Minutes Matter, Don’t Wait!

Or so my local "Emergency Room of Brookside" bleats from its website  but, even more oddly, from the pop up advertising that is dodging my web browsing these days.  Yes, many are haunted by targeted impulse buy purchase opportunity pop ups during their web browsing.  It is called behavioral targeting. I get it. And, I am looking at lots of hospital service sites and articles as part of research on a manuscript.  But, generalizing from that, is there really behavioral targeting for using ER services?

And what an ER add it is, telling me the current waiting time at this local ER in minutes.   Of course, when you click through they offer a list of all the conditions that may be ER worthy, stressing the danger of ambiguous symptoms. To be fair, they also post an equally ambiguous list of what may not be ER worthy but only Urgent Care worthy.  Overall, I do think the pitch is that what you don't know may kill you and better be safe than sorry when parsing urgent from emergent.

The curious thing about this is how at odds it is with current health insurance plan design that is trying to  move the "prudent lay person" standard on current covered ER services more than a bit by structuring plans or Medicaid coverage to include  financial disincentives for ER use that is not, retrospectively, deemed to be life threatening.  Of course, 20-20 hindsight is not the  current legal standard and so the law stands at the crossroads of insurance plan design hoping to lower non-emergent ER use and hospital systems constrained by EMTALA's screen all bias and  incentives to seek higher reimbursement rates for certain procedures delivered in the ER. Consumers, of course, are caught in the cross-fire. I won't call it friendly fire because I don't think either polarized position serves consumers well.

Anthem is making a name for itself as it rolls out these "non-emergency clauses" on a state by state basis. Missouri is on those states, though there has been surprisingly little push back — except by hospitals and Senator McCaskill — over the re-making of the standard.  This may be, in part, because hospitals have been incrementally declining to cover ER services for years or it may be that health insurance plan enrollees may not fully appreciate the non-emergency clause until it bites.

Interestingly, in coaching its plan enrollees on how to self-screen for appropriateness of ER use, Anthem sends them to a web page not unlike the Emergency Room of Brookside page linked above, minus the fear-inducing warnings that life-threatening conditions may masquerade as merely urgent conditions. So, there it is, two sets of troubling symptoms and the layperson responsible for sorting through them and deciding whether a fear-inducing or fear-rationalizing reading is appropriate. Of course, I 'm still trying to figure out how the auto accident victim who was transported  by ambulance on back board and later released with a diagnosis of not ER covered bruises and scrapes was supposed to have stopped all the clocks to complete their self-diagnosis while in the ambulance. 

I can't help but think that this is really another battle in the epic war between hospitals and insurers over who will determine cost and control of  coverage.  Clearly, Anthem contemplates that hospitals will screen more stringently for ER care in light of the distinct possibility that they may be treating an individual who is going to be uninsured for the ER encounter. And ERs are riding into battle under the banner of consumer protection and EMTALA enforcement fears.

When public discussion turns to surprise medical bills, I sometimes wonder if this misnomer — for they are health care bills whose price often could not be determined in advance and whose insurance status often could not be determined in advance — helps to screen the roles that providers and insurers combine to play in this phenomenon.  




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