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As an RN Case Manager for a large hospital system, and already watching the Medicaid debacle, all it will do is move the cost to the hospital system. They will still come, it's just the hospital won't get paid. Just because Medicaid won't pay for their visit in no way means the patient will. Remember, to qualify for medicaid means you do not have any money. So the state is just transferring the cost to the hospital, already drowning in medicaid patients.

Our hospital will receive 32 million dollars less this year due to Medicaid cuts. We will still have to provide the care, but we just won't get paid. These Medicaid/medicare cuts in no way stop these people from receiving care. It stops hospitals and doctors from getting paid for care they provide as stipulated by the law and medical ethics.

***To fix it, the hospitals need to set up triage nurses at the door. Do not let these people register or make it to the waiting room. If the problem is determined to be non-emergent, call their MD and make an appointment for them for when the MD can see them and send them on the way. Before they get in the hospital to even sit down.***

I hope you have presented your brilliant idea to the Hospital trustees;) Common sense and practical. If the patients don’t already have an MD - the hospital should have an ‘outpatient’ area staffed with PAs and rotating GPs.

The upswing in “urgent care centers’ is clearly the best way to solve Emergency Room abuse.

About 20 some-odd years ago I was at a financial low point, unemployed (read, working off the books) and had to go to a NYC ER at about 12:30 AM. I had contracted a severe and aggressive infection that resulted in what I was told was “blood poisoning”. I was jumped over many that were in line and was treated immediately. Since I was basically broke, when the bills came they went to the circular file...un-opened.
A couple of years later, now on my feet financially, I returned to the city hospital with the intent to square things up. I was told that doing so would cause so much time and trouble that they were just not interested. They told me to just forget about it.

>>To fix it, the hospitals need to set up triage nurses at the door.<<

I would LOVE this. And here’s a way to get around lawsuits, have a “minute clinic” set up nearby. Toothache, broken toe, tummy ache, send them over to the clinic. One could staff the clinic 24 hours a day and it would still cost less than the ER because most of the easy stuff could be handled by an RN.

To fix it, the hospitals need to set up triage nurses at the door. Do not let these people register or make it to the waiting room. If the problem is determined to be non-emergent, call their MD and make an appointment for them for when the MD can see them and send them on the way. Before they get in the hospital to even sit down.

Thats an EMTALA violation, which will get the hospital huge fines and banned from participation in any federal program ie Medicare. No one wants to go there.

“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?

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.