The following is a reader take by Nathan Lanier.
I am not an expert on health care and I don’t pretend to be. What I am is an avid observer of emergency care.
My view is not without experience. The issues with my health aren’t important. What is important is that they land me in the ED far more often than I’d like. I can confidently say that my use of the ED is needed. However, some observers without all of the facts may accuse me of abusing a broken system.
I see a lot of overcrowding and can’t help but wonder why. Here are a few thoughts.
One idea is that medical records are not easily transferred among hospitals, which inevitably leads to repeat diagnostics and unnecessary rises in costs. It is imperative for the medical community, insurance companies, government, and patients to ensure that state-of-the-art systems to transfer medical records seamlessly are integrated in all hospitals. The cost of failing to do so is far greater than the upfront cost such a system will need.
Another point is that there is nothing to depress patients from abusing the ED. I think this stems from a fear that hospitals and doctors will be seen as insensitive if they attempt to shun the bad apples from showing up night after night at the ED.
A simple idea is that if a patient shows up, say, four times for the same thing and is sent home with the same medication and the same diagnosis, that person should have to pay regardless of their ability to pay. However, if upon examination of a non-insured patient something is discovered, the visit should be comped. These rules would bring true emergencies to the forefront.
You may be wondering: “What about the patients who truly need emergency care, but stay home because they are afraid of ‘paying the consequences?’” I answer that with a question of my own. What if the patients abusing ambulance services and emergency services weren’t there to distract resources from true emergencies? The amount of abusing patients negatively affected by such measures would be far less than the number of lives saved by keeping them home.
Such measures would not only benefit the patient, but the overall cost of health care as well.
There’s no denying that the growing misuse of EDs is a dire health care issue, but the problem can be fixed. It calls for radical thinking. What we need is bravery on behalf of hospital management and government officials not to be afraid to stand up for the citizens and patients who are most in need of urgent care.
Our future well-being just might depend on it.
Nathan Lanier blogs at natelanier.com.
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- Specialist shortages in the emergency room
- Emergency physicians and the medical home
- "Malpractice fears have thrown the emergency medicine system into crisis"
{ 5 comments }
Must Revoke EMTALA
“four times for the same thing and is sent home with the same medication and the same diagnosis”
Edith Rodriguez.
——————-
She might like to be comped her life.
Legitimate reasons but there are many more:
1.)EMTALA
2.)de facto clinic for illegal immigrants
3.)Nursing shortage
4.)Problem with hospital boarding of admitted patients in the ER. This is probably the most significant issue, and is itself multifactorial.
5.)liability fears: longer more extensive work ups in the ED and more cases “sent to the ER” by PCP’s, nursing hotlines, etc
6.)CYA crapola. example: medical clearance for every drunk going to jail or psych ward.
7.)Mental health service crisis with patients waiting days to go to psych wards.
8.)older and sicker population that requires time and resources.
9.)futile medicine the public keeps demanding.
10.) Lack of good primary care follow up.
11.) Actually ER’s are victims of their own success. Why wait a week for your ultrasound or CT your doctor ordered when it is available 24/7 in the ER.
12.)Time consuming JCAHO requirements.
13.)The importance placed on patient satisfaction scores for job retention. You gotta be nice to that person who abuses the ER 10times a month for the same complaint.
14.)alcohol and other substance abuse
15.)No copays for medicaid service
16.)people who don’t speak English so time is wasted in interpretation.
17.)Closure of ER’s and Trauma centers. There are far fewer of each than 10-15 years ago.
18.)Fewer specialists that are on the call panel. Patients wait a long time to be transferred for speciatly services at other hospitals.
19.)Malpractice crisis and liability issues drives number 18
20.)Dwindling remimbursement drives number 18
21.)Uninsured have no other option
22.)The worried well: “I read on the internet that it could be a symptoms of………”
There is more, but my head hurts and why I am transitioning out of it.
ER’s are overcrowded because people lacking insurance use emergency rooms for primary care, access for primary care for those with insurance is terrible, and because, even for the insured, non-emergent health care is usually only available Monday through Friday, 9-5. Some of these problems are being addressed through Minute Clinics in retail pharmacies and Urgent Care centers allowing after hours care. However, these are not widely available and likely can not provide the services that most of us need. The only way to fix the ER problem is to fix the health care system. Penalizing sick people for a faulty system makes no sense.
This poster directly above this makes alot of sense. When my mom was almost 80 she had Gallbladder surgery. Not the lap but large open surgery. Apparently ins. companies and medicare will allow for a certain number of days covered, and then you must be discharged. Other medical issues mean nothing, age means nothing, complications from said surgery means nothing.
The Doctor told us mother HAD to be discharged but he also told us she really needed to stay hospitalized, so he say to take her home and then bring her right back through the ER and have them call him and he will readmit her through emergency. This was the most crazy, time consuming waste of ER time and effort I ever seen. Not to mention her being very sick uprooted, made to get dressed, hauled to the car, home and then back and through all the mess at the ER.
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