An afternoon in the ER
The average emergency medicine physician at Grady sees about 5,000 patients a year, more than half of whom are considered “self-pay,” meaning they have no medical coverage whatever.
The term self-pay is a bit optimistic: the current collection rate for self-pay patients is about three cents on the dollar. But the doctors don’t know and don’t have time anyway to think about which insurance category patients might be in. They are too busy prioritizing patients’ needs and meeting those needs as fast as humanly possible.
Take, for example, one afternoon in the life of Leon Haley (above), Emory’s vice chair of clinical affairs at Grady. It started quietly enough with an asthma patient wheezing from the summer heat and an abashed weekend handyman limping from a fall off his ladder. Then a couple from Cobb County arrived, the man seemingly oblivious to the blood drying on his shirt, the woman with no memory of the accident on I-75 who kept looking at the bruises on her arms as if they were coming out of nowhere. What other internal damage could the blunt trauma have caused? As a team of physicians began orchestrating her care, two more ambulances arrived, both with trauma patients. One held a man and woman, each with several gunshot wounds, the other, the shooter and would-be robber who had been shot three times in the leg by the intended robbery victim. The woman, wounded in the abdomen, was rushed to surgery.
The bills kept mounting. Most gunshot wounds cost more than $5,000, often more than twice that, depending on which bones or organs are affected. Most car crashes cost even more because of the complexities of the injuries involved and the typically longer ICU stays.
Who pays? The nicely dressed couple were uninsured, both laid off from professional jobs more than a year earlier. The robbery victim and his wife turned out to have Medicare and Medigap insurance. Even the young robber was covered by Medicaid, thanks to his mother. It was not a bad day in the ER, from Haley’s perspective—everybody got put back together. And although he was unaware of it, some were even able to pay.