September 5, 2019

Freestanding Emergency Center Conversation

Ever wondered why insurance companies have so much influence on healthcare and healthcare laws?  Ever thought that things were not fair to the health providers or patients?  Ever thought about trying to do something to make things fairer but got frustrated or felt so overwhelmed that you didn’t try or gave up because you felt that no matter what, the insurers would come out on top because they had too much influence, pockets too deep to fight and would ultimately win any fight anyway?  You are probably not alone.  Many freestanding emergency center operators and physicians probably share some of your frustrations and probably many others.

In spite of meeting state requirements and being legally licensed, following state laws and regulations, providing emergency services from board-certified emergency physicians and delivering care and service equivalent, and in some cases superior, to the care delivered in a traditional emergency department located within the confines of a hospital, freestanding emergency centers are often being denied payments by third-party payers/insurers for emergency services they provide to patients.  What’s more, the free-standing emergency centers are sometimes portrayed as being fancy urgent cares, facilities that overcharge for services or even detrimental to patients or communities.

Insurance companies often deny payment, delay payment for services, or do not respond quickly to efforts to collect what is owed.  It is reported that insurance companies may intentionally do so in order to cause financial hardship to these FECs in hopes of forcing them to agree to contracts that are very favorable to the insurers; contracts that would not allow FECs to stay in business.  Some may say that insurers deny payments with the intention to cause such financial hardships to the FECs that they are forced to go out of business.

Without getting into all the reasons why this is done or think about how insurers can get away with it, perhaps it is more useful to think of how to make things better.  While one will agree that insurance companies have more money than most any FEC operator, insurers have more lobbyists on their payrolls than FECs do, insurers are very good at marketing and spinning stories in order to make the system or others within the system as the problem or cause of the high insurance costs and high health care; it is the physician and FECs that have one big advantage over insurers.  We are on the right side of the issue. 

Not only are we right but also we are resourceful.  We are historically great advocates for patients.  We have patients’ best interests in mind.  So why do we continually allow insurers to run over us?  OK, OK, there plenty of excuses.  We already mentioned a few earlier.  This was more of a rhetorical question.  If we want things to change, we have to do things differently.  Some guy named Albert said something about doing things the same way and expecting different result…. But I regress. 

We have to think differently, and we have to be willing to step out of our comfort zone a bit.  No one has all the answers but maybe here is one of many ideas to consider. Educate the public.  Not just one patient at a time, although we should always try to educate our patients, many citizens and voters at a time.  We need a campaign to spread our word to the public i.e. television, internet, printed materials, email campaign, etc. pointing out factual data in a simple, easy to understand catchy way.  Something that is more likely to be remembered and repeated.  i.e. insurers are about “inadequate insurance policies”, “denied access”, “less choice” to name a few. Or FECs believe in “It’s your choice”, patients deserve better, “your right to choose”, “your family, your choice” etc.

We are intelligent, resourceful people.  It takes a lot of determination to get to where we have gotten.  It takes a lot of work and resourcefulness to be a great physician.  So, don’t tell me that insurance companies are smarter or work harder.  Yes they spend a lot of money but money alone does not always win.  Remember, we have right on our side.  Our profession is respected because we care about patients.  This is a patient care and choice issue.  Not a doctor issue, not an insurance issue, not a businessman issue, it is about what is fair and right for patients.

As for money, yes it helps and we do need to spend some in order to help get our point across and help citizens understand the truth.  If we can get past our reluctance to work together, there are ways for FECs to pool their money together to market important points in an effective manner through public service announcements and commercials citing benefits of FECs i.e. choice, board-certified physicians, convenience.  Help people realize the benefits we bring to them and the community.  Help them understand in a simple way what insurers are doing.

Doing television, radio or print interviews cost little to no money.  Yes, they cost time but do you want things to get better or not?  How many TV or radio stations have you and your colleagues contacted this week to discuss healthcare issues facing our citizens?  How many speaking engagements have you or your staff done this week?  Reaching out to teachers' unions, businesses, churches, chemical plants, community leaders and other citizens who utilize health services, pay for health care, vote and have influence over lawmakers can be very powerful.  Why do you think the surprise billing issue is getting so much attention?  It’s not because we think it is a problem, it is because citizens are complaining, it is getting radio, television and print coverage and those complaining and affected are voters.  When voters start demanding something to happen, things often happen or at least have a much greater chance of happening.

We have to show our value to patients and our communities.  We have to compete with the insurers at delivering the message we want the public, the community and state leaders to hear; the message they need to hear.  With the trust the public has in us comes a lot of responsibility.  We have to take the high ground and police ourselves and make sure we are not allowing ourselves or fellow FECs to abuse our positions, bill irresponsibly, perform unnecessary testing or procedures or admit patients to observation that could be safely discharged.  The more we can demonstrate that FECs are responsible and a valuable part of healthcare and the community, the better our position and our chances of winning the fight we have to win in order to protect our livelihoods, our businesses and most importantly our patients and their ability to have increased access to and more choices in healthcare.

Op-Ed by Edward Shaheen, MD, FACEP