Ever notice that most things vendors recommend as a way to save money first require spending money — often on exactly the same service the vendor offers?
Ever notice that no matter who your vendors are or the service they provide, they always report a dramatically positive ROI? As one chief medical officer recently said to me: “If all the vendors got the ROI they claim to get, I’d have negative medical spending.”
But what if you or your clients could save money immediately without spending any money, hiring any vendors and paying actuaries to review the vendor’s alleged savings? And what if you could delight your employees at the same time?
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You can dramatically — and I do mean dramatically — reduce employee and employer spending for emergency room visits and emergency admissions and deliveries simply by writing this language on their insurance cards or teaching employees how to write it in themselves: I consent to responsibility (including insurance) for up to two times Medicare following receipt of an itemized bill for appropriate treatment.
Typically, emergency services — whether in-network or out-of-network — are priced at a large multiple of Medicare. That’s why your bills are four to five figures for emergency visits and five to six figures for emergency admissions. Not so with this “prevent consent.” Tying the fee to Medicare knocks a digit out of them.
So why does this work and what are the catches? A federal law called the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) requires hospitals and emergency rooms to treat emergencies regardless of the payment arrangement. There are a couple of limitations. Some free-standing ERs are not covered because they don’t have a hospital license. And while hospitals must admit and stabilize you, they can then transfer you if they don’t like your payment proposal. Otherwise, you have the legal right to be treated — particularly for straight ER visits.
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While required to treat you, the hospital or ER is not required to accept this Prevent Consent. However, to date, all that we are aware of have done so, albeit occasionally with some prodding. If they don’t accept the language at first, they will. Some executive in or near the C-Suite will eventually figure out that the risk of a collection lawsuit is too great. If they lose, their entire pricing structure could be undermined, since precedent (other than in small claims court) is created that two-times Medicare is a reasonable price.
This consent form has been used hundreds of times, and five of the users have gone public with their names and details. One patient, whose daughter (now doing well) was coded to the
It’s also important to educate employees on how to use this consent, and remind them what to do in the stressful environment of an ER. We recommend equipping employees with a handy checklist that can be written down and sent around to avoid paying massive bills when asked to sign a financial consent form. Even better, create a downloadable “mobile app” that contains all the needed information — the actual consent and the suggested protocol. The reason for an app is that most people take their phones to the ER, but might forget to bring a piece of paper.
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Our emergency financial consent language includes five steps to avoid being on the hook for a huge financial obligation. They include asking that the financial consent be printed for the patient to review; writing in the text “superseding other consents, I consent…”; demanding to see a supervisor if they object; suggesting they need to provide medical treatment even if they object to the patient’s consent language according to EMTALA; and insisting on treatment if they still object and don’t sign the facility’s consent form. Ideally, you’d add a sixth line, a 24/7 support phone number for employees who run into resistance.
Pre-COVID, your clients probably incurred about 180 ER visits per 1,000 employees. Some employees will forget they have this powerful tool, or be too stressed out half the time to think about it. One way around that is to tweak the benefits design to incentivize use, perhaps by covering ER visits at 100% if indeed the consent is used. Even if half of the consent opportunities go unused, saving a very conservative $1,000 per visit creates $90,000 in savings per 1,000 employees.
This figure does not include emergency hospital admissions for heart attacks, COVID or even unscheduled deliveries, where EMTALA also protects patients who use this consent form.
And, for once, your ROI is definitely positive – if for no other reason than the cost is $0.
