I haven’t been in one in more than 10 years. I learned how much of a losing proposition it was long before that and got off call, but still went occasionally for my patients (to abort unnecessary admissions). Then I would get two interesting results: The ER personnel all stared in disbelief, then, as they recovered from their shock, lining up other consults for me to see.

Which leads me to the conclusion that if the payers payed a reasonable fee then the very same ER could just staff an emergency psych service. I think the ER docs would be happy to not have to mess with it, and a lot of admissions would be diverted to other care settings–with a huge net savings to the system in the end.

Physicians are so busy in the office churning through the volumes of patients necessary to cover their overhead that any emergency can literally inconvenience as many as 25 or 30 regularly scheduled patients. Basically the minimum reimbursement necessary to cover a visit to the hospital or ER is probably in the realm of $500 to $1000 depending on the problem/specialty. Consider how much it takes to get a plumber or electrician to come out in the middle of the night or on a weekend. Doctors get as little as zilch on a trip to the hospital ER. Neither Medicare nor private insurance offer sufficient reimbursement. This is really a hospital and public health problem, not a physician problem. It is incumbent on the hospital to find a way to obtain coverage and meet EMTALA requirements.

So I don’t go near ERs professionally. No way, no how. The only way I would, is if I had a shift to work there and was going to get paid for it. It is pretty much the same all around in this region.

If they want a psychiatric eval (not a useless social worker eval) on ER patients, then somebody is going to have to pay for it. Meanwhile, they can just do cursory evals, send half to jail, the other half to the psych unit to be seen in the morning, and get it right about half the time. It would be cheaper for Medicaid/Medicare to pay up front for a good eval and crisis intervention, but that would make too much sense.

EMTALA takes away what used to be an effective tool in dealing with the psychiatric ER abusers “You will comply with this treatment plan, go to this half-way house, keep these appointments and put clean pee in the bottle, or you will not longer be able to get care at this facility–even if you do show up claiming you want to kill your self for the 48th time”

it IS partly about the money, but some respect & gratitude go a long way too. And these things are out the window with the current entitlement & patient empowerment mentality.

The highly effective ER coverage of the past is gone forever thanks to these lunatics.

I have no clue as to a solution.

Ed Sodaro MD

BTW, it’s NOT about the money. It’s about the sleep and the peace of mind. That’s why all these schemes hospitals are coming up with to pay specialists to cover the ER are doomed.