Memorial Hospital at Gulfport (Miss.) ushered in a new policy regarding nonurgent care in its emergency room Nov. 1.
Under the policy, nonurgent ER patients aren't diagnosed and treated unless they pay their insurance copay or a $200 deposit prior to receiving care. Those nonurgent patients who don't pay their copay or the deposit are sent to the hospital's walk-in clinics. According to the hospital, nonurgent patients are those who are in stable condition at the time of assessment and are not likely to develop a life-threatening condition. Qualified providers will assess patients to determine whether they fit that definition.
By implementing this policy, hospital officials hope to reduce the number of nonurgent visits in the ER to make room for more critical patients. Memorial Hospital at Gulfport's ED sees approximately 6,000 patients each month, and about a quarter of those patients do not have an emergency medical condition, the hospital said in a press release.
Memorial Hospital President and CEO Gary Marchand recently answered questions from Becker's Hospital Review about the reasoning behind the policy and how patients are responding.
Note: Responses have been lightly edited for length and clarity.
Question: What prompted the policy?
Gary Marchand: We initially had about a 30 percent population loss [after Hurricane Katrina], and we never really recovered to those population levels again until about 2012, 2013. Still, since 2012 and 2013 our population base is only about 5 percent higher than it was pre-Katrina. So, we're looking at the same relative population size we were in 2005.
Even though our population is only up 5 percent, our visits are up by 30 percent in the ER. The sicker patients we're seeing in the ER are up 25 percent and the number of patients we admit to an inpatient bed from the ER is up 40 percent over this same period of time. So, we have a population growth netting 5 percent but we're seeing much sicker and much higher volume of patients, and we're admitting more patients than ever out of the ER to an inpatient unit.
The rationale behind the change is to ease the congestion in the ER to allow us to focus our resources on the sickest residents that are presenting in the ER at higher volume levels. We have expanded our ER beds recently from 42 to 49. A fair number of those beds are being occupied by psychiatric patients rather than medical or acute or trauma type injuries. We are resource constrained because of Medicare [and] Medicaid payment policies so we're basically shifting resources to care for sicker residents.
Q: What does the policy entail?
GM: Clinically we've always done a medical screening examination in the ER. We have historically treated and then sought to bill and collect from the patients once they left. What the new policy entails is continuing our medical screening examination process. When we get to the end of that, a qualified provider will make a determination as to whether the condition is emergent or nonurgent. If you are nonurgent, at that point you're required to make your copayment or a $200 deposit toward the cost of your treatment. If you elect not to be treated, then we'll refer you to one of our 15 walk-in clinics.
Q: How is this different than what the hospital did before?
GM: We have always done a screening examination and allowed the care to continue and then we were basically trying to bill and collect from insurers and patients — if they were self-insured. So the clinical track is historically we had a medical screening examination process and you were diagnosed and treated. Now, after the medical screening examination process occurs, if you're emergent you're diagnosed and treated. If you're nonurgent and you don't make your required copay or make the deposit, you're referred to one of our walk-in clinics, which shares a single EHR with the hospital, as well as its diagnostic centers and physician clinics.
Q: Have you noticed other hospitals adopting similar policies?
GM: We do see nationally and in the state of Mississippi ERs being constrained by the volume of residents seeking care. We do see movement among key insurance players at the national level to begin to treat any ER visit that is a nonurgent condition as an out-of-network claim. That's not happening in Mississippi yet, but the trend is starting to emerge nationally for that to happen. We are aware from the Healthcare Financial Management Association that about half of the nation's hospitals do charge upfront fees for nonurgent visits in their ER. When you laser in down to the state of Mississippi, there is one other hospital we know that's done this in maybe the past four or five months.
Q: How have staff and patients reacted to the new policy?
GM: Generally, we find the community being supportive of the policy because I think they do understand the congestion issue we're trying to address in the ER and that those resources need to be first and foremost for the most acutely ill residents. And our staff are supportive of the organizational goals — they're all prepped up and trained to do it — and, obviously, we started easing into this Nov. 1. The staff is trained, the workflow has been adjusted, any renovations required in the ER to accommodate the new workflow have been done. So, a lot of planning has gone into this. We're still [willing] to, two, three months down the road, change course a little bit [if we need to].
Q: Anything to add about the policy?
GM: I think what makes us unique — at least in our own mind — is over the past five or six years we have opened 15 walk-in clinics in the three coastal counties in Mississippi. These walk-in clinics [are] open up to seven days a week, [and] several of them have extended evening hours. They're open on Sunday and late on Monday through [Saturday]. I think what makes us a little bit unique is we've already invested in a way the community can access care close to home. Walk-in clinics provide care that is more cost-efficient for both the hospital and the patient.
Also, in the past three years — I think largely because of these walk-in clinics — about 10,000 visits have been lowered in the ER. What we've seen, though, is despite our lower-acuity visits being down by about 10,000 visits a year, they've been replaced by sicker patients. One of the goals of the new policy is to get those last 10,000 or so visits that are low acuity into the walk-in clinics over the next several years.
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