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Emergency Room Coverage Follow-Up

Davison, Steven P. D.D.S., M.D.

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Plastic and Reconstructive Surgery: April 2008 - Volume 121 - Issue 4 - p 1518
doi: 10.1097/01.prs.0000305371.14837.79
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In 2004, I published an article entitled “Emergency Room Coverage: An Evolving Crisis.” This communication is a 3-year follow-up to update the readership.

In that article, I evaluated the emergency room remuneration at three different hospitals over a 30-month period: an inner city tertiary care center, an urban university hospital, and a suburban tertiary care hospital. There were unexpected findings. Although the ratio of uninsured was 66 percent in the inner city tertiary care center, 50 percent in the suburban hospital, and 22 percent in the university hospital, the lowest reimbursement was at the suburban tertiary care hospital (14.48 percent). The Inova Fairfax Hospital is in one of the wealthiest counties in the country. The patients in this hospital who required the greatest amount of services and who constituted the highest risk for untoward outcome, complications, and lawsuits were not insured.

The conclusions of the article drew much interest. I have received more correspondence on this article than on any other publication. I surmised that if a per diem or contracted rate for emergency room plastic surgery services was not covered, this luxury in the emergency room may cease to exist in the future. So what has transpired in three years?

  1. The hospital has added two hospital-based trauma surgeons to cover the increase in trauma volume.
  2. The hospital has had to hire four hospital-based ortho-trauma surgeons to replace the ortho-trauma call schedule.
  3. Ophthalmology calls coverage, in essence, ceased to exist.
  4. Otolaryngology and urology have both revolted; urology as a department dropped privileges secondary to the burden of uninsured care. They later recanted after negotiations.
  5. The hospital has now agreed to pay uninsured care at a rate of 85 percent of Medicare from a hospital-funded financial pool.

In 3 short years, this growing institution has had to replace several key services with hospital employees and now pays outside physicians at a contracted rate through a hospital-funded private pool. This is done to avoid violating Emergency Medical Treatment and Active Labor Act rules on specialty coverage for the emergency room.

Steven P. Davison, D.D.S., M.D.

Division of Plastic Surgery

Department of Surgery

Georgetown University Hospital

3800 Reservoir Road, N.W.

1st Floor PHC Building

Washington, D.C. 20007-2113

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©2008American Society of Plastic Surgeons