Bills

Study: Colorado hospital staffing company causing spikes in medical bills

DENVER — Emergency room staffing companies have been around for decades. But now, they are getting a lot of attention–some of it negative–because of criticisms they drive up medical costs.

A study by Yale University shows hospitals that turn to outside companies to staff their emergency rooms see a significant increase in patients’ medical bills.

One of those companies, Emcare, part of publicly-traded Envision Healthcare, is headquartered in Greenwood Village.

Emcare confirms it has a few hospital contracts in Colorado. But it wouldn’t say which ones.

Problem Solvers called hospitals around metro Denver.

The ones we got a hold of that do not contract with Emcare include:

  • Denver Health
  • Good Samaritan
  • St. Joseph
  • Lutheran
  • UC Health
  • St. Anthony
  • Children’s Hospital

So unless you do your due diligence, patients don’t know which hospitals contract with staffing companies, which ultimately means a lot more money out of your pocket.

A surprise medical bill is enough to make patients who went to the emergency room, even more sick than they went in–especially if a patient made sure the hospital was in-network.

“It’s very common for a patient go to a hospital where they have a contract with the patient’s insurer, and then find the ER group or other physicians at the hospital that don’t contract with the same insurer, then they get surprised (with out-of-network billing),” Metro State University Associate Professor Jeff Helton said. He worked as a hospital chief financial officer for 25 years and says hospitals are required to have doctors staff their emergency rooms around the clock.

He says it’s a difficult job. So some turn to staffing companies like Emcare to bring doctors into their ERs.

But some patients pay the price.

“We are finding more and more physicians groups like an Emcare are saying, they don’t want to take health insurance benefits anymore. It’s a business decision. They say the insurer is not paying enough, so they take what can get from the insurer and go after the patient for more,” says Helton.

So Problem Solvers asked how to avoid going to an in-network hospital with out-of-network doctors?

Helton says ask your insurer if the ER at your in-network hospital is also contracted with your plan.

But he says, if you can, avoid going to an ER if Urgent Care will do.

“Health care is a business. We do the same thing with airlines. If we are rushing to get on an airplane because you’ve got to go to a family emergency or something like that. They care going to charge you $1000 for the same seat, if you had bought it three weeks ago $200,” he says.

Emcare said the Yale study is fundamentally flawed and dated.

But also, the health care company says it’s working to move the majority of their doctors to in-network status.

Here is their full statement:

“The study appropriately identifies out-of-network reimbursement as a source of dissatisfaction for all payors, providers and patients in our current healthcare system. While the focus 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.

It is important to note that out-of-network is not an issue for any individual company; it is a structural issue impacting the healthcare industry. We are proactively and collaboratively working with payors, providers and legislative leaders to develop solutions that support patients so they can be afforded the right level of care without creating undue financial burden.

For Envision specifically, in February 2017, our organization made a bold first step with the public commitment to move the majority of our providers in network. In addition, we are working alongside our professional partners to support reforms to address out-of-network billing concerns, including aligning providers and payors to follow generally accepted and transparent guidelines for reimbursement, such as following the Fair Health database.

Envision is fully committed to migrating to an in-network status in an equitable manner while maintaining quality patient care. Successful execution will require a shared vision from the leaders of the payor, provider and legislative communities.”

 

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