Saturday, June 19, 2004
More on ER (mis)use
Medpundit has commented on the ER (mis)use piece written earlier this week, emphasizing the convenience ("In fact, you don't even have to walk to your tests. You get rolled to them in a wheelchair or gurney." - how true). Perhaps people are willing to wait the 5-6 hours in exchange for a second opinion, or in some cases a specialist evaluation. Beats waiting months.A recent radiologist commenter had this to say:
. . . clearly a large part of the increase in ER visists is clearly the increased convenience, however, in recent years it has clearly become apparent that the ER is in a large part covering the off hours of the many primary care and specialist practices affiliated with that hospital.
It is interesting to note that when I now call doctors' offices off hours for an emergency interpretation, there is almost never a service on call that will take the message and contact the doctor on call. Instead, most practices now say, "If this is an emergency, please call 911 and go to the ER". There is no option for patients to reach their physican practices on call on off hours anymore. Thus they use the ER for all complaints.
I cannot comment on how other practices work around the country - just in my area. My particular 5-person group has 24-7 physician coverage by pager. Whenever the ER wants to consult on our patients, a simple call should be able to reach a physician within the group. More difficult is the telephone consultation. When a patient calls on the phone off-hours, I would have a pretty low threshold to send them to the ER. Too much risk in giving advice and treatment over the phone without actually seeing the patient.
Posted by Kevin |
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Comments:
It is not just patients that are guilty of misuse of the E.R.. Several weeks ago my daughter and son-in-law awoke to find their 2 yr. old was ruuning a high fever and very hoarse with vomitting. My daughter waits until 9:00am when their PCP office opens and makes the phone call. She is told they have no openings until the middle of the next week and they should just take the baby to the ER...This was a week day and she was then forced to spend hours waiting in the ER to be seen..PCPs in many areas willingly send non-emergency pts.to E.R.
# posted by 
: 10:25 AM
: 10:25 AM
"Beats waiting months".
Beats paying a bill as well. Many insured patients who go to the ER for specialty evaluation, especially those with plans that require referrals, end up stiffing their consulting specialist. Too often, their insurers deny payment to consultants called to evaluate patients in the ER by the ER staff physicians on the grounds that no referral was given (who do you call at 0200?). Of course, the indigent do not pay either, and the government indemnity programs that cover the hospital's costs of services provided to medically indigent ER patients do not extend to the providers of specialty care asked to come to evaluate and treat those patients during their ER visit.
Is it any wonder that so many specialists withdraw from hospital staffs where the medicolegal risk of ER care is high and the compensation is zero?
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Beats paying a bill as well. Many insured patients who go to the ER for specialty evaluation, especially those with plans that require referrals, end up stiffing their consulting specialist. Too often, their insurers deny payment to consultants called to evaluate patients in the ER by the ER staff physicians on the grounds that no referral was given (who do you call at 0200?). Of course, the indigent do not pay either, and the government indemnity programs that cover the hospital's costs of services provided to medically indigent ER patients do not extend to the providers of specialty care asked to come to evaluate and treat those patients during their ER visit.
Is it any wonder that so many specialists withdraw from hospital staffs where the medicolegal risk of ER care is high and the compensation is zero?
# posted by : 5:57 PM
: 5:57 PM
