The hospital emergency room.

[spade2you]

You don't need to be in a dire emergency to visit the emergency room. If there is a non-severe medical issue and your doctor can't see you, then you are advised to go to the emergency room. Nowadays, you can go to private medical facilities, like Patient First, that provide emergency room-ish services where the severity of the medical issue is not severe, e.g. flu, minor cuts, sore throat, headache, pain, etc.

I think there are plenty of options before heading to the ER. A good physician group should have someone on call and they might be able to call in prescriptions to a 24h pharmacy.

I think the idea that there's only one option kinda shows why nothing ever gets fixed, eh?

 

[blue4]

I think there are plenty of options before heading to the ER. A good physician group should have someone on call and they might be able to call in prescriptions to a 24h pharmacy.

I think the idea that there's only one option kinda shows why nothing ever gets fixed, eh?

Again, all things you need insurance to use. The fact is that for certain areas, and a large portion of uninsured, the ER is the only option.

Fixing this will need people to work together and to sometimes accept things that may fall outside their chosen political platform. So, nothing coming soon to help.

 

[spade2you]

Again, all things you need insurance to use. The fact is that for certain areas, and a large portion of uninsured, the ER is the only option.

Fixing this will need people to work together and to sometimes accept things that may fall outside their chosen political platform. So, nothing coming soon to help.

There are eleventy things that can be done with or without insurance to prevent an unnecessary ER visit. This further proves my point that people suck at problem solving.

A good chunk of our heart failure ER admits simply ran out of meds AND had Medicaid. A $10 problem just became a $10k problem. They'll still need those $10 meds when they're discharged.

 

[MJ5150]

So do the people without insurance plan not to pay the ER bill? As mentioned previously, a trip to the ER is going to be much more expensive than a trip to a regular doctor.

I went about 10 years without health insurance, five of those married with two children. When we went to the doctor, we were cash customers and we set up payment plans with the doctor office.

-Mike

 

[Selta]

So do the people without insurance plan not to pay the ER bill? As mentioned previously, a trip to the ER is going to be much more expensive than a trip to a regular doctor.

I went about 10 years without health insurance, five of those married with two children. When we went to the doctor, we were cash customers and we set up payment plans with the doctor office.

-Mike

*nods*. I'm slightly confused why people think doctor offices will turn away non-insured patients? There's been plenty of times when I paid for services out of pocket, with no insurance in site.

 

[BawanaRik]

I think there are plenty of options before heading to the ER. A good physician group should have someone on call and they might be able to call in prescriptions to a 24h pharmacy.

I think the idea that there's only one option kinda shows why nothing ever gets fixed, eh?

There's never only one option. People who narrow their minds to the point where there is only one option not only limit their lives significantly but they tend to force the responsibility of their poor problem solving capabilities on their betters.

 

[BawanaRik]

*nods*. I'm slightly confused why people think doctor offices will turn away non-insured patients? There's been plenty of times when I paid for services out of pocket, with no insurance in site.

Same here. I found I got much better service without insurance since they tended not to order all those worthless tests when I explained I was paying.

In fact I bet people who are responsible enough to be willing to pay for their own healthcare are also responsible enough to take better care of themselves.

 

[Selta]

Same here. I found I got much better service without insurance since they tended not to order all those worthless tests when I explained I was paying.

That's a problem with pay-for-services-rendered model. The doctors in my company are salaried, so they don't need to load up on tests and lab work to get more reimbursement.

 

[BawanaRik]

That's a problem with pay-for-services-rendered model. The doctors in my company are salaried, so they don't need to load up on tests and lab work to get more reimbursement.

A doctor who orders any unnecessary test is an evil individual. No better than the crooked car mechanic.

The real problem is the monopoly that exists allow crooked docs to survive and even thrive. Albeit supported by a rampant tort system that allows them to hide behind that excuse.

How often did you see House order tests?

 

[Selta]

A doctor who orders any unnecessary test is an evil individual. No better than the crooked car mechanic.

Well, that's where claims authorization and adjudication is supposed to kick in, but it's a pretty loose system all around. A lot of times the order is just valid enough to sneak through, and may even catch something related to the diagnosis. So they're not entirely unnecessary, but may only be shots in the dark to try to find what's wrong.

 

[BawanaRik]

Well, that's where claims authorization and adjudication is supposed to kick in, but it's a pretty loose system all around. A lot of times the order is just valid enough to sneak through, and may even catch something related to the diagnosis. So they're not entirely unnecessary, but may only be shots in the dark to try to find what's wrong.

I underwent close to 100K in test to explain a massive loss of energy and a 3 figure weight gain.

I eventual lucked onto a doctor who wrote a script for Levo Throxine. A 9 dollar 90 supply.

So I'm not feeling any tests. I think the end was they wanted to collect 20 gallons of my urine to be sent to a lab for testing. I asked the doc what is this going to show?

His answer. I don't know. We just run tests.

Every doc should be required to take a course in Boolean logic.

If they order an unnecessary test that should be required to under the same test 100 times and pay for it.

The concept of a "doctor" is flawed. Many people can and should be allowed to handle their own healthcare. Bringing in a specialist when needed.

Not only would this save trillions, I have no doubt it would save millions of people's lives and improve tens of millions of other people's lives.

 

[brianrost]

I found it so very interesting how people define a medical emergency in 2013.

Treatment in emergency rooms is one of the biggest problems in the US health care system. ERs by law cannot turn people away whether they can pay for their treatment or not.

My daughter is an ER nurse and my wife is a nurse case manager who has to deal with discharge of patients who came into the ER. What they have told me:

When weather is bad, addicts show up complaining of any symptom they can think of (chest pain is a good one) to get a bed, a hot meal and maybe some free oxy if they state their pain is "10 on a scale of 1-10".

Stating you are suicidal is an automatic ticket to a few days of "observation".

Alcoholics show up when they run out of money for booze, they get medication to reduce the DTs.

People who don't have insurance come to the ER every day because noone else will treat them if they can't pay.

Hospitals cannot discharge someone who is "at risk". If someone drops off Granny at the ER and says they cannot take her back home, Granny can't leave the hospital until a nursing home bed can be found (and paid for).

My daughter says any time there is a large concert in her city, the ER gets multiple drug and alcohol casualties showing up...and throwing up.

Etc.

Hospitals never get reimbursed 100% for free ER care. Most states and some cities have funds they pay to hospitals to help cover the care but it's pennies on the dollar. Whether through taxes or insurance premiums, every US citizen is already paying for ER care that uninsured people receive.

 

[blue4]

There are eleventy things that can be done with or without insurance to prevent an unnecessary ER visit. This further proves my point that people suck at problem solving.

A good chunk of our heart failure ER admits simply ran out of meds AND had Medicaid. A $10 problem just became a $10k problem. They'll still need those $10 meds when they're discharged.

Im not saying there's not things that can be done. But you're trying to solve the human stupidity factor. That can't be solved. What I am saying is that an ER is the place that most desperate and or stupid people without insurance go to get treated. They are told to do this by many people, including one former president. Shaking our fists at the waiting room won't help.

 

[BawanaRik]

Treatment in emergency rooms is one of the biggest problems in the US health care system. ERs by law cannot turn people away whether they can pay for their treatment or not.

My daughter is an ER nurse and my wife is a nurse case manager who has to deal with discharge of patients who came into the ER. What they have told me:

When weather is bad, addicts show up complaining of any symptom they can think of (chest pain is a good one) to get a bed, a hot meal and maybe some free oxy if they state their pain is "10 on a scale of 1-10".

Stating you are suicidal is an automatic ticket to a few days of "observation".

Alcoholics show up when they run out of money for booze, they get medication to reduce the DTs.

People who don't have insurance come to the ER every day because noone else will treat them if they can't pay.

Hospitals cannot discharge someone who is "at risk". If someone drops off Granny at the ER and says they cannot take her back home, Granny can't leave the hospital until a nursing home bed can be found (and paid for).

My daughter says any time there is a large concert in her city, the ER gets multiple drug and alcohol casualties showing up...and throwing up.

Etc.

Hospitals never get reimbursed 100% for free ER care. Most states and some cities have funds they pay to hospitals to help cover the care but it's pennies on the dollar. Whether through taxes or insurance premiums, every US citizen is already paying for ER care that uninsured people receive.

Thanks for a "from the trenches" report. Narco seeking is pretty common. Legalizing these substances would go a long way to solving that behavior.

 

[BawanaRik]

Im not saying there's not things that can be done. But you're trying to solve the human stupidity factor. That can't be solved. What I am saying is that an ER is the place that most desperate and or stupid people without insurance go to get treated. They are told to do this by many people, including one former president. Shaking our fists at the waiting room won't help.

Actually it can be solved. Merely closing the ERs to anything other than real emergencies with paying customers would go a long way to doing that.

 

[Skeeter1]

People that don't have much, if any, money and no insurance go to the state hospital ER for all medical needs because it doesn't cost a fortune like paying out of pocket to a GP for each visit and test.

At least that's why they do it around here.



Yeah... I should probably delete the above post before someone takes it the wrong way and laments the fall of society... I'm not being political, though. I'm just explaining what I've observed.

In you are in the US you are wrong. It does cost a fortune and others pay for it.

Due to the Emergency Medicine Treatment And Labor Act (EMTALA) [Invalid or Expired Link Removed]. A hospital's ER must at minimum treat and stabilize you according to your need just by the fact you walk in the door irregardless of your citizenship statuses or your ability to pay.

The Hospital is then allowed to submit a year end request to the fed government for reimbursement of bad debt due to uninsured care. This is usually a percentage settlement.

The issue is the lawmakers in their infinite wisdom made no such provision for the physicians that are providing that care which in the US about 85% of ER physicians are not employees of the hospital but independent contractors. So basically they are working for free under threat of loosing their license. State run hospitals usually keep their ER Physicians as employees because they see so much uninsured care the ER physician would never see a paycheck if they chose to work there as an independent contractor.

 

[spade2you]

Im not saying there's not things that can be done. But you're trying to solve the human stupidity factor. That can't be solved. What I am saying is that an ER is the place that most desperate and or stupid people without insurance go to get treated. They are told to do this by many people, including one former president. Shaking our fists at the waiting room won't help.

As long as we can admit that it's a lack of problem solving. I don't call it "stupid" simply because I feel that people have the ability to solve things. If we can figure out how to turn on a TV or car, we have the inherent ability to solve problems. Honestly, I think education would be pointless because most people simply don't care.

An easy way to stay out of a trauma center is to NOT drive like a psycho. I see plenty of that on the roads.

 

[spade2you]

Thanks for a "from the trenches" report. Narco seeking is pretty common. Legalizing these substances would go a long way to solving that behavior.

IDK, for every day pains, the current OTCs are adequate. Stronger pain should still require the supervision of a physician. I've known enough pill poppers that legalizing it probably won't solve anything.

 

[Selta]

IDK, for every day pains, the current OTCs are adequate. Stronger pain should still require the supervision of a physician. I've known enough pill poppers that legalizing it probably won't solve anything.

Not to mention that legalizing it wouldn't necessarily make it cheaper

 

[Skeeter1]

I'm gonna need to see proof of this. Contrary to what people might believe reimbursement with Medicaid tends to be as good as most insurance companies. Sometimes there is more paperwork and hoops to jump through. Private insurance can also mean paperwork and jumping through hoops.

Medicaid is a State run program with federal matching funds. Reimbursement can vary State to State.