The ambulance arrives at your door at 3 AM.
Your elderly father's urinary catheter is blocked. He's in pain, anxious, and can't urinate. Your family called 911 because you know it’s bad and you didn't know what else to do.
The paramedic takes one look at the situation and knows exactly what's wrong. The catheter needs to be flushed or replaced - a 10-minute procedure that any experienced paramedic can handle with the right supplies.
But here's what happens next: Your father is getting loaded into that ambulance anyway.
Not because he needs to go to the hospital. Because the paramedic can't bill insurance unless they transport him and company policy says transport pays the bills.
There are no CPT codes for "problem solved at home."
Over 65 years ago in Alexandria, Virginia, 4 physicians established America’s first 24/7 year-round “emergency room” to avoid always being on call.
Today, the ER has grown to many rooms and we’ve rebranded it as the “emergency department” It’s accessed (and over-accessed) for everything and everyone - for treatment of the most minor ailments to the most life-threatening ones.
Back then, an ER visit cost just $8.
Today's reality is very different, and one of the reasons is our attachment to health insurance and medical billing.
And when no transport = no billing = no revenue, things change quickly.
So, the paramedic who could have fixed your father's catheter in 10 minutes at home?
They're required to take him to the ER anyway, where he'll wait 4-6 hours for the exact. same. procedure.
This isn't a training problem. It's not a competency issue. It's a billing system that punishes efficient medicine.
What Really Happens When You Keep Someone Out of the ER
Let's talk about what's actually at stake here.
That unnecessary ambulance ride costs $1,500. The ER visit for a blocked catheter? Another $3,000-5,000. Total bill: $6,500 for a 10-minute procedure that could have been done in your father's bedroom.
But the real cost isn't just your money.
While your father sits in the ER for 6 hours waiting for someone to flush his catheter, he’s exposed to whatever cold or flu is going around. The stroke patient who comes in behind him waits. The heart attack patient waits. The trauma victim waits.
And those other ambulances that transported patients with blocked catheters, minor cuts needing stitches, and medication refill issues? They're not available for the actual life-threatening emergencies.
“911. What’s your emergency? Please hold.”
Every unnecessary ER visit creates a cascade effect that makes the system worse for everyone.
Here's a real story that illustrates the insanity:
A 90-year-old physician with metastatic cancer was in hospice care. He had a recurring medical issue that flared up every few days - something completely manageable by an experienced paramedic.
Under the current system, this man would have needed to go into the ER 2-3 times per week. Each visit would have meant 6-8 hours in a hospital bed, massive bills and pure misery for someone who just wanted to die peacefully at home.
Thankfully they access to Tony Barone’s company, Emergility, a private EMS service that operates outside the insurance billing system.
They responded to this patient 34 times over 6 months with a trained team. Every single response was for a genuine emergency that would have otherwise been a 911 call. Every single response was handled at home.
Total cost: $10,000.
Compare that to 34 ER visits at $4,000+ each. You're looking at $136,000+ in hospital bills.
But here's the beautiful part: Because his emergencies were handled at home, this dying physician had the energy to attend church, visit the Kennedy Center with his wife and maintain his dignity during his final months.
When he passed away, his wife mentioned the Emergility team in his eulogy. A hospice patient - someone who was literally dying - kept telling them they were "saving his life."
The solution is embarrassingly simple: Remove insurance from the equation.
Barone and his team operate on a ‘direct-pay model.’
No insurance billing, no CPT codes, no bureaucratic nonsense.
When you call them, a team responds with hospital-grade equipment: 12-lead EKGs, ultrasound, advanced medications, the works. Depending on your needs, this might be an experienced paramedic, or for more complex cases, a PA or nurse practitioner working alongside EMS personnel.
If they can solve your problem at home, they do. If you need to go to the hospital, they facilitate that transport and can even accompany you to ensure continuity of care.
The pricing is transparent and affordable.
No surprise bills, no insurance hassles, no network restrictions
Most importantly: The incentive structure is aligned. They succeed when they solve your problem efficiently, not when they generate maximum billing.
Why This Benefits Everyone (Including Hospitals)
This isn't about putting hospitals out of business or competing with 911 services.
It's about right-sizing the response to the actual problem.
For patients: Faster response, better care, lower costs, no unnecessary hospital exposure.
For hospitals: ERs can focus on actual emergencies instead of being clogged with routine issues.
For 911 services: Ambulances stay available for true life-threatening calls.
For the healthcare system: Massive cost reduction, better resource allocation, improved outcomes.
But, as Tony shared,
"Hospital protocols are not about patient safety. Hospital protocols are about risk management and protecting the hospital."
This of course also extends to billing maximization.
The current system forces everyone into the most expensive setting for care, regardless of whether it's appropriate.
That's insane from every angle.
A team with the right equipment can handle a broad range of conditions that would otherwise require ER visits - without the wait, the expense, or the hospital exposure.
And if the emergency requires a hospital visit? That’s easy. They make sure they get there.
Let's break down the real numbers:
Traditional path for blocked catheter:
Ambulance: $1,500
ER visit: $4,000
6-hour wait time
Total: $5,500+ for 10-minute procedure
Direct access paramedicine:
Based on Tony’s math… $10,000/34 visits?
Total: $294 for a better, more convenient outcome
You're looking at HUGE cost reduction with dramatically better patient experience - especially for elderly or frail patients who shouldn't be sitting in ERs for hours, or for those who require additional privacy for security reasons.
Scale this across the calls that don't need ER-level care, and you're talking about hundreds of billions in healthcare savings annually.
Why the System Fights This So Hard
If you could solve even 50% of "emergencies" at home for 5% of the cost, several powerful entities lose money:
Hospitals lose ER revenue
Ambulance companies lose transport fees
Insurance companies lose justification for high premiums
The current system isn't broken. It's working exactly as designed - to maximize revenue extraction from human suffering.
Direct access medicine threatens that entire model by proving you can deliver better care for less money when incentives align properly.
The Future is Here
During our conversation, Tony emphasized that this model isn't about competing with hospitals or 911 services - it's about filling the gaps. As he put it, "We are here to be the change we demand in healthcare."
Tony's Emergility is operational in Northern Virginia right now, handling real emergencies and keeping real people out of ERs they don't need to visit. They've proved the model - navigated the regulatory maze, secured the proper insurance, and built the infrastructure.
Hopefully other entrepreneurs are taking notice. The model is scalable and desperately needed everywhere.
I believe this is the future of care.
Maybe soon you won't have to accept 8-hour ER waits for minor issues.
You won't have to accept $5,000 bills for problems a paramedic could solve in your living room.
The alternatives exist. The technology exists. The expertise exists.
The only missing piece is enough people demanding something better.
Every time you choose direct access over the traditional system, you're voting for a future where:
Healthcare costs reflect actual value delivered
You and your doctor determine what's best
Real emergencies get immediate attention
Routine issues are handled efficiently
Your dignity matters
Your Move
In the future maybe we'll all be asking ourselves:
Do I really need the ER, or do I need a competent medical professional with the right equipment to assess my situation?
More importantly: Am I willing to pay a reasonable fee for that assessment at my home, or do I want to spend 3x more to get the same assessment after waiting 6 hours in a hospital?
The choice will be yours. The infrastructure is being built.
The question is whether you'll use it.
Learn more about Tony, direct access paramedicine and protective medicine at emergility.com. I have no financial ties to disclose, but I am proud to support the amazing work Emergility is doing!
And as a reminder:
Direct pay medical care is AMAZING and pairs perfectly with CrowdHealth
Ready to experience healthcare differently? Visit joincrowdhealth.com and use code “Liberty Lab” for $99/month for the first 3 months.
Until next week,
Tiffany
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