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posted: 12/9/2012 6:09 AM

Some emergency rooms are taking reservations

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Bloomberg News

Just before her wedding this year, Ashleigh Kondracki came down with bronchitis and went to the emergency room. Instead of an onerous wait, the 22-year-old receptionist from Imperial, Mo., simply walked through the doors at SMM St. Clare Health Center and was seen right away.

Kondracki was able to breeze through the crowded waiting room because she made a reservation online from home, where she waited until her appointment.

Hospital emergency departments eager to woo patients are borrowing an idea from the restaurant industry. ER online reservations are available at more than 100 hospitals, including facilities run by Tenet Healthcare, the third largest U.S. hospital company.

Reservations and other concierge services, including mobile apps that provide wait times, are intended to make emergency room experiences more palatable.

"We value it as a service," Tenet spokesman Rick Black said in an interview. The Dallas, Texas-based company provides the online ER check-ins at 42 hospitals. It's free for patients at all but a few of those facilities.

Reservations, already available in some doctors' offices, are part of an increasing effort by hospitals to shore up revenue by enhancing patient satisfaction. On that score, the emergency room is an especially sore spot: From 2003 through 2009, the mean wait time in emergency departments increased to 58 minutes from 47 minutes, according to a report by the National Center for Health Statistics.

Hospitals need to improve or the bottom line could suffer. The Affordable Care Act is shifting how hospitals are paid for patients on Medicare, the U.S. health plan for the elderly and disabled. Patient satisfaction scores will be taken into account in reimbursements, with higher-scoring hospitals landing bonuses.

In fiscal 2013, an estimated $850 million -- funded by reducing hospital-based Medicare payments by 1 percent -- will be allocated according to performance measures that include scores from patients such as those admitted through the ER.

Hospitals also want to benefit by attracting insured patients. About 60 percent of the patients at the Medical Center of Central Georgia in Macon, part of Central Georgia Health Systems, come through the emergency department, spokeswoman Cyndey Costello Busbee said in an interview. It began offering ER reservations about a year ago, and the service has boosted patient satisfaction scores and improved efficiency.

"Because we make money on inpatient admissions, we want as many to move through our portal as possible as opposed to competitors," she said, noting that the reservations are free for patients."We were trying to clean up the way people just flood in. It's revolutionized the experience."

To use the reservation service, patients must describe their ailments when making a reservation. The online booking system won't accept requests that involve serious symptoms such as chest pains, instead directing patients to go to the hospital or call 911.

InQuicker, a Nashville, Tenn.-based company with $4 million in sales, offers the concierge service to about 140 hospital emergency departments.

"Doctors and nurses have embraced InQuicker because they can focus on the business of healing rather than apologizing for lengthy waits or a lack of communication," Tyler Kiley, InQuicker's co-founder and chief technology officer, said in an email.

Still, ER reservations may run afoul of a U.S. law that bans hospitals from giving different treatment to patients for nonmedical reasons, said Robert Bitterman, president and CEO of Harbor Springs, Mich.-based Health Law Consulting Group, which specializes in emergency medicine risk management.

That's because customers who hold their place online may be seen ahead of others with similar complaints that have been sitting in the waiting room, he said in an interview.

"It's a wonderful system for urgent care or primary care, but it should be kept out of the emergency department," Bitterman said, adding that it discriminates against lower- income patients. "Poor people don't have access to smartphones or computers."

Some critics say the service encourages overuse of already crowded emergency rooms.

"I'm just floored," Sara Rosenbaum, a health law and policy professor at George Washington University in Washington, said in an interview. "It's concierge emergency departments, and by definition, if you're making an appointment, it's not an emergency. These are the same hospitals that go crying that they're awash in patients and don't know what to do."

The check-in service has undergone legal review and doesn't violate the U.S. statute, said Chris Song, a spokesman for InQuicker. He said hospitals who had charged a fee of about $4 to $20 are now dropping patient charges.

"A hospital's triage and throughput process remains the same for patients whether or not they use InQuicker, and care is always given based on the most urgent medical need," he said.

Other novel efforts by hospitals to appeal to emergency room patients include roadside bulletin boards that advertise wait times and mobile apps that provide real-time wait data.

"There's more of an interest and focus on patient experience," Andrew Sama, president of the American College of Emergency Physicians, said in an interview.

Richard Easterline, nursing director for emergency services at Seton Northwest Hospital in Austin, Texas, is also a fan.

Unnecessary use of the emergency room hasn't risen since Seton Northwest Hospital rolled out reservations last year, he said in an interview. Instead, it helps patients who would otherwise have to delay treatment until they can see their own doctor, he said.

"If a mother gets a call that her child is sick and can't get an appointment with a doctor for a week, yet she can get an appointment in the ER, why should that mother wait?" he said.

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