California Plastic Surgeons and The Emergency Room

Seeing as the topic of plastic surgeons and emergency department coverage in Southern California keeps coming back to the evening news and newspapers, I thought it made sense to address it. At present most Plastic Surgeons (myself included) look at covering emergency departments at local hospitals as a losing proposition. Often emergency calls come in the late evening and early morning hours and progressively fewer emergency patients seem to have insurance coverage of any kind. Looking at my billing company statements over the time (14 years) that I took emergency room call, I see roughly 40% of all my emergency department calls as uninsured. Nearly 80% of these patients paid nothing towards their bill or have disappeared following their procedures. If this were happening less frequently, we could look at it as "the cost of doing business." At it's present rate, it impacts upon a surgeon's ability to make a living. As you will see below, even the patients who have insurance are reinbursed at rates that are mediocre at best. Most surgeons run overhead at 50-60% of gross at the least.

A Few Emergency Room Patients For Whom Dr D Cared

The patients listed below were covered by insurance at the time I managed their injuries (Medicare plus a secondary as I recall). Their injury, procedure, time spent, reimbursement and time to payment are listed. How people can make money defrauding Medicare is beyond me. I often can't even get paid adequately for the things I actually do for them.

Case 1

This pleasant 79 year old gentleman had injured the tip of his index finger of his left hand on a table saw. The x-ray showed no fracture of the bone. The emergency room physician felt that this hand injury required the attention of a plastic surgeon.

emergency plastic surgery hand case

The hand was examined and no nerve of joint injury was appreciated. The laceration was cleaned and closed under local anesthesia. The surgeon's time in the emergency room for this patient was 1 hour. Medicare and the secondary reimbursed a total of: $21.39 three months after the case was billed (an average time). At this rate, the case is not worth keeping the other patients waiting in the office. I was late to see patients in the office as a result of taking care of this gentleman.

Case 2

This nice 77 year old gentleman had injured his forehead and eyelid in a fall earlier the same day. Hopefully, few emergency department physicians would undertake such an injury without assistance. No argument. This patient was better served by having a plastic surgeon address these injuries.

emergency plastic surgery facial case

This patient's injuries were cleaned and closed under local anesthesia in the emergency department. The surgeon's time in the emergency room for this patient was 3 hours. Medicare and the secondary reimbursed a total of: $283.14 two months after the case was billed.

I don't really have an issue with managing emergency patients, but if only half of them have any coverage and those that do pay fairly poorly, it is not worth getting up from bed to go see them. This is nothing personal against people needing emergency care, but with this renumeration my coverage of emergency departments decreased to nearly none a few years ago.

Hopefully, this will be seen as it has been designed; namely as an explanation of the status of emergency plastic surgery in Southern California. Once upon a time someone would be able to respond:

"But those were Medicare patients! My insurance pays better! I have good insurance."

Seeing as most insurance companies in Southern California pay based upon Medicare rates (often less than Medicare rates), your statement would no longer be correct.

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