Is ER Service Becoming More Business Like

June 5, 2002
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GRAND RAPIDS — Thirty- and 60-minute guarantees are garnering publicity for hospital emergency rooms around the state, but not every caregiver is in a position to offer — or wants to offer — such a service.

That’s because each hospital is different.

The Emergency Medical Services Department at Saint Mary’s Mercy Medical Center in downtown Grand Rapids is an award-winning unit that prides itself on offering the best possible care in a timely fashion.

But it doesn’t offer a time-based guarantee. Health care, doctors say, should be personal and not reduced to a cookie-cutter mentality where every “customer” is the same.

Dr. Bryan Buller, director of emergency medical services at Saint Mary’s, realizes that both sides of the issue are important. Buller told the Business Journal that the ER guarantee does make the doctor-patient relationship seem less personal and more like a business transaction. But, at the same time, he also said it demystifies the aura of a once religious-like relationship.

“People used to think that their doctors walked on water and we’ve kind of come off that throne. It’s hard for someone who has been in practice for 20 or 30 years to see this going on,” said Buller.

“We’d like to be treated like kings, but we’re not. To that extent, I think it brings that relationship to a level that is a little bit more realistic,” he added.

As far as patients being referred to as customers, Buller brushed that off as semantics. Instead, he said there was a larger issue that needed attention and clarification.

“I think it’s the attitude of how we treat patients. They deserve not to be lowered from a patient level to a customer level. But maybe we need to increase what needs to be given to them, which is what is expected in the business world when we have a customer,” he said.

Buller said patient service has changed drastically over the past few decades, as hospitals and physicians have tried to find treatments that are more acceptable to what certain patients want.

For instance, he said some patients are deathly afraid of having blood drawn for tests. Twenty years ago, the blood would have forcefully been drawn from their veins, or they would have been told to leave the hospital.

Today, Buller said doctors regularly use alternative methods to meet the wishes of their patients — or to phrase it another way, to satisfy their customers.

“Maybe we’ll do a better job if we look at other areas, like business, and consider patients as customers that deserve more than what we were giving patients before,” said Buller, who has spent three decades working in emergency medicine.

“But do I represent all of medicine? By no means. There are a lot of people that think it is abominable that we’d do that.”

Buller said, however, that if Saint Mary’s could pull it off, he would like his busy inner-city ER to also offer a 30-minute guarantee. But realistically that’s a tough number to reach in emergency medicine, which often deals with unscheduled life-or-death injuries. Patients have been known to wait for even longer periods in their doctors’ offices, and they had appointments. So their doctors not only knew that they were coming, but also knew why.

“The problem with emergency medicine is nothing is planned. So we have to figure out when to do our staffing — with an appropriate and affordable staffing, given that there has been a tremendous cutback in health care dollars the last five to 10 years,” said Buller.

The ER wait at St. Mary’s can range from 40 to 90 minutes depending on patient traffic, which may be the heaviest in the city, and the types of injuries or illnesses. To meet a 30-minute guarantee, Buller estimated that he would have to double the current space his ER has, and add at least five more beds. He also said that ER construction is very costly — over twice as much per square foot as standard office space runs.

As for personnel, Buller felt he would need a minimum of two more full-time physicians. A pair of experienced trauma nurses also would need to be found, during a nursing shortage. Properly scheduling the staff is another issue, and the system that processes patients would also have to be reviewed, retooled and retrained.

Then there is the sticker shock that administrators would almost certainly experience. Buller said Saint Mary’s ER would need another $1.5 million added to its budget just to cover the start-up costs the guarantee would bring to his department.

“That would give us some additional facilities. Then, on a yearly basis, we would probably have an additional half-million in salaries,” he said.

And there is one more business consideration: a little thing called profit.

“If you more than double your staffing and you only increase [business] 30 to 50 percent, that’s not a money-making proposition,” said Buller.

So with the additional staff, space and expense required, not to mention the cost of the movie passes, why would a hospital offer a 30-minute ER guarantee that isn’t likely turning a profit? Business people should know the answer to that question, especially the retailers.

“It becomes sort of a loss-leader,” said Buller. “You throw a lot of resources into the front end, with the idea that you know a lot of patients will be admitted down the road. It makes sense to have those patients come in and be admitted to the hospital because it will generate in-patient stays and charges that can compensate for all those resources.”

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