Overbilled and underserved. That's how a local family describes their recent visit to a hospital emergency room. Chief investigator Darcy Spears reports on why the family says they got better medical care at a gas station.
When Brianna Lee isn't playing soccer, the nine-year-old girl scout likes to help her parents, but that help recently turned to hurt. What happened to her could have happened to anyone. Brianna's mom was showing her how to pump gas and when Brianna went to remove the nozzle some gasoline splashed into her eyes.
Brianna's eyes were burning and her mother raced her into the gas station restroom where they flushed her eye. But the burning persisted.
"It was actually kind of scary because my mom didn't want my vision to go away and I was scared that I wouldn't have good vision anymore," Brianna said.
Fearing a chemical burn they went to the emergency room at Centennial Hills Hospital where records show they were told to spend more time washing Brianna's eyes.
"The eyewash station was too unsanitary and was too dirty so they couldn't use it," Brianna's father Ronnie Lee told us. It's a fact that's documented in her medical record.
"For the emergency room not to be properly equipped, not to be ready to process any type of emergency that comes in, is scary!"
Because the eyewash station was dirty, Brianna was sent to a regular sink and her mom rinsed her eyes.
Centennial declined an interview but reponded via email that they are reviewing the circumstances surrounding this matter to ensure that proper procedures are followed.
Ronnie says they got more help at the gas station, "there I actually had an eyewash, which they didn't charge me anything for."
The Lees received two bills:
$600 from Centennial Hills Hospital
$800 from the ER doctor
Beth Petschauer is a certified professional medical billing coder and auditor who's helped the state medical board with investigations. She says Brianna's records raise red flags.
"There's documentation in the medical records that makes me question whether or not the provider actually performed the services that he's billing for," Petschauer said.
"The doctor really didn't do anything. He walked in the room and he said that I need an eyewash station and he walked out. And that's pretty much all he did and I didn't see him after that," Brianna added.
The doctor's notes confirm that the family was sent to a sink then became disappointed in their care and left. But in the record, the doctor claims he did a complete review of body systems and a full physical exam.
According to Petschauer, "It would either be that the provider just automatically clicked on each of the things as if he did them, or he's padding the note in an attempt to get further additional funds. Level 3 and 4 are moderate where there's more testing required."
The doctor billed Brianna's care as level 3. Petschauer says her record shows something called "upcoding" and that it's an industry-wide problem.
Contact 13 left multiple messages for the doctor and the out-of-state emergency physicians group that contracts with Centennial Hills Hospital. None of our calls were returned.
Statement from Centennial Hills Hospital
Thank you for the opportunity to respond. Due to federal patient privacy laws, we cannot share patient information.
We are reviewing the circumstances surrounding this matter to ensure that proper procedures are followed.
The eyewash station referenced is located in a utility room and is for staff use in case a chemical/caustic substance splashes in their eye while they are working in the room. It's not in a patient care area and not intended for patient use. That eyewash station is cleaned weekly.
We would like viewers to understand they can always contact the hospital directly if they have questions about the care they received or the costs associated with that care. No complaint was logged with hospital administration, either about care provided or the bill received.
Due to patient privacy laws, we cannot discuss any associated specific billing matters. Further, Centennial Hills Hospital does not perform the billing or coding for the emergency physician services. Emergency department physicians at Centennial Hills are independent and not employees of the hospital. You would need to address any concerns relative to their billing or coding with them directly.
Centennial Hills Hospital Medical Center is committed to providing high quality, efficient patient care and aims to consistently meet or exceed our patients' expectations.
Statement from the Nevada State Medical Association
As it relates to hospital charges, the Nevada Hospital Association has a price transparency tool on its website which can help explain what goes into a charge. That is accessible here: http://www.nvpricepoint.net/ [nvpricepoint.net]
Physician charges – background information
As it relates to the physician charges, I wanted to give you more background on ER bills.
Emergency care represents less than 2 percent of the nation's $2.4 trillion in health care expenditures while covering 136 million people a year. Emergency departments are open 24 hours a day and provide "one-stop shopping" with all the hospital's resources – such as diagnostic testing and consultation by other medical specialists – in one place. The most pressing economic issue in emergency medicine is uncompensated care: poor reimbursement for emergency medical care has led to the closure of hundreds of emergency departments.
We invest in our ERs every day to ensure that this critical piece of our safety net is available to us when we need it.
The cost of providing emergency care relates to the severity of a patient's illness or injury and the necessity for the facility to be prepared for patients with the most severe conditions who may present without advance notice at any time. An illness or injury requiring multiple diagnostic tests and the services of medical specialists will cost more than something less complicated. Unlike a physician's office, the ER must have all appropriate diagnostic resources available 24/7/365, which contributes to the cost of care. Given that two-thirds of emergency department visits occur after typical business hours, having all the essential resources located in one place gives emergency departments an efficiency advantage no other part of the health care system can match. The major categories on emergency department bills include professional services (physicians, APRN's, Physician Assistants, etc.), pharmacy, supply, ancillary (laboratory, radiology), and miscellaneous.
When we as patients pay for physician services, we are paying for a highly skilled cognitive assessment and diagnosis. ER specialists are trained to quickly assess and triage patients to meet the rapid demands of the presenting patient population. As patients, we do not always see this process. The Nevada State Medical Association "NSMA" has no specific information on this occurrence, but it is important to understand that in many circumstances of chemical exposure, including hydrocarbons like gasoline, there is no specific test to perform, especially if the history obtained from the family is felt to be reliable and consistent with clinical findings. The appropriate protocol may be as simple as an eye wash to decontaminate the affected area - what the family had instinctively done - but for a greater length of time to ensure complete clearing of the foreign substance and appropriately address the pain, as was presumably ordered by the physician.
It's worth noting that even if "nothing is done" the physician is still required to do an assessment, document and complete an entire medical record, bill the visit (admin time) and pay for malpractice insurance (often a specific $/visit), so while more acute and complex cases certainly require additional resources, a fair bit of resource attaches to even the simplest of visits in the emergency setting because of the requirements of state and legal mandates.
NSMA does not speak for the ER physician attending this patient and, again, cannot address this incident with any specificity. While we regret to hear that any patient has a disappointing ER experience, we are pleased to note that the family felt reassured enough to leave the ER, that their insurance covered their visit, and most importantly that the child is feeling well.