This loophole in coverage has been previously identified as a policy failure, and advocacy groups and politicians are leading ongoing efforts to fix this.9-11 In the meantime, clinicians are faced with valid concerns from their patients about the risk of medication costs. This summer, we surveyed members of the ACEP Observation Section and Association of Academic Chairs of Emergency Medicine to better understand how our colleagues are approaching this challenging issue. We received completed surveys from members representing 28 institutions, and their responses highlight the pervasive nature of the problem and various strategies to address it (see Table 1).
Until a policy solution is implemented, providers are left to identify local solutions. Four main strategies are being utilized: do nothing; allow patients to take their home medications (if they happen to bring them in); bill at a reduced rate; or not bill at all. The second option introduces significant logistical barriers because the Joint Commission and the Centers for Medicare & Medicaid Services both require medication verification, a time-consuming activity. After verification, medications typically still require specific orders, nursing involvement in their administration and documentation, and secure storage. Billing at the lowest contract rate or at hospital cost is another option that could mitigate patient fears but still leaves some potential exposure for those patients on many or particularly costly medications, and it does not account for the fact that patients already paid for the medication when they filled the prescription. Providing medications at no charge shields patients while shifting responsibility entirely to the hospital.