I spent most of my evening at the urgent care clinic. My little guy’s asthma had been getting bad and we wanted to avoid the overnight ER visit for a multitude of reasons. The inhalers and nebulizer treatments had been creating sixty to ninety minute long bubbles of good breathing and then the therapeutic period would end. The primary objective tonight was to get a prescription for liquid steroids and then watch and wait after another round of breathing treatments. We were released and he fell asleep before we were out of the parking lot.
Before we left the clinic, the doctor gave me a brief list of instructions — get the prescription, make sure he is propped up while sleeping, and if he is having significant problems overnight, take him to the regional pediatric specialty hospital ER. This specific recommendation caught my ears. The urgent care clinic is staffed by the same provider group that staffs that particular ER.
We’ve taken my son to the ER a couple of times for breathing problems. We have gone to the pediatric specialty hospital. We have gone to the community hospital. The claim always comes back as a Level 3 ER visit with very similar sets of procedure codes. The only difference on the explanation of benefits and the bill is the contract rate for a basic Level 3 ER visit and basic asthma treatment. The regional specialty hospital gets two to three times as much from my insurance than the community hospital. Our experience had been there was minimal difference in the time it took my son to resume breathing reasonably well on his own at either location.
I only know this because I play with claims data and fee schedules on a daily basis so I have an absurd attention to my EOBs. If my son is in trouble overnight, the most probable case scenario will have me take him to the community hospital as the care is fine there. If he is in extreme trouble/turning blue, we’ll head to the specialty hospital, but the 90% scenario if we leave the house is to go to the community general hospital.
Most parents in my shoes would not even think through the choice of the two hospitals. They would not have the knowledge nor the readily available data to make this type of choice, nor would they know that the referring doc works for the same company that staffs the specialty ER.
My question, and this is an honest question, is simple — does a doctor who makes a referral have any obligations to the patient beyond not sending them to grossly incorrect providers (ie sending someone to a neurologist for a broken ankle)? Is there a reasonable man standard or higher for referrals or are conflicts of interests fully allowed?