Pamela Treister, New York Institute of Technology – Uncompensated ER Care

On New York Institute of Technology Week: Uninsured E.R. visits are costly for hospitals.

Pamela Treister, clinical assistant professor of nursing, determines preventive care can help alleviate this cost.

As a nurse for more than 30 years, Pamela Treister has had the opportunity to have worked in many specialty areas: Trauma/Emergency Room, Neurosurgical ICU, Respiratory ICU, Nursing Education and Staff Development, School Nursing, Adjunct Professor in both RN-pathway BS program, and NYIT as a full time faculty member in the Nursing BS program for the past seven years. She is also the Nursing Arts Laboratory Coordinator and Simulation Laboratory Coordinator for sophomores, juniors, and seniors in the nursing program.

Treister is nationally certified in Adult Medical/Surgical Nursing (CMSRN). She also has her Asthma Educator Certification. Part of her responsibilities as a clinical expert are teaching nursing students in the junior level, both didactic and clinically. She has also taught Education for a Partnership in Asthma Care at Asthma Educator Institute (Asthma Coalition of Long Island). She received her Doctor of Nursing Practice (DNP) in Leadership from Quinnipiac University in 2016. Her Clinical Nurse Specialist degree was received from Hunter College, along with the Master of Science degree.

Treister’s research interests are using technology as a pedagogy for critical thinking, nursing education, education of parents to help prevent childhood asthma exacerbation, school nursing, emergency room nursing, competencies of baccalaureate nurses, use of simulation in nursing education, knowledge retention of nursing clinical skills from semester to semester, and leadership in nursing education.

Uncompensated ER Care


Since the 1986 passage of the Emergency Medical Treatment and Labor Act (EMTALA), emergency room professionals are obligated to treat all patients, regardless of their ability to pay. Consequently, hospitals are left to deal with the bills.

Increased volume of uncompensated care has caused more facilities to close, leaving others to carry the burden of overcrowding.

Many uninsured patients are undocumented immigrants who rely on Emergency Medicaid, costing the nation $2 billion dollars each year. While coverage definitions vary by state, emergency care and childbirth are typically covered. And one premature birth resulting from lack of prenatal care can cost the same as a dozen healthy births.

Primary and preventative care can avoid exacerbation of symptoms and costly ER visits. Reallocating federal funds to prevent and manage chronic health conditions for undocumented immigrants could greatly reduce uncompensated care.  

But there are other challenges. Many patients have high-deductible plans with large out-of-pocket expenses. Health Savings Accounts can help cover bills.

In addition, the electively uninsured, often identified as the “working poor,” may struggle. Referrals to providers with a sliding scale for uninsured patients can address conditions earlier.  

More thought must be placed on how hospitals can bear the burden of uncompensated care. ER staff is proficient in saving lives, now they must master fiscal health.

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