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‘Er’ Patients Run Up Hefty Bills Amid Scant Mention Of The Bottom Line

Mon., May 29, 1995

Patients on the medical drama “ER” get treatment that is swift, certain - and apparently free.

The rapid-fire series rarely pauses to acknowledge the cost of all those RNs and MDs administering TLC to the bruised and battered.

But in the real world, somebody’s going to get stuck with the bill.

And the bottom line can be a heart-stopper, according to a sampling of figures from an emergency center.

Burn dressing, around $266. A chest X-ray, $78. A catheter to deliver intravenous fluids, $105. A physician’s attention for a tummy ache: maybe $200, depending on how much it hurts.

Buyer beware: Costs vary widely, depending on where you’re treated and who ultimately pays. A private hospital is likely to charge more than a nonprofit facility like “ER’s” fictional County General Memorial Hospital.

And the bill may reflect whether a patient is insured or indigent, or if a hospital has a “managed care” agreement with a medical insurer that limits charges, experts say.

Some facilities itemize each procedure, while others charge flat fees. At Cook County Hospital, Chicago’s real-life counterpart to the “ER” hospital, trauma patients are charged an inclusive daily rate.

That ranges from $450 for simple observation to $2,200 if admitted to the hospital’s intensive-care trauma unit, said spokeswoman Tabrina Davis.

A separate Cook County Hospital ER facility for less-urgent cases charges $200 to $400 for treatment, plus test and other costs. Last year, the ER and trauma centers combined saw nearly 160,000 adults and children.

Nationwide, more than 100 million emergency department visits are expected this year, according to the American College of Emergency Physicians. Forty percent of hospital admissions arrive via ERs.

If the fictional patients swarming the corridors of “ER” this past season wandered out of TV land, here’s an estimate of what their treatment would have cost at one nonprofit hospital in a midsize Southern city.

(Other charges could be incurred, so consider the following amounts a minimum, according to an emergency room physician who provided the fee schedules.)

A utility worker is brought in after a high-current jolt sends him tumbling 20 feet and inflicts third-degree burns. Doctors start a central IV line ($342) in the chest to provide large amounts of fluids ($130). An IV catheter ($105) and IV pump tubing ($25) are required.

Burn dressing costs up to $266, and X-rays are $78. Physician’s charge is $372, with a nursing and facilities fee of up to $861. Total: $2,101.

A middle-aged man complains of lower abdominal pain. “ER’s” Dr. Mark Greene (Anthony Edwards) orders blood tests ($25), an abdominal ultrasound ($276) and liver function tests ($26). Add physician’s charge ($212) and nursing and facilities fee ($252). Total: $791.

Greene’s supervisor diagnoses indigestion and cancels all tests. Unlikely, real doctors say. In today’s litigious times, at least blood and urine samples would be analyzed.

A young girl is suffering headache, dizziness, nausea, rapid heart rate. Pediatrician Doug Ross (George Clooney) puts her on a heart monitor ($40; another $26 to interpret the data) before attempting a diagnosis.

Child’s mother: “Doctor, are these tests going to cost a lot of money?”

Ross: “You have insurance, don’t you?”

Mother: “No.”

Ross: “Well, we’ll work something out.” A Medicaid application will be made, he says.

The drug Adenosine is administered (about $100). When the girl’s pulse fails, defibrillation is required ($6 for defib pads). Physician’s fee is $372, while nursing and facilities fee is $252. Total: $790.

While the above numbers may be unsettling, be comforted by this: ER doctors insist that cost is disregarded during treatment.

“My perspective is that if I have a person come through the door, I do everything I can possibly do for that person and then sort it (payment) out later,” said Dr. Lance Gentile, an ER physician and technical consultant to the NBC series. “ER” deliberately bypasses the pressing issue of healthcare costs, he says, for the good of the show: “It’s not that dramatic, frankly. It would bog down a story.”

“We have lots of nurses crowding around trauma victims because it looks REALLY cool,” Gentile said.

Tags: television

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