Another Rural ER Bites The Dust

Tift Regional Health Center recently announced that its affiliate, Cook Medical Center in Adel, will close its emergency department next month. This action will leave the citizens of Adel and Cook County without immediate access to emergency department services. And it didn’t have to happen.

The reason for the forthcoming closure isn’t mismanagement on the part of administration or declining utilization or even a bad economy. The reason, actually, is a dirty little secret that the general public isn’t aware of and that those on the Left refuse to acknowledge…overutilization of emergency services by “self-pay” patients. Why the quotation marks around the term “self-pay?” Because, in the medical community, self-pay is a euphemism for “no-pay” as the vast majority of self-pay patients ultimately don’t pay their medical bills.

How do I know this? Because I am an emergency medicine physician and I once practiced in the emergency department at Cook Medical Center. While working there, I noted that the administrative and medical staff were excellent – caring, capable, and committed to patient care. Adel and Cook County, it seemed, had a good thing going with regard to its emergency department. But it was doomed, and I knew it. It was only a matter of time, and I said so, often. And now that time has come.

In addition to practicing medicine, I hold an MBA in management/finance and I can attest to the fact that there is no such thing as a successful business model in which a business loses more in revenue than it earns. That applies to hospitals as well – yet another fact the Left refuses to accept.

During my first shift at Cook, I treated a patient who had been to the ER 63 times that year already – it was only March – and he never paid a dime. On several occasions, he made multiple visits to the ER in the same day – on one occasion, six visits in 24 hours, all by ambulance. His objective, which he readily explained to me after I questioned the frequency of his visits, was that he had applied for disability and was told he was more likely to win his case if he had multiple ER visits in his medical record. When I brought this up to administration, I received the universal palms up sign along with the statement, “There is nothing we can do.”

A simple, if only partial, solution to this problem is known as a medical screening examination (MSE) in which patients are evaluated by the ER physician and if their complaints are deemed non-emergent, these patients are referred to their primary care provider or local clinic. In this regard, most hospital administrators are at fault for not establishing MSE programs due, they argue, to concerns over litigation.

The other dirty little secret is that federal and state lawmakers could pass legislation to correct these abuses but choose not to in an effort to avoid being seen as insensitive. By implication, these legislators would prefer a rural hospital close and deny services to an entire community rather than run the risk of being seen as denying coverage to a certain segment of the population – that is, the no-payers.

Maybe when all of Georgia’s rural hospitals close, legislators will finally heed the call to real action. My impression, based upon experience, is that this is merely wishful thinking. The recent effort to solve the financial shortfall by offering tax incentives to encourage businesses to donate money to rural hospitals, though well-intentioned, has little to no chance of succeeding. Why? Because this plan avoids the fundamental problem of refusing to place responsibility on those responsible – that is, on the no-payers. Don’t believe me? Wait and see. Of course, improved insurance reimbursement rates would help some, but this does nothing to address the reality that rural ERs are being abused and that those in a position to do something about it aren’t doing anything about it. The lack of state and federal leadership with regard to Georgia’s and America’s failing rural hospitals is at best a travesty and, at worst, a dereliction of duty by those holding public legislative office. To save these hospitals requires strength of character on the part of our legislators – that is to say, the strength to tell people when they choose to visit a rural ER that they should be prepared to pay their bill and not expect someone else to pay it for them.

Posted in Contributors.

Spencer Price, MD, MBA

Spencer Price grew up on a farm near Thomaston, Georgia. A published author, Spencer is a former newspaper staff writer and has written numerous magazine articles. Currently, his conservative political column appears weekly in several Georgia newspapers.