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Why switching hospitals could cost you


Marcus Pickett

Making visits to multiple hospitals? Your care could be pricier than if you had stuck with just one hospital.

According to a study published by the Archives of Internal Medicine, patients who visited more than two emergency rooms saw a bill that was more than one and a half times higher than that of patients who visited only one ER ($12,050 vs. $7,465).

Patients being treated at multiple hospitals can waste time and money. Often, there is no way for a doctor or nurse to see the results of tests administered at other hospitals. That means performing duplicate tests. Not knowing which medicines were prescribed elsewhere can further delay care and result in a longer hospital stay. And if doctors don't have timely access to patients' medical records, they may not be able to make a critical diagnosis and may wind up prescribing less effective medications and treatments.

Increased costs may not seem significant to patients with health insurance, who are unlikely to be directly affected by them. However, insurance companies pass higher costs (like those associated with multiple hospital visits) onto customers in the form of higher health insurance premiums.

Trying to convince people to visit the same ER every time they need emergency care is not the only solution. Two other solutions: the introduction of electronic medical records and the rollout of better health information technology.

Health insurance and health networks

Ironically, health insurance may actually be the cause of patients switching hospitals. By switching health insurance plans, the original hospital may no longer be part of the plan's health network. Health insurance plans may make exceptions for emergency care, but not all ER visits may qualify. Worse yet, if a patient must be admitted for extended care, a transfer may be necessary to avoid higher out-of-pocket costs associated with these health networks.

ERs  vs. doctor's offices and other facilities

This issue primarily affects emergency rooms, urgent care facilities and their patients because treatment may be required before adequate medical records can be obtained. Emergency rooms and urgent care centers see patients at all hours. When a patient makes an appointment at a doctor's office, it's typically during normal business hours when other medical facilities are open and available to submit records. But it may not be possible, for example, for an ER in New York to get medical records from California at 8:00 a.m. EST. As a consequence, important tests and treatments may be delayed, additional doctor visits may be necessary and extra costs may be accrued.

Electronic medical records

Electronic medical records and better information technology are key components of the health care reform debate and, some experts believe, an effective way to keep health care costs from spiraling out of control. Under this scenario, a health care provider would be able to instantly access medical records, determine whether a new medication will adversely interact with current medications and communicate this information to a nurse practitioner should unexpected symptoms arise. This scenario is cited in a December 2010 report from the President's Council of Advisors on Science and Technology.

This report warns, however, that electronic record-keeping must be carried out in a comprehensive way before many of its advantages can be realized. The federal Centers for Medicare and Medicaid Services, the report says, need "major modernization and restructuring" of technology infrastructure and staff to engage in such a "sophisticated exchange" of health information.

Until medical record-keeping is modernized, patients would do well to avoid visiting multiple ERs whenever feasible.

In August 2010, the medical journal Health Affairs and Brandeis University's Health Industry Forum hosted a news conference with experts, insurance company representatives, health care providers and patients to discuss guidelines and incentives for moving from paper record-keeping to electronic health records.

This program is not alone. Organizations across the country -- representing patients, doctors, hospitals and insurance companies -- are working to create better health information technology and maximize its benefits.
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