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Highlands Today

The cost of emergency care

Diagnosis: It's not cheap at all

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By BRAD DICKERSON

Highlands Today

Published: August 1, 2010

SEBRING - A recent incident of chest pains sent Elliott Moses to the emergency room.

The owner of Computer MD in Lake Placid said doctors didn't see anything, but they wanted to keep him for observation anyway.

Moses said he refused and went home. Then he got a bill for $1,500. Shortly thereafter, he called for an itemized list of expenses.

"And there were all sorts of errors," he said. "Doubles of everything."

After the bill was reviewed, $500 was knocked off and the new total was $1,000.

So what were some of the individual charges? Moses said it cost $36 to have an X-ray read and $4 for an aspirin.

Then, he got a $1,000 doctor bill, bringing the new total to $2,000.

Without insurance, Moses set up a payment plan to take care of the expense. His current balance is $900.

The bill has meant cutting back on spending for a few months.

"And (trying) not to go to the doctor," Moses said.

Of medicine and money

It should come as a surprise to no one that health care isn't cheap. And it continues to be a hot topic across the country.

The purpose of this story is to discuss just what those costs are when it comes to emergency care.

Not all information will be presented. Representatives from Florida Hospital Heartland Division did not wish to comment, and calls to Highlands Regional Medical Center were not returned.

Still, a glimpse into itemized costs in emergency rooms can be found in the bills patients like Moses receive.

Avon Park resident Steven Person said via e-mail that he went to the ER on March 30 for a lower back injury he suffered after falling in the shower.

"I was C-scanned, X-rays, the works," he said.

The ER visit was $1,150, the ER doctor's examination cost $373 and there was a $600 fee for the radiologists to read the scans, according to Person.

Leah Pace-Aubrey recently took her son to the ER for stomach pain, where he was given an IV and a CT scan.

"The hospital charge was over $8,000, and I am now receiving the EOBs (explanation of benefits) for his blood work and radiologist reading," she said via e-mail. "So far, total is over $9,000. My part after insurance is over $1,000."

Pace-Aubrey said she will probably have to pay off the balance in several payments.

Fees for a ride

Of course, before any tests or blood work can be done at a hospital, a person must first get there.

If that way is by ambulance, the patient will be charged $10 per loaded mile, according to Steve Coltharp, director of EMS services for Highlands County.

Hence, if the patient is 10 miles from the hospital, the ambulance ride will cost $100.

"Ten miles is more than the average of what we're going to be transporting in the county," Coltharp said.

If a patient is treated at the scene and not taken to a hospital, the cost is $75.

The basic life support (BLS) base rate, which includes an IV or less, comes out to approximately $327.54, according to the Highlands County EMS fee schedule for the 2009-2010 fiscal year.

Then there are the advanced life support (ALS) base rates. If an ALS 1 is billed, it will cost $388.95.

An ALS 2 rate is $562.96.

The ALS treatments include at least three administrations of medication or one of the following procedures: manual defibrillation, endotracheal intubation, central venous IV line, cardiac pacing, chest decompression, surgical airway or an intraosseous line.

The majority of cardiac calls would be an ALS 2 charge, according to Coltharp.

Up until a year ago, patients suffering from certain types of heart attacks were flown by Aeromed to Tampa General Hospital for treatment.

These patients, as it turns out, are under the gun to meet a deadline. They are referred to as STEMI, which is a certain type of heart attack and stands for "ST segment elevation myocardial infarction."

"What that's telling us is if they can do a (catheterization) on you in 90 minutes, from the time that you call us, they can reverse the heart attack," Coltharp said. "So, we're in a very close timeframe and the only way to get them into that receiving center would be to fly them."

According to information from Tampa General, the 2010 Aeromed fee schedule is $11,041.71 for liftoff and $113.97 per loaded mile.

Recently, Florida Hospital opened up a STEMI program as well, and Highlands Regional is in the process of starting one, according to Coltharp.

"So, our patient options in the last year, in the cardiac end of it, have really opened up to where you don't end up with heart damage in a lot of cases," he said.

And if a cardiac patient can be treated locally, the Aeromed bill goes away, which Coltharp said can cost locals upwards of $15,000.

Of course, if a patient is given a $15,000 flight bill, Coltharp and his team have to be correct with the diagnosis. The risk of false positives is out there, even if the initial information is accurate.

"But when they did the cath, they found out, well, the heart's in good shape, but maybe something else that was ... causing the chest pain, causing the cardiac monitor and the 12 lead that we started doing in the field, to look like it was a STEMI," Coltharp said. "You look at that and say, 'Man, you just got a $15,000 bill for indigestion.'"

Future form of emergency care?

Could ice and refrigerators hold the key to future forms of emergency care, thereby helping to save a patient's life and cut costs?

Coltharp thinks so.

He said preliminary research continues in the area of cooling down a person's core body temperature during a heart attack, stroke and certain other trauma.

This process, according to Coltharp, helps to slow down and almost preserve body functions.

"Eventually, from what I'm looking at the research, we'll start doing it," he said.

According to a May 2007 issue of Newsweek magazine, Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania, developed an injectable slurry of salt and ice to cool the blood quickly.

He hoped to make it part of the standard emergency-response kit.

Coltharp said if cooling the body proves to be effective, not only could it result in less damage to the system, but it could also mean less time in the hospital and less rehabilitation.

Obviously, that also means less cost.

Still, the numerous procedures and high costs associated with emergency care don't seem to be going away anytime soon.

"One of the biggest problems is you go in the hospital, every test imaginable has to be done, because if the doctor's wrong and says, 'Well, it's indigestion,' but it ends up as a heart attack, well, the doctor's sued," Coltharp said.

Highlands Today reporter Brad Dickerson can be reached at 863-386-5838 or bdickerson@highlandstoday.com

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