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ER Doctors Paid to Aid Uninsured at JFK Medical Center

Posted on: Friday, 2 June 2006, 12:01 CDT

By Phil Galewitz, The Palm Beach Post, Fla.

May 23--In an effort to alleviate the shortage of medical specialists handling emergency cases, JFK Medical Center in Atlantis has started paying doctors for treating uninsured emergency patients.

JFK is setting aside at least $800,000 a year to pay physicians under the program that started last month, said Dr. Ross Stone, an orthopedic surgeon and president of the JFK medical staff.

"This gives us an incentive to cover the ER where otherwise we would lose money on indigent patients," he said.

While many South Florida hospitals have recently started paying hard-to-find specialists such as neurosurgeons and hand surgeons a daily stipend for being on call for emergencies, JFK is believed to be the first to directly reimburse doctors for treating uninsured emergency patients. JFK is owned by HCA Inc. (NYSE: HCA; $43.44), the largest hospital chain in the country.

JFK doctors are paid only if uninsured patients don't qualify for Medicaid, the Health Care District of Palm Beach County's Coordinated Care program or other government insurance programs. The doctors are paid a rate based on how much the federal Medicare program pays for the service.

Some doctors say the JFK reimbursement program is fairer than paying physicians a daily stipend for being on call. That's because a doctor who treats a patient with health insurance under that system gets to "double dip" -- receive a payment from both the hospital and the patient.

Another complication with the stipend system is that hospitals tend to pay medical specialties different rates, which irks doctors getting the lower rate.

"This is a unique approach to the problem, but actually quite a rational one," said Dr. Jack Zeltzer, JFK's chief of surgery.

For the past three years, local hospitals have struggled to get enough specialists to treat emergency patients.

The shortage has led to long delays in getting treatment and has forced Palm Beach County hospitals to send patients to Miami or Gainesville for care.

JFK CEO Gina Melby declined to comment on the new program. A spokeswoman declined even to confirm the existence of a new payment system.

The compensation does require some commitment from physicians. If specialists agree to the ER payment system, they also must agree to handle nonemergency hospital patients who don't have their own doctor, Stone said.

The doctors are obligated to see the patients in their office as part of follow-up care.

Mitch Feldman, the top Palm Beach County executive for Tenet Healthcare Corp., which owns five local hospitals, said he looked at a reimbursement system for treating uninsured patients but concluded it was too complicated.

"We did not want to become a de facto insurance company," he said.

It used to be doctors worked a few days a month in the emergency room as part of their obligation to have hospital privileges.

Those days are long over in Palm Beach County and the rest of South Florida. With many specialists no longer carrying medical malpractice coverage because of its high costs, doctors say they are doing all they can to limit their liability risk.

Doctors perceive treating emergency patients as risky because they have no prior relationship with them.

The growing number of Palm Beach County patients without health insurance also has spurred doctors to avoid the ER.

That's because doctors worry about not getting paid for their services, particularly when they show up in the middle of the night to conduct emergency surgery.

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Copyright (c) 2006, The Palm Beach Post, Fla.

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HCA,

Source: The Palm Beach Post

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