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Scamming the system costs everybody more

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Patients calling for an ambulance because they can't afford a taxi, or fabricating complaints to avoid having to pay, are among the issues confronted by hospital staff.

Roslyn Bascome-Adams, the Emergency Department Director, told

The Royal Gazette that misuse or outright abuse of the Emergency Room (ER) at King Edward VII Memorial Hospital affected staff morale, stretched resources, and drove up costs.

The Director said that demands from unnecessary or “contrived” calls to KEMH end up hurting the entire healthcare system.

“I think we have always been abused by people using the Emergency Department as a GP's office. We've seen more of that recently,” Dr Bascome-Adams said.

Patients have come to the ER demanding pregnancy tests, flu shots or unnecessary X-rays, she added.

“A GP's co-pay may be $30, but a minimum call to the ER is almost $300.

“We understand there will be the need for patients to come for things they perceive as urgent, because they're in pain and unable to get relief.

“But in today's world we are getting more people coming without trying anything. While we will deal with it, because we don't turn anyone away, it carries with it a burden for the healthcare system.”

There were 33,439 ER visits in the latest fiscal year, at a direct cost of $10.2 million. Visits arriving at the facility are placed on a five-level waiting list by order of urgency, and those deemed the least urgent carry a price tag of $276.

The most urgent cost $849.

While most patients have valid health concerns, and not every misuse is intentional, Dr Bascome-Adams recounted cases of people who “work the system”.

“We have asthmatics who can't buy their pumps, and stay without until they start wheezing,” she said. “But there are some who only come when the pharmacies are closed, after hours or on weekends. They know.”

She recalled a recent case of insurance fraud where a patient called on the ER, and was filed into the system under her sister's insurance — and thus the wrong name.

“She had to have blood tests taken, and it so happened that the results that we got were different from what we had on file for the person which we had taken two years ago. The lab thought the Emergency Department had messed up so they scrapped all the labs taken. We had to scrap all the labs for that particular day.”

This meant that every patient who had been blood tested that day had to come back.

Until the deception was noticed, and Dr Bascome-Adams realised that the discrepancy had been caused by the patient using her sister's insurance, the entire ward's work was impeded.

“We're fortunate we did not have to give an emergency transfusion that day,” she added.

Dr Bascome-Adams said the poor economy was behind “some of what we see. But lack of understanding is another reason why we see cases that don't need to be seen here.”

Some patients have demanded X-rays against medical advice, or to get tests done more quickly.

“In some cases there is a quick fix mentality, and people see the ER as a one-stop shop for everything. One person told me: 'Why should I go to my GP when I have to wait for my results until the next day?'”

Dr Bascome-Adams added: “An important concept for people to wrap their minds around is the fact that if they don't pay [it] doesn't mean it didn't cost anything. It comes from the premium you have been paying — and everyone ends up paying more.”

Counting the cost: Visits to the ER are not cheap
Director of the Emergency Department Dr Roslyn Bascome-Adams (Photo by Glenn Tucker)
<B>Healthcare isn't free</B>

With non-essential calls on the Emergency Room increasing, a Bermuda Hospitals Board spokeswoman gave a reminder that the services there aren't free.The Royal Gazette that uninsured patients will still be billed for services.www.bermudahospitals.bm

The ER is for those who believe they are in need of immediate medical attention, she said.

“Within the hospital and the ER department, we continually monitor our spending to ensure that we are always receiving the best value for money — while at the same time providing our patients with quality care,” she added.

“Last autumn we completed a comprehensive review of all our spending plans and we are currently in the process of carrying out a further detailed examination.”

ER director Roslyn Bascome-Adams told

While the ER doesn't have its own agent to follow up after people refuse to pay, “the hospital has that in place”, she said.

“Our finance department will work with all people to set up payment plans and assist where necessary.”

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Published May 15, 2013 at 9:00 am (Updated May 14, 2013 at 11:51 pm)

Scamming the system costs everybody more

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