Late-night ER fee dropped
By Elizabeth Cooney
Globe Correspondent
In the face of criticism from a union of health workers, a physicians group has decided to drop its late-night surcharge for patients who come to emergency rooms after 10 p.m. at five Massachusetts hospitals.
Harvard Medical Faculty Physicians said today it would no longer add $30 to bills for emergency care delivered between 10 p.m. and 8 a.m. The fee was attacked earlier this week by a health-care union that is trying to organize workers at Beth Israel Deaconess Medical Center, where the doctors are affiliated. The other affected hospitals are Beth Israel Deaconess-Needham, Nashoba Valley Medical Center in Ayer, Saint Vincent Hospital in Worcester, and Milton Hospital, which dropped the fee earlier this month.
"The general feeling is if it could cause one single patient not to seek emergency care, then we don't want it," Dr. Richard Wolfe, chair of emergency medicine at Harvard Medical Faculty Physicians and Beth Israel Deaconess, said after talking with physicians at the five hospitals. "We've instructed our billing company to no longer bill for that code."
The union called for refunds.
"It's good that when this indefensible practice was called to the public's attention that Beth Israel stopped it," Mike Fadel, executive vice president of Local 1199 of the Service Employees International Union said in a statement e-mailed to the Globe. "These fees never should have been charged in the first place, so if they want to do the right thing, they now need to refund the fees to the patients who were charged."
Patients with insurance might not have seen the fee. The government Medicare and Medicaid programs do not pay doctors who bill such a fee, nor do private insurers Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Tufts Health Plan, and Aetna, spokesmen said today. If insurers reject the fees, the patient cannot be charged under a state law that forbids what is called balance billing.
The few patients without insurance who pay their own bills might have been charged what would represent less than 5 percent of a total charge for emergency care, Wolfe said. David McKenzie, reimbursement director of the American College of Emergency Physicians, said the late-night fee is commonly billed throughout the country, although the group does not track such claims. Doctors at none of the other major Boston hospitals charge the fee.
Wolfe compared the fees to different rates that nurses are paid for working late shifts, defending them as a way to reward people willing to work overnight, especially at a time when emergency physicians are in short supply.
"It ends up being a morale issue to support the people that are doing the work," he said.
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Elizabeth Cooney is a former
health reporter for the Worcester Telegram & Gazette, where she also was a
business reporter and an editor. Earlier in her career, she edited medical
books and journals at Little, Brown, and worked for Boston magazine.Boston Globe Health and Science staff:
- Gideon Gil, Health and Science Editor
- Ishani Ganguli, Short White Coat blogger
