Your training was intended to give you a skill set that you can use however you wish, including limiting your practice to only taking care of patients who pay you for your services. No physician is required to take Medicare or Medicaid, nor to work for free. We do so because nonprofit hospitals are where most of our jobs are, and because (like you said) many of us feel an obligation to take care of indigent patients.

I’m just pointing out that there are other options.

Some patients prefer (and are willing to pay a premium for) faster more personalized service rather than waiting hours in a busy waiting room with the dregs of society only to be treated like meat moved by overworked staff. That is their prerogative in a free country.

If a patient with a GSW is dropped off at the front door of a non-trauma hospital, I assure you that they are going to call 911 too. This guy shot himself INSIDE one ER and was transferred to a different trauma hospital. No difference, less paperwork.

Your opinion on how you think things ought to be is noted. I’m just trying to inform you how things are. Freestanding ERs offer full service emergency medical care more promptly and in a far nicer environment than most hospital-based ERs can manage. Having worked in some of them, I can assure you that they are indeed “real ERs.” They aren’t going away; there are dozens of them here, and more are being built every month.

Some insurers balk at paying the ER facility fee for these types of practices, but they generally pay ER billing codes. The patient is responsible for the amount unpaid by the insurers, like with every ER (including yours).

All admissions have to be transferred elsewhere, but many rural ERs/hospitals have to transfer many of their patients too, so that criteria isn’t really a valid argument. A hospital-based ER doesn’t have to be a level 1-2 trauma facility to bill ER fees, nor do they technically have to follow EMTALA.

An ER also does NOT have to be physically attached to a hospital to bill for emergency services. This one, for example, does bill Medicare/Medicaid and so they must see all comers, but it is not physically attached to a hospital.

“We accept most medical insurance plans and all major debit and credit cards. We do not accept Medicare or Medicaid.”

Food Service Ninja—I think there should be a special exception for ER docs since, as I say, they are the only profession that I can think of that’s mandated by law to work for free if they choose to work in 99% of emergency departments out there. Not all care they provide is free, but it’s like saying grocery stores have to allow customers (whether it’s 20% or 100% is random depending on the day) to steal $300 or more dollars worth of food each and you are obligated to not even ask them to pay. In addition, if they don’t like the food or it gives them diarrhea, they can sue you for as much as they want. F that. You can’t tax them if they’re forced to give stuff away; it’s only courteous to allow them to offset the forced freebies by not paying taxes.

No it doesn’t. Freestanding ERs (in this area at least) do not take Medicare, Medicaid, TriCare, or uninsured patients. They can (and do) refuse service even to obviously ill or injured patients, turning them away at the front desk without ramification, because EMTALA only applies to facilities that accept Medicare.

personally I think the cali suit will fail simply because the states broke and th state admins the medicare funds it gets from the federal govt.

Nurse K I think you have 2 problems with your logic

1. Your assuming the sole income of the er doc is medicare patients so there no way they get 100% tax deduct

2. if they belong to corp separate from the hospital why does that auto give them special tax status they are still an employee of a for profit corp.

Finally primary care docs are refusing to carry patients not on reg insurance because the lack of pay per service as well the cost to process the repayment by the govt and the delay in getting payment. These guys are losing money and all the billing/documentation costs are borne by the doc so why should ER docs get special treatment.

Conclusion the fed needs to fix our healthcxare system-hey I think ERP has posted this before sometime

I don’t think any of us mind losing money on an indigent patient that’s actually sick (MI, trauma, gangrene, lupus flare, whatever). But’s it is wrong to ask every doc to be forced to give her skills away for free to treat meaningless back pain, “I think I might be pregnant”, flu and other things that the privately insured patients would not get any medical care for.