visits represent non-emergent complaints. That seems about right in my experience. But the truth is almost all of those are Medicaid and very few are true "self-payers" AKA no-payers.
The world is far more complex than it seems young paduan. Your suggestion that "a normal EM attending" would know what's emergent and what isn't the second he sees the triage note simply isn't true. And if he has to do more than that to determine if an emergency exists, well he's already done 90% of the work, so might as well finish up and bill the patient. There's always a chance they might pay anyway.
You're also missing the upside to EMTALA. We get to be the White Knights of medicine. I make a helluva lotta money yet still get to take care of people who can't afford to pay. Most docs can't afford to do nearly as much charity care or their practice would go out of business. Most docs don't see patients without insurance. Many docs don't even see Medicaid/Medicare patients. Yet I get to take care of people without ever having to even know what insurance they're on. I rarely even turn to the face sheet in the chart. I never have to tell someone "I'm sorry, I can't do anything for you because you can't afford to pay me this instant." That can be a beautiful thing.
If you're bitter now about not making more cash because some fraction of your patients doesn't pay you, think about how you'll be a decade from now.
