Hospitals Guarantee Health-Care Delivery


Thirty minutes or it's free. The marketing concept has become a hit in the business of pizza delivery, but is it good medical practice in the nation's emergency rooms?

Columbia Medical Center Phoenix is one of a number of hospitals in the US that are testing the idea for patients with minor emergencies. It and other affiliates of Columbia/HCA Healthcare Corp., the hospital-chain giant, are offering the 30-minute guarantee of service in an effort to attract emergency-room patients, who say long waits are their top complaint.

The Columbia experiment has intensified an already-searing debate over quality of medical care in an increasingly commercialized - and competitive - environment. It comes at a time when high costs of health care have been driving the nation to rethink the way health services are delivered and shifting the balance of power between doctors and the business office.

The idea is causing some in the medical community, notably emergency-room doctors, to ask whether a profession that prides itself on adhering to the Hippocratic oath should be resorting to the same marketing techniques as fast-food chains.

Columbia's pitch is simply stated in its newspaper advertisements: "You'll be seen by our triage nurse and then an ER professional in 30 minutes or your visit is free." Typical emergency-room waits are about 1-1/2 hours.

Improving its emergency-room service has paid off, according to Columbia spokeswoman Caroline Berger. Since the 30-minute deal started a few months ago, Columbia has seen a rise in emergency-room visits.

The medical center sees about 15,000 emergency-room cases a year, a small number compared with other Phoenix area hospitals. During a recent survey, she notes, the hospital recorded a 5 to 10 percent increase in weekday emergency-room traffic, compared with the same period a year ago. On weekends, patient traffic jumped 20 percent over the comparable year-ago period.

Some patients are driving past other emergency rooms in more outlying areas to come to Columbia, believing that the total time to receive treatment will actually be less than if they had stopped at a closer site, Ms. Berger says. The policy applies only to minor emergencies. More severe cases are moved ahead in line.

The idea is being tried, as well, at non-Columbia hospitals around the country. Baptist Hospital East in the Louisville, Ky., suburb of St. Matthews offers "Emergency Care Express" to patients whose needs appear to be less serious. Spokeswoman Marilyn Clark says treatments there begin in about a half-hour, but the hospital does not offer the guarantee Columbia does.

Even critics of the idea laud the service improvements, noting that emergency rooms generally have been lacking in speedy response for some time. But the marketing ploy raises deeper concerns, they say, striking at the very heart of the relationship between doctor and patient and possibly trivializing health care.

"It is one more nail in the coffin of professionalism" when the public comes to regard doctors in the same way it views pizza deliverymen and overnight delivery services, says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. Marketing programs like Columbia's, he adds, "contribute to the pizzafication of medicine."

He is especially concerned about where the trend might lead. Might a hospital, he asks, advertise a "30-days-or-it's-free" strategy for patients seeking to recover from an illness?

Todd Taylor, former president of the state chapter of the American College of Emergency Physicians, says Columbia's idea runs against "the most fundamental tenets of emergency care." In a letter to hospital chief executive Denny Powell, he said the practice would start "a disconcerting trend" if allowed to continue.

But Columbia's Berger insists that "quality of care is our No. 1 issue for all our patients." So far, she adds, the hospital has not had to pick up the tab for a single patient.

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