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ER bills questioned – Calaveras Enterprise

Dignity Healths Mark Twain Medical Center is one of many hospitals that partner with EmCare.

EmCare, a company responsible for staffing emergency rooms in hospitals across the country, including Mark Twain Medical Center, is linked to a spike in surprise medical bills, according to health policy and economics researchers at Yale University.

The study examined close to 9 million emergency room visits run by a variety of companies between 2011 and 2015. It found that when EmCare partnered with a hospital, not only did out-of-network bills increase, but the number and rate of tests ordered and patient admissions also rose.

EmCare is a subsidiary of Colorado-based Envision Healthcare. Since April 2017, Mark Twain Medical Center in San Andreas has partnered with EmCare to provide emergency room staffing.

In a prepared statement, Mark Twain Medical Center officials said their rates and services offered have remained consistent since partnering with EmCare.

Mark Twain Medical Center and its more than 300 physicians, nurses and support staff are committed to providing, high-quality care to the residents of Calaveras County. In a continually changing health care landscape, were proud that for nearly 30 years we have been able to offer the community 24/7access, 365 days a year, consistent, highly skilled emergency medical services, the medical center said in a statement.

The statement did not provide additional information about billing rates or the number of out-of-network verses in-network bills, as requested.

Television shows paint the emergency room as a place of drama, but for patients, one minor medical emergency can turn into a monetary burden.

A trip through the emergency room doors is followed by a brief talk with the triage nurse and, depending on the status of the emergency, youll wait before seeing an emergency room physician.

Many patients do not know that the physician is an out-of-network doctor until it is too late.

Zack Cooper, assistant professor of public health and economics at Yale University, was one the studys three authors. He said that companies might bank on patients failing to look too closely into their plan and their hospital of choice.

If patients were aware, they may not go to these hospitals, Cooper said. The challenge has been in an emergency, they may not have enough choice.

In 2015, the Consumers Union published a survey that showed that 1 in 4 Californians who underwent surgery or received other treatment at a hospital believed their services were in network but were billed at out-of-network rates.

The New York Times interviewed a woman who received a $500 surprise bill in the mail following a stint at Sutter Coast Hospital in Crescent City. After slipping outside her Crescent City home, she was a taken to Sutter Coast Hospital, where she was treated for a broken ankle. While working on paying off her deductible, she was stunned to receive the bill.

The physician did not identify himself, and only briefly touched her ankle. The physician worked with EmCare.

Network: A network is a group of health care providers, including doctors, specialists, dentists, hospitals and surgical centers.

Out-of-Network Care: Going out of network means youll have to pay a larger chunk of the cost or the total cost of services depending on the plan.

Hospitals typically negotiate rates with major health insurers, but EmCare has traditionally negotiated its rates independent of hospitals. Physicians can bill at higher rates when they are out-of-network providers.

Using insurance claims data, the study found that 22 percent of emergency room visits were treated by out-of-network physicians, with an average surprise bill of $622.55.

Over 1 in 5 visits nationwide to in-network emergency rooms results in bills from out-of-network physicians, according to a previous study. But the most recent study found that 80 percent of those out-of-network bills were issued by about 15 percent of the hospitals studied. Many of those hospital emergency rooms were staffed by EmCare personnel.

That really looked like a light switch had been flipped, said Cooper. It had changed so rapidly.

Gregory J. Duncan is the chief of surgery at Sutter Coast Hospital and sits on his countys health board. He has 25 years of experience dealing with hospital services and billing. He began to notice an issue with billing and coding following an abrupt change from a prior staffing company to EmCare in 2015.

Colleagues working within the hospital began to float horror stories of past experiences with EmCare. He also began to receive complaints from patients who received the surprise bills.

Ive spoken with individuals at two other hospitals and they also had concerns, said Duncan. One doctor worked with a patient and agreed to lower the bill. One of my concerns is if you are someone who understands the billing, you can do that, but most dont have that and to me, that is not fair.

The billing became so bad in Crescent City that on April 25, the Del Norte County Board of Supervisors passed a resolution severing ties between the hospital and EmCare. The resolution specifically mentions EmCare, but was extended to include any out-of-network health care provider.

When the bill arrives, that is when you have your heart attack, Duncan said.

Envision Healthcare provided a prepared statement that dismissed the study as fundamentally flawed. The statement also said that out-of-network billing was not an issue specific to any one company.

The study appropriately identifies out-of-network reimbursement as a source of dissatisfaction for all payers, providers and patients in our current health care system. While the source and methodology of the study is fundamentally flawed and dated, we agree with the implied recommendation which is to advance a shared goal to re-engineer the current system in a positive way.

Cooper agreed that out-of-network billing was not inherently indicative of EmCare, but that firms like EmCare might be taking advantage of the situation.

The research compared EmCare to its top competitor TeamHealth, which took over mostly nonprofit emergency room departments. The research found a smaller increase in out-of-network billing and almost no change in admissions, coding or testing.

When the bill arrives, thats when you have your heart attack.

Its not necessarily that it is good or bad; it just turns out that in this case, EmCare is engaging in behavior that I think we can describe as not being in the patients best interest, Cooper said.

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ER bills questioned – Calaveras Enterprise


A look at the opioid abuse epidemic from inside NJ emergency rooms – New Jersey 101.5 FM Radio


Its not exactly shocking news.

The opioid epidemic is sending more and more Garden State residents to the hospital.

A study by the Agency for Healthcare Research and Quality shows between 2005 and 2014 there was a 64 percent increase for inpatient care and a spike of 99 percent for emergency room treatment of cases involving opioid abuse.

Hospitals and emergency rooms in New Jersey are well suited to handle this crisis because we have no choice. We are the safety net and any of societys ills find their way to our doors. But its distressing, said Dr. Michael Gerardi, emergency physician at Morristown Medical Center and a member of the Medical Society of New Jersey and the past president of the American College of Emergency Physicians.

He noted the medical community over the past decade has been paying more attention to treating the pain of patients, which is good. However, we may not always realize how addictive these drugs really are.

He also pointed out ER doctors are ready and able to handle the overflow of opioid abuse cases theyre presented with.

We saw this coming several years ago, and therefore we put out clinical policies on opioid use, how to treat it, recognize it.

According to Gerardi, ER docs are acutely aware of the rise in the overdose problem.

Were the ones that see these people coming in on deaths doorstep or deceased and its tragic and its the emergency physicians who have to go talk to the family or parents or loved ones, he said.

Its emblazoned in our consciousness and our souls that we want to see this epidemic stopped.

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He said in recent years, emergency room physicians have become pretty good at spotting patients with an opioid abuse problem.

Its not only their behavior. They sometimes come in specifically requesting for certain drugs that other people wouldnt know about. Theyre also allergic to every non-opioid drug, if you know what Im saying.

He said many times these individuals also have these multiple drug allergies and the only drug that can work for them is drugs that begin with a D dilaudid, for instance, or I can only have morphine, Im allergic to the non-opioid pain medication.

He said doctors may also suspect a patient is having an opioid abuse issue if they have pain out of proportion to what were seeing on an exam, or what they say is causing them pain. So many people may have 10 on a scale of 10 pain for something you and I would barely notice, or take a Motrin for.

These are little alarms that are setting us off that we say, Hmmm, I think something else is going on here.

He noted because of the Prescription Drug Monitoring program, doctors can now electronically look up what medications patients have been prescribed as well as their past ER visits, which has helped to curb abuse.

Gerardi also pointed out emergency room doctors have been decreasing the amount of opioid drugs theyre prescribing and administering to patients for many years.

In case you missed it: Important stories on heroin crisis in NJ

You can contact reporter David Matthau at

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A look at the opioid abuse epidemic from inside NJ emergency rooms – New Jersey 101.5 FM Radio