For evidence of a still broken health care system with a really screwed up financial incentive structure, you need look no further than
this story in the
Washington Post.
It details hospitals' "aggressive marketing" efforts of their ERs to boost admissions and profits, all while strapped Medicaid systems are trying to reduce ER visits to control costs.
Efforts to reduce unnecessary ER visits by patients in Medicaid, the joint state-federal health program for the poor and disabled, are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals’ aggressive marketing of ERs to increase admissions and profits.
"Many hospitals are actively recruiting people to come to the ER for non-emergency reasons," said Anthony Keck, South Carolina's Medicaid director, citing facilities that tout their speedy ER service on highway billboards. "When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims," he said.
ER visits totaled 124 million in 2008, an increase of about 31 percent since 1997, according to the Centers for Disease Control and Prevention. The average wait time for treatment is 33 minutes, up from 22 minutes.
HCA, the nation's largest for-profit hospital chain, launched a major ER marketing campaign in the past year in Virginia, Florida, Texas and other states. The campaign includes billboards highlighting average ER waiting times and a service that provides waiting times to smartphone users.
Hospitals get paid for every service they provide. While the ER might be a more convenient option for many, including Medicaid patients, it's an expensive means for primary care delivery. Emergency room reimbursements for non-emergent care are a significant expense for cash-strapped Medicaid programs, and states are trying to fight back. For instance, in Washington state, WaPo reports, officials had to issue new rules "making it harder for hospitals to qualify for Medicaid bonus payments if they promote their ER for primary care."
The costs for both private and public health care systems of overuse of ERs is nothing to sneeze at. Health Affairs estimated that as much as $4.4 billion annually could be saved if urgent care and retail clinics were used for nonemergency care. But as long as there's a profit incentive for hospitals to draw ER patients, and the fees they bring with them.