Comments on: The real reason for the ER crisis http://www.kevinmd.com/blog/2006/08/real-reason-for-er-crisis.html medical blog Sun, 22 Nov 2009 07:50:13 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2006/08/real-reason-for-er-crisis.html/comment-page-1#comment-65717 Anonymous Wed, 02 Aug 2006 02:03:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-real-reason-for-the-er-crisis.html#comment-65717 I wouldn't be so sure about that. There is certainly leeway in charging extra for "extra" services outside of the consultation/treatment (ex: some practices charge a fee for filling out FMLA/disability forms or for copying medical records, etc.) After-hours advice could be looked at as an acillary service which is not a part of the fee schedule for consultation/treatment in the course of an office visit. Physicians are not obligated to provide it. I wouldn’t be so sure about that. There is certainly leeway in charging extra for “extra” services outside of the consultation/treatment (ex: some practices charge a fee for filling out FMLA/disability forms or for copying medical records, etc.) After-hours advice could be looked at as an acillary service which is not a part of the fee schedule for consultation/treatment in the course of an office visit. Physicians are not obligated to provide it.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/08/real-reason-for-er-crisis.html/comment-page-1#comment-65712 Anonymous Wed, 02 Aug 2006 00:42:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-real-reason-for-the-er-crisis.html#comment-65712 Anon 3:08<br/><br/>Unless, you can work outside a health insurance contract, you can't charge a patient for extras with regard to the patient's medical care (read your contract). Nice idea, but the patient will complain to the health insurer and they may drop you from their provider list. Anon 3:08

Unless, you can work outside a health insurance contract, you can’t charge a patient for extras with regard to the patient’s medical care (read your contract). Nice idea, but the patient will complain to the health insurer and they may drop you from their provider list.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/08/real-reason-for-er-crisis.html/comment-page-1#comment-65703 Anonymous Tue, 01 Aug 2006 21:12:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-real-reason-for-the-er-crisis.html#comment-65703 The density of primary care physicians has nothing to do with ER usage...I practice primary care in downtown Washington DC...if you take a piss in the middle of the street like many of the animals that live around here do, you will likely hit a doc-in-a-box...<br/><br/>the er's here are busy as all fuck...the reason is we send you animals there to coverour ass, if anyone says tehy are having chest pain, shortness of breath, headache...gues what, go to ER! The density of primary care physicians has nothing to do with ER usage…I practice primary care in downtown Washington DC…if you take a piss in the middle of the street like many of the animals that live around here do, you will likely hit a doc-in-a-box…

the er’s here are busy as all fuck…the reason is we send you animals there to coverour ass, if anyone says tehy are having chest pain, shortness of breath, headache…gues what, go to ER!

]]> By: Anonymous http://www.kevinmd.com/blog/2006/08/real-reason-for-er-crisis.html/comment-page-1#comment-65696 Anonymous Tue, 01 Aug 2006 19:08:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-real-reason-for-the-er-crisis.html#comment-65696 "it's no wonder that the insured are flooding into ERs, frustrated by the outpatient system."<br/><br/>Let's be honest, it isn't as if the internal medicine docs aren't already working hard, it is just that there is a limit to how many hours in a day a doctor is willing to work, and how many patients can be seen per hour. It is also due to the fact that many patients wait until after hours to call in only to discover that when the office is closed it is in fact that, closed. <br/><br/>I don't do primary care, but many times I have patients calling my office after hours expecting someone to be available on demand, even when the problem isn't an emergency. And when it isn't, they are asked to call for an appointment in the morniing. Sometimes they understand, and sometimes they become angry, as if 24-hour 7-day a week availability on an outpatient basis were some sort of right, which it isn't.<br/><br/>I am arriving at a solution to this problem though. I am going to charge $300 cash minimum up front for any after-hours service, regardless of coverage or complaint (postoperative patients excepted). I think this way, it is far easier to give the patient the choice, as well as a clearer understanding that exceptional demands come at an exceptional price.<br/>It is far easier than saying no. “it’s no wonder that the insured are flooding into ERs, frustrated by the outpatient system.”

Let’s be honest, it isn’t as if the internal medicine docs aren’t already working hard, it is just that there is a limit to how many hours in a day a doctor is willing to work, and how many patients can be seen per hour. It is also due to the fact that many patients wait until after hours to call in only to discover that when the office is closed it is in fact that, closed.

I don’t do primary care, but many times I have patients calling my office after hours expecting someone to be available on demand, even when the problem isn’t an emergency. And when it isn’t, they are asked to call for an appointment in the morniing. Sometimes they understand, and sometimes they become angry, as if 24-hour 7-day a week availability on an outpatient basis were some sort of right, which it isn’t.

I am arriving at a solution to this problem though. I am going to charge $300 cash minimum up front for any after-hours service, regardless of coverage or complaint (postoperative patients excepted). I think this way, it is far easier to give the patient the choice, as well as a clearer understanding that exceptional demands come at an exceptional price.
It is far easier than saying no.

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