The hospital emergency room.

[swlees]

A comment on ER wait-times. (I currently work for a provider - sponsored health plan that administers a Medicaid contract for an eastern state, so I have some familiarity with these things)

Federal EMTALA laws require any hospital that accepts Federal funds (Medicare or Medicaid payments) to treat ANY patient that walks in regardless of whether the patient can pay or not. There are virtually no hospitals that do not accept Medicare or Mediciad payments. The hospitals are legally required to perform minimal triage and treatment. They cannot wait the patient out and hope they leave. The result is the flood of people showing up in the ER with earwax, stomach aches, etc., slowing you up when you show up,with a real problem. The hospitals could refuse the Faustian bargin and turn down the Federal money, but that won't happen.

 

[MJ5150]

The rise of ACO's in the USA will impact how medicine is practiced. While the concept is not new and bears resemblance to an HMO, it is gaining renewed momentum. The hospital I just left was very excited when they were asked to help pilot a program in NH.

-Mike

 

[BawanaRik]

An issue in the US is that the private portion of our system is utterly massive. For instance huge numbers of people are employed by the health insurance industry. It's like the Dole. If you made that industry vanish, there would be a lot of people thrown out on the streets.

I'm not making light of this. Even absent ideological obstacles, supporting the insurance industry is why we can't just switch to a single payer system. This is why the compromise reached by the Affordable Care Act resulted in such a complex solution. And it's not a complete solution, but just a band-aid, because it doesn't directly address costs. But the hope is that by standardizing the system and fostering competition, costs will become easier to account for, and that will drive excess costs out of the system.

Most people have found their premiums tripling or quadrupling.

I'm failing to see the affordable part of that.

But hey, it's only money.

 

[BawanaRik]

A comment on ER wait-times. (I currently work for a provider - sponsored health plan that administers a Medicaid contract for an eastern state, so I have some familiarity with these things)

Federal EMTALA laws require any hospital that accepts Federal funds (Medicare or Medicaid payments) to treat ANY patient that walks in regardless of whether the patient can pay or not. There are virtually no hospitals that do not accept Medicare or Mediciad payments. The hospitals are legally required to perform minimal triage and treatment. They cannot wait the patient out and hope they leave. The result is the flood of people showing up in the ER with earwax, stomach aches, etc., slowing you up when you show up,with a real problem. The hospitals could refuse the Faustian bargin and turn down the Federal money, but that won't happen.

Instead the hospital are chaining together and closing the less profitable operations.

Usually in poor areas. Which is essentially refusing that Faustian bargain.

And people clamor but the bottom line is if they don't make money they can't stay open. Hospitals aren't hobbies. They cost money.

 

[swlees]

The rise of ACO's in the USA will impact how medicine is practiced. While the concept is not new and bears resemblance to an HMO, it is gaining renewed momentum. The hospital I just left was very excited when they were asked to help pilot a program in NH.

-Mike

The health system that employs me has also registered to pilot an ACO. I've seen nothing in the plans that lead me to believe it will be profitable or even break even. They look like the latest fad to me, but I could be wrong this time. Forgive my cynicism; I've worked in the health business on the funding side for 30 years, and none of the great new ideas to reduce expenses have worked over the long haul.

 

[fdeck]

Most people have found their premiums tripling or quadrupling.

I'm failing to see the affordable part of that.

But hey, it's only money.

Evidence? I'm calling BS. While this is just anecdote, my premiums for employer provided insurance have followed widely reported patterns, which have health care costs growing but the rate of growth slowing down. I looked up what my premiums would be if I went onto one of the exchanges, and they would be comparable to my employer based plan.

 

[swlees]

Instead the hospital are chaining together and closing the less profitable operations.

Usually in poor areas. Which is essentially refusing that Faustian bargain.

And people clamor but the bottom line is if they don't make money they can't stay open. Hospitals aren't hobbies. They cost money.

It is a tough business for sure. The system I work for has a good year if we have a 3% margin. We are not for profit; our mission is teaching and research, but as you say we still need to make money to keep the lights on. Our state regulates hospitals heavily, and I can't recall any closing. The regulators here won't let that happen. Usually what happens is one of the healthier hospitals will acquire a failing institution and run it at a loss. Not sure if that is good policy or not, but it is what the voters have chosen.

 

[MakiSupaStar]

Mike, sorry to hear. That is a scary. I've been there. A good rule to follow is ABC's (Airway, Bleeding, Circulation) This is largely how basic triage and ER's work. Generally, priority will go to patients in that order. For less urgent patients (which really shouldn't be there in the first place) I'm sure ability to pay, order and the availability of particular personnel comes into play too. This is why a conscious dude with a broken arm takes a back seat to a kid having an asthma attack. Of course there are exceptions, but if you think ABC's it'll make more sense.

 

[BawanaRik]

The health system that employs me has also registered to pilot an ACO. I've seen nothing in the plans that lead me to believe it will be profitable or even break even. They look like the latest fad to me, but I could be wrong this time. Forgive my cynicism; I've worked in the health business on the funding side for 30 years, and none of the great new ideas to reduce expenses have worked over the long haul.

Cynicism is great. It's essential to survive.

Any program that uses initials is gonna fail.

It's the way of the world.

 

[BawanaRik]

Evidence? I'm calling BS. While this is just anecdote, my premiums for employer provided insurance have followed widely reported patterns, which have health care costs growing but the rate of growth slowing down. I looked up what my premiums would be if I went onto one of the exchanges, and they would be comparable to my employer based plan.

I think checking out Google would give you all the evidence you might want.

I'll be glad to help if you need it.

 

[BawanaRik]

It is a tough business for sure. The system I work for has a good year if we have a 3% margin. We are not for profit; our mission is teaching and research, but as you say we still need to make money to keep the lights on. Our state regulates hospitals heavily, and I can't recall any closing. The regulators here won't let that happen. Usually what happens is one of the healthier hospitals will acquire a failing institution and run it at a loss. Not sure if that is good policy or not, but it is what the voters have chosen.

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You might find this interesting. They tend to be in poor areas.

It's impossible to operate at a loss indefinably. Caring for hang nails at ERs is not a working paradigm.

 

[StayLow]

Also I think the reason we see so many non emergency cases in the er is because many people have no where else to turn being uninsured.

In Canada, where everyone's insured, I took a friend to emergency with a real life-threatening issue that required immediate surgery.

He goes in for care fairly quickly, and I'm sitting in the waiting room with people who seem perfectly fine ... talking, walking, watching the television, so I presume they're waiting on people taken inside for care same as I was. After a few conversations had and overheard, I realized most of them were waiting to be treated for their "emergencies". None of them bleeding, crying, or even apparently in any pain or crisis.

People in general are just whining spoiled brats with a massive sense of self-importance and entitlement.

 

[RaginRog]

In Canada, where everyone's insured, I took a friend to emergency with a real life-threatening issue that required immediate surgery.

He goes in for care fairly quickly, and I'm sitting in the waiting room with people who seem perfectly fine ... talking, walking, watching the television, so I presume they're waiting on people taken inside for care same as I was. After a few conversations had and overheard, I realized most of them were waiting to be treated for their "emergencies". None of them bleeding, crying, or even apparently in any pain or crisis.

People in general are just whining spoiled brats with a massive sense of self-importance and entitlement.

That's the truth...we live in an age where people are wimps. Time and Ibuprofen can heal just about any ache and pain.

 

[BawanaRik]

In Canada, where everyone's insured, I took a friend to emergency with a real life-threatening issue that required immediate surgery.

He goes in for care fairly quickly, and I'm sitting in the waiting room with people who seem perfectly fine ... talking, walking, watching the television, so I presume they're waiting on people taken inside for care same as I was. After a few conversations had and overheard, I realized most of them were waiting to be treated for their "emergencies". None of them bleeding, crying, or even apparently in any pain or crisis.

People in general are just whining spoiled brats with a massive sense of self-importance and entitlement.

No. Imagine that. People are people. Not much of a surprise.

At least your bud got taken care of. That's the important thing.

One of the talking points here was that the new "process" would eliminate ER visits. It's my opinion many of the people using ERs as PCP lack the ability to future-think enough to make an appointment to see a real PCP. Just my opinion.

 

[BawanaRik]

That's the truth...we live in an age where people are wimps. Time and Ibuprofen can heal just about any ache and pain.

I find most flu respond well to acetaminophen. I bought a jug for next to nothing years ago and it still works.

Pain is part of life. To get a handle check out the US consumption of oxycodone. The API in many popular pain meds.

 

[hrodbert696]

That's the truth...we live in an age where people are wimps. Time and Ibuprofen can heal just about any ache and pain.

Well, except for infections. If you don't get antibiotics, either your immune system can handle it... or it can't. Strep throat used to have a fatality rate around 25-35% if I remember right. It's not entirely irrational that people take their sore throats to the emergency room when they can't get to a PCP.

 

[blue4]

That's the truth...we live in an age where people are wimps. Time and Ibuprofen can heal just about any ache and pain.

You might want to be a little more proactive than that.

 

[BawanaRik]

Well, except for infections. If you don't get antibiotics, either your immune system can handle it... or it can't. Strep throat used to have a fatality rate around 25-35% if I remember right. It's not entirely irrational that people take their sore throats to the emergency room when they can't get to a PCP.

The rest of the world a person can go to the Farmacia and pick up some antibiotics. No need to bring germs to a hospital where most people are in a weakened state.

 

[i_got_a_mohawk]

The rest of the world a person can go to the Farmacia and pick up some antibiotics. No need to bring germs to a hospital where most people are in a weakened state.

You can't in the UK, you'd need to see your GP / family Dr and get a prescription to get antibiotics from the pharmacy. Broad spectrum antibiotics aren't always the solution and buying antibiotics over the counter isn't such a great idea when they are over prescribed as is (leading to immune strains of bacteria, "superbugs" and all that).

The use of antibiotics has to be managed on a fine line and given the number of people who still think they need antibiotics for a cold, it's probably wiser not having them over the counter!

 

[BawanaRik]

You can't in the UK, you'd need to see your GP / family Dr and get a prescription to get antibiotics from the pharmacy. Broad spectrum antibiotics aren't always the solution and buying antibiotics over the counter isn't such a great idea when they are over prescribed as is (leading to immune strains of bacteria, "superbugs" and all that).

The use of antibiotics has to be managed on a fine line and given the number of people who still think they need antibiotics for a cold, it's probably wiser not having them over the counter!

And if they complain enough the doc will give them a script.

I recall they were available on the continent. Not sure now.

I need more money so I can travel more.