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emergency rooms

The down side of scooters

Watch out for that tree. And that pedestrian, and that street light, and that strange bump in the sidewalk, and that abandoned scooter someone just left lying there…

Photo: Richard A. Marini, San Antonio Express-News

In September 2017, Tarak Trivedi, an emergency room doctor, and Catherine Lerer, a personal injury attorney, started seeing electric scooters everywhere. Santa Monica, California, where they live, was the first city where the scooter company Bird rolled out its rechargeable two-wheelers, which could be rented with a smartphone app and dropped off anywhere. Lime and other scooter companies soon followed. As riders zipped down the street, reaching speeds of 15 miles per hour without helmets, both Trivedi and Lerer thought of the inevitable injuries.

Soon enough, victims of e-scooter accidents, both riders and pedestrians, began to show up in the ER. “I started seeing patients who had significant injuries,” Trivedi recalls. Calls about scooter-related injures poured into Lerer’s office. She says she now gets at least one new call a day. “We recognized that this is a very important technological innovation that has a significant public health impact,” Trivedi says.

More than a year after the Birds landed, Trivedi and researchers at the University of California-Los Angeles have authored the first study to quantify the public health impact of e-scooters. Their peer-reviewed study, published in JAMA Network Open, details 365 days of scooter crashes, collisions, and wipeouts. Digging through records from two Los Angeles-area emergency rooms, the researchers found 249 patients with injuries serious enough to warrant a trip to the ER. In comparison, they found 195 bicyclists with injuries and 181 pedestrians with similar injuries during the same period.

The goal of the study was to characterize how people were getting hurt, as well as who was getting hurt. Of the 249 cases the study looked at, 228 were riders, most of whom were brought to the ER after falling, colliding with an object, or being hit by a moving vehicle. The other patients were injured after being hit by a rider, tripping over a scooter in the street, or getting hurt while attempting to move a parked scooter. About 31 percent of patients had fractures, and around 40 percent suffered from head injuries. Most were between the ages of 18 and 40; the youngest was eight and the oldest was 89. While many of the injuries were minor, severe and costly injuries like bleeding in the skull and spinal fractures were also documented. Fifteen people were admitted to the hospital.

Trivedi thinks that the actual number of scooter injuries was likely higher, since the study took a conservative approach to tallying up patients, focusing only on standing electric scooters and dropping many ambiguous cases. (It also eliminated instances where riding a scooter was not the cause of a scooter-related injury—such as assaults where a scooter was used as a weapon, or injuries during attempts to steal a scooter.)

That’s from California, and it’s a partial picture of what has been observed in Los Angeles, based on two emergency rooms. The authors didn’t extrapolate from there, but it’s clear there would be a lot more than just what they focused on. That’s the first study of its kind of scooter injuries, but we do have some anecdotal evidence from Texas cities where the scooters have invaded, including San Antonio, Austin, and Dallas, where there has also been one reported fatality, though it is not clear if that person (the victim of a hit-and-run) had been using the scooter at the time of his death.

Let’s be clear, cars cause vastly more havoc every day than scooters do. The magnitude of injury and death resulting from our automobile-centric culture just dwarfs anything even an onslaught of electric scooters can do. In the long run, more scooters may lead to less vehicular damage, if it means more people rely on them in conjunction with transit to take fewer trips by car. That doesn’t mean we should ignore or minimize the potential for injury that scooters represent. It’s up to cities and states to figure out how to regulate these things in a way that maximizes their benefit and minimizes their risk. That means we need good data about the real-world effect of scooter usage, and we need to avoid being unduly influenced by the scooter companies and the venture capital behind them. Let’s pay attention to this stuff and be responsible about what we learn.

Now how much would you pay for that emergency room visit?

Guess higher, and it is a guess because who knows what you’ll wind up getting charged for it.

Fifteen months after Texas enacted a law to bring transparency to the state’s for-profit free-standing emergency rooms, many of the facilities continue to send mixed messages about insurance coverage that could expose unsuspecting patients to surprise medical bills.

A Houston Chronicle review of websites representing the 52 free-standing emergency rooms in the Houston area shows a pattern in which many of the facilities prominently advertise that they “accept” all major private insurance. Some even list the insurers’ names and logos.

But often tucked under pull-down tabs or at the bottom of the page is a notice that the facilities are outside the networks of those insurers, followed by a reassurance that under the Texas insurance code, network status does not matter in emergency treatment, implying patients needn’t worry about coverage.

What the websites fail to disclose is that out-of-network status can result in insurance reimbursements far below the charges, leaving patients on the hook for the remainder of the bill — sometimes thousands of dollars.

“The word ‘accept’ means something very different to them than to the consumer, and they know that when they write their websites,” said Stacey Pogue, senior health policy analyst at the Austin-based Center for Public Policy Priorities. “They do not tell the rest of the story.”

For example, many of the Houston-area facilities advertise that they accept Blue Cross and Blue Shield of Texas, the state’s largest insurer. But the Chronicle’s review found that only five — about 10 percent — are in that insurer’s network.

Those findings are consistent with a statewide report by AARP Texas, to be released Monday at a state Senate committee hearing, that found 77 percent of the state’s 215 free-standing emergency rooms said they “take” or “accept” Blue Cross and Blue Shield insurance, but were out-of-network.

Free-standing emergency rooms defend their websites, describing concerns raised by advocacy groups and Texas lawmakers as manufactured outrage.

“I don’t see a problem with saying they ‘accept,’” said Dr. Carrie de Moor, CEO of Code 3 Emergency Partners, a Frisco-based network of free-standing emergency rooms, urgent care clinics and a telemedicine program. She insisted that patients understand that accepting someone’s insurance is different from being in that company’s network.

It may seem like a hair-splitting distinction, but it can carry high costs, health policy experts said.

Obvious point #1: It’s ridiculous that we live in a society where basic medical needs, including emergency care, are not met. It’s utterly scandalous that prior to the Affordable Care Act, there were thousands upon thousands of bankruptcies caused every year by medical issues. Plenty of other countries have figured this out. Our standard of medical care is no better than theirs. It’s just more expensive.

Obvious point #2: For those who believe in the power of the free market, why is it that medical services, especially those tied to emergency and hospital care, are so utterly opaque when it comes to their pricing? Think of all the other goods and services you buy. In nearly all of them, you know up front how much it’s going to cost. That is universally untrue for the vast majority of medical services, from basics like painkillers and bandages to anaesthesia and specialist fees to higher-end products like EKGs and colonoscopies. There’s no such thing as a free market with unknowable prices. You want to move towards something like a free market in health care, fix that.