Even as District of Columbia officials gave a cautious, interim report on their push to reduce with nurses’ help the expensive misuses of the 911 emergency system, a news organization’s story on a sky-high medical transport bill has underscored why regulators and lawmakers need to fix a pricey part of the health care system: Why can’t sick and injured patients get to treatment, quickly but without breaking the bank?
In the nation’s capital, it will take special nurses more time to settle in, overcome excess caution, and better help emergency dispatchers decide: When can they avoid sending expensive EMS vehicles and teams and when can patients with less urgent medical complaints be helped to get to care with cheaper commercial options, like app-based ride-sharing services Uber and Lyft, D.C. Fire Chief Gregory Dean has said.
The data from the first 90 days of the $1-million “Right care, right now” program to tap nurses’ expertise to divert non-emergency medical care out of the 911 system may offer modest cause for optimism, as the Washington Post reported:
Of the 1,103 calls routed to nurses for questioning known as triaging, officials said that 130 patients were sent to clinics, 289 calls were canceled, and 131 calls received ‘self-care,’ which includes nurses advising a caller to take prescribed medications to stabilize blood pressure or blood sugar levels or to buy over-the-counter ointments for other problems.
Robert Holman, D.C. Fire and EMS medical director, told the paper that nurses initially “were over-triaging back to 911 and they were doing so with an abundance of caution.” He counseled them, “not to send ambulances for strains and pulled muscles in the lower back or migraines and headaches that did not indicate any other serious disorder like a spike in blood pressure.” And, the newspaper said, “as nurses have gained experience and feedback, the calls resulting in emergency crews being dispatched has dropped from a weekly average of 33 in June to 15 by late August.”
In the District’s experimental program, the registered nurses not only triage the urgency of medical concerns, if they deem them to be non-life-threatening, they can help callers find commercial options near them — including doctors, hospitals, clinics, and retail and urgent care clinics. The nurses can work with Uber and Lyft to drive them to facilities, with costs sometimes covered under public support programs like Medicaid. (Indeed, national attention is focusing on these ride-sharing options as one way to reduce medical transport costs.)
That the sick and injured would make 911 calls may not reflect just abuses but also the significance of what experts call social determinants of health. These have major impacts: If patients live on the streets or in unfit apartments, drink substandard water, breathe polluted air, lack access to healthful food, and can’t travel by affordable public transportation to get screenings and treatments, their health too often declines — and the health system groans under the higher cost of caring for them.
Younger, lower-income women of color in the District struggle now to get critical maternal care services because has led officials to shut them at problem-plagued United Medical Center, a key hospital serving Southeast and Prince George’s County, Md. Providence Hospital in Northeast also closed its maternity ward. This has forced lower-income expectant moms to take multiple bus rides for months to get medical services to safeguard their unborn children.
A costly air-lift
But for Naveed Khan, 35, a Texas radiologist and married dad of three, it wasn’t a street car but an emergency air ambulance flight that turned into a medical billing nightmare. Khan was hanging out with friends on a rural dirt trail when he decided, what the heck, and he took his first, only, and last ride on an all-terrain vehicle. The ATV flipped as he was making circles in the sand on it. He suffered a deep gash in his forearm and knew his bleeding was serious enough he needed to get medical care fast.
After first going to an ER, he was told he needed to be flown to a more specialized facility with more resources if he were to save his arm — part of which he lost after eight later surgeries. He was charged $56,603 for a 108-mile helicopter trip. His insurer paid $11,972. But the air ambulance company came after Khan, now disabled, for $44,631 more.
The parties still are haggling, and the independent, nonpartisan Kaiser Health News Service, which told Khan’s story, has reported that it has received many complaints, as part of its series on extreme medical bills, about airborne emergency ambulance services. Kaiser has a separate story on them, including their defense: Operators say emergency care is among medicine’s most expensive. This can be even more so when equipping, staffing, and running such demanding treatment in planes or choppers.
Patients, to be clear, also have howled for some time now about ambulance costs on the ground.
In my practice, I see the harms that patients suffer while seeking medical services, and their struggles to access and afford safe, efficient, timely, and excellent medical care. My colleagues at the firm and I represent clients injured in car, truck, and motorcycle wrecks, and those whose lives and health have been upended by defective and dangerous products — including ATVs, notorious for hurting and killing their users. It’s unacceptable that Americans, in most dire circumstance, get hit with excessive charges for getting them to emergency care.
Doctors, hospitals, insurers, health policy experts, lawmakers, and ambulance companies — on the ground and in the air — need to step up and help the sick and injured before their anger boils over and they force changes in an area of health care where costs appear especially out of control.
It’s also painful as taxpayers, effectively, get hit twice with the costs of medical transportation services: We may be hit for private services and we also support with our taxes the dedicated, hard-working emergency staff in police and fire departments. We shouldn’t put first-responders in harm’s way and throw away precious public resources, answering calls for medical services that aren’t urgent and can be handled more appropriately by others.