Posted on 10/02/2011 6:25:01 AM PDT by ilovesarah2012
“Our hospital will receive 32 million dollars less this year due to Medicaid cuts.”
You hospital, if they are like most other hospitals will compensate by providing extra procedures that Medicare/Medicaid will pay for, as well as cost shifting to those with insurance, and/or the ability to pay.
If this sort of thing were illegal like it should be, your hospital would be bankrupt.
If someone goes into the ER and asks “How much will this visit cost?” will they get a straight answer?
but illegals without even MediCaid will still get free ER care, right?
too many use the emergency room for the doctor’s office
**********************
Yep.
True, but OTOH, some primary care doctors will refer patients to the ER without evening seeing them first. That happened to me when I had severe pain and numbness in my left arm and I had insurance BTW.
I was confident that it was some sort of muscular problem and I wasn’t having chest pains, shortness of breath or other coronary symptoms and thought it was something else, probably tendinitis. After being up all night in severe pain and I mean severe pain, I still waited until my doctor’s office opened to call and make an appointment only to be told to call 9-11 or have someone drive me to the ER. I vehemently argued that I didn’t need to go to the ER; that I wasn’t having a heart attack but my primary care doctor insisted that I should go to the ER. That and that I couldn't be seen for a regular appointment for at least another week and while I didn't think it was a life threatening emergency, I couldn’t see myself being in that much pain for another week or more, especially since OTC pain relievers and heat and ice packs weren’t doing anything for me. (And I actually went to work that morning only to be told by my boss to go to the doctor's or the ER or go home as they didn’t want to be responsible if it was something more serious).
I fully understand that non-emergency visits to emergency rooms, people using the ER for primary care visits especially those on Medicare and Medicaid or without any insurance, put a huge strain on the system and greatly drive up health care costs. I don’t disagree that this is a big problem and something needs to be done about it.
OTOH, I think that sometimes it is hard for a person to objectively self diagnose whether the chest or severe abdominal pain or shortness of breath they are feeling is an emergency or not or a pregnant woman with bleeding isn’t in need of immediate care. Fortunately my self-diagnosed tendinitis was just that, but what if I was wrong and I was having a heart attack and didn’t go to the ER? As it was my insurance company didn’t want to pay the ER claim until I provided proof that my primary care doc had actually referred me to the ER. It took months and many phone calls and letters to get it straightened out and not being made to pay out of pocket for the ER visit as a non pre-approved "emergency".
I havr no problem with cutting Welfare Medicaid coverage.
The problem is that it is a federal crime and malpractice liability to refuse these parasites.
Why do you call the poor “parasites”?
One of our hospitals here does exactly that. You go to the emergency room and check in and are seen by a triage nurse. She decides if you go to the clinic or into the emergency room. The clinic closes at 10 pm but it would probably be cost effective for them to keep one person there round the clock.
I suppose. How would the hospital know if they were legal or not?
Again, maybe tgose Medicaid patients should claim to be illegals. heh
thats not an ER. ER's have to be staffed 24/7 by an MD or maybe in a tiny rural one a PA or Nurse Practioner. I will bet you it was an Urgent Care, which can operate any time they please.
Depending on the type of insurance you have, an HMO for instance, an “Urgent Care” facility may not be covered. If your doctors office is closed and the hospital ER won't see you and all you have left is an independently operated, non-hospital affiliated “Urgent Care” facility you are screwed as, if they are not on your insurance companies list of facilities and you don’t have the money to pay out of pocket, they can refuse to see you. I could be wrong but I don’t think non-hospital affiliated private “Urgent Care” facilities are under the same rules as an ER to not deny treatment.
The hospital ER CAN’T not see you. Under EMTALA they have to do a medical screening exam. If they determine the problem is non emergent THEN they can refer you away, but they MUST do the screening exam and establish that no emergent medical condition exists. And yes, EMTALA does not apply to Urgent Care clinics not physically on a hospital campus.
I work in a hospital ER - I would agree with that figure of 85% of ER visits not being actual emergencies.
I also really like that RN’s suggestion of having a triage nurse at the door to filter out the non-emergents.
FrogDad and I have lived in this town for 20+ years and have been to the emergency room twice.
Once, I went to the doctor with chest pains - made an appt with the doc, because I’d had a cold and assumed it was muscle pain from all the coughing I’d done. They slapped me into a wheelchair and pushed me across the street to the ER. I was taken directly to a treatment room. My self-diagnosis was correct, BTW.
Then, FrogDad had surgery for a hernia. One morning, about 6 weeks later, he coughed and his incision opened up, squirting blood around (NOT arterial bleeding, just the force of the cough). We weren’t sure what to do since he now had an open wound in his abdomen leaking blood. Called the doctors office, they said, “take him to the ER”. The ER was full of non-English speaking people (this IS Arizona) and I dreaded a wait, but he was seen after about 15 minutes by a nurse who said he could wait to see the doc. She sterilized the area, bandaged him up, gave us some instructions about what to watch for with the wound and sent us on our way.
I have no complaints, but we haven’t had a real emergency, either.
“Thats an EMTALA violation”
I do not think so. The patients are not being turned away, they are being triaged. If during triage it is found that they do not have a life-or-limb-threatening condition they can be referred to a basic care provider -or- told they need to cough up some cash to be seen in the ER.
I personally know of several hospitals in the Salt Lake City area that do this and they have succeeded in making their emergency rooms places where EMERGENCY care is provided.
I would estimate that in the ER where I used to work about 25% of the Medicaid patients were able-bodied, under 30, and seeking opiate pain medication. In Idaho there is a Board of Pharmacy website that records all of the controlled substance prescriptions a person received along with the name of the prescriber. I had a lot of fun confronting these losers with 4-5 pages of the narcs they had been prescribed by others and were not going to get from me.
I don’t know how that can even be called an “emergency room”. Where I’m from, ERs are open 24x7 with an ER doc on duty at all times. The hospital also has to have a 24 hour on-site stat lab.
So explain this: I went into the hospital last year on the orders of my doctor because I was having chest pains and had an irregular EKG. 24 hours later I was discharged after a battery of tests and monitoring that determined that my problem was NOT my heart. The bill for the 24 hour stay was $50,000! But since I was on Medicare/HMO, my responsibility was the $50.00 copay for the ER portion of the stay. Medicare/HMO paid the hospital a little over $5,000! Huh? To my mind, neither of these amounts is representative of the true cost of my care. I know one thing, I”d hate to be the poor bastard who went in on a similar situation uninsured. So please tell me what’s the answer. Looks as though the hospitals are as guilty as the insurance companies. The other thing that’s happening here at least is that the local hospital is taking over the out of hospital care (they are “partnering” with the HMO “buying up” local clinics ). One by one, the white doctors are being eliminated and being replaced with doctors whose names you can’t pronounce. In my particular clinic ( one I’ve been using for 40 years) two doctors retired and were replaced with one Indian and one Vietnamese. My Opthamologist no longer takes my insurance and I’ve been directed by my HMO to go to “their guy” whose name I can’t pronounce. My guess is that these doctors will work “cheaper.” Evidently, they are willing to downgrade my care for a buck. Yeah, they all have medical licenses (from a foreign country), but in my experience they do not deliver the quality care that I have had all my life. And all this BEFORE we get the full effect of Obamacare.
The quality may not be there, I agree, but to practice in the US, you have to be licensed in the state where you are practicing.
After working in the ER for many years I have found:
“”The bill for the 24 hour stay was $50,000! But since I was on Medicare/HMO, my responsibility was the $50.00 copay for the ER portion of the stay. Medicare/HMO paid the hospital a little over $5,000! Huh?””
It makes no sense but this is standard practice by hospitals and doctors to charge an exhorbitant rate and then settle for 10% or less.
Doesn’t it strike you as a bit odd you can buy gas 24 hours a day but you can’t get non emergency medical care anytime except M-F 9-5 excluding holidays, if you can get an appointment?
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