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An investigation by KFF Health News in its national “Bill of the Month” feature recently outlined a Virginia woman’s experience at her local urgent care when she needed shot of epinephrine after a wasp sting began causing swelling and difficulty breathing. The KFF report describes how the woman was quickly diagnosed with anaphylaxis, but the care was delayed because she was required to complete a transaction to pay $400 up front before the shot could be delivered. Because anaphylaxis can be a life-threatening condition and epinephrine typically needs to be delivered to the patient immediately, the KFF investigation sought to uncover the reason why the patient’s care was not prioritized before the payment. According to KFF, the urgent care company’s officials confirmed the patient was asked to pay first but only after a nurse practitioner had determined the patient’s condition was stable. The federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital emergency departments to stabilize patients, regardless of ability to pay, but urgent care centers generally don’t fall under that law. So urgent cares can require insurance or payment up front for nonemergent care, but no policy should put a payment-transaction step between a patient in distress and that patient’s treatment, says Alan A. Ayers, MBA, MAcc, President of Urgent Care Consultants and Senior Editor of JUCM. “Every center should have a written emergency protocol, and every staff member, from the front desk to the exam room, should know it,” he says. “The reputational cost of getting this wrong is far higher than the unrecouped price of an epinephrine shot.”
Written protocol: Ayers and Urgent Care Association CEO Steve Sellars both spoke to KFF for the report, noting that patients do not always know the severity of their condition and asking for payment should not delay care for patients with emergencies. Ayers also says all urgent care centers should be equipped to recognize an emergency and stabilize the patient. “When a patient presents with red flag symptoms like shortness of breath, throat swelling, fainting, uncontrolled bleeding, or chest pain, that patient should go straight back to a provider, and the conversation about payment waits,” he says.