Comments on: Will more primary care doctors keep patients out of the ER?

By: jsmith

jsmith — Sun, 11 Oct 2009 16:07:43 +0000

You make an interesting case, but we should all prefer fact to theory. To what extent increasing primary care access will decrease ER visits is really unknown.
I can spin a counter-theory. We do a lot of urgent care in our office. When we’re open, pts with 2 cm lacerations or otitis externa see us. When we’re closed, they go to the ER. We’re super busy, in a primary care shortage area. If we could hire another family doc or two, would that decrease volume in the ER ? I bet it would.

By: Martin Young

Martin Young — Sat, 10 Oct 2009 06:51:45 +0000

I call my own practice of charging the wealthy to subsidise cheaper or even free treatment of the poor “Robin Hood” medicine. I think it’s a good and easily understandable term. If I can do it and survive, others should be able to as well. I hope! But I make sure all patients know why my charges may differ – that is transparency!

By: MANALIVE

MANALIVE — Sat, 10 Oct 2009 01:34:11 +0000

Repeal of the Stark Laws would be helpful too. Most ill patients need labwork and x-rays; even if a primary care doc were open 24/7, he couldn’t provide these necessary services.
Why can a dentist provide x-ray services, but not an internist?

By: christophil M.D.

christophil M.D. — Sat, 10 Oct 2009 01:21:56 +0000

Primary care doctors can keep some patients out of E.D.’s but they need to change how they practice. Primary care v2.0 will need to serve up care fast food style- cheap, fast and 24/7. A paradigm shift toward telemedicine and home visits is needed. The question is will fast food primary care medicine, like cheeseburgers turn out to be bad for your health; maybe, but done well, it can provide quality non-emergent care and take some of the load off E.D.’s.

By: H

Sat, 10 Oct 2009 00:31:43 +0000

Socialize medicine so payment in the ER isn’t an issue. Fine people who abuse the system.

Get rid of EMTALA. Make medicine a truely capitalistic endeavor. Retail clinics can fill the gap for those non-life threatening conditions. People will gravitate toward the cheapest service.

By: ninguem

ninguem — Sat, 10 Oct 2009 00:30:00 +0000

I get people in my office with emergency conditions all the time. Severe hypertension yesterday 200/120 with headache. New diabetic last week. The usual flu and such. Dehydration. Sometimes sent on to the hospital, most of the time followed closely as an outpatient. They come to me because they know I can usually see them on short notice, most of the time the same day. No I’m not open nights and weekends. So they don’t call me at 3-AM because they know they can just come in the next day.

Then again, I’m solo, independent, so I don’t have some boss forcing me to run a mill. And I expect to be paid for services rendered.

I have some Medicaid on a limited basis. They show up at the ER, they get sent straight back to me, teaching them to use the doctor’s office. Uninsured patients learn the urgent care is charging literally twice my fee for the same service. I’ve seen the fee schedules at a couple of the nearby urgent care clinics, it’s right at 2X my fee schedule.

Then again……I understand what some go through. I’ve worked at some urgent care clinics and hospital-based primary care clinics. Fortunately I managed to negotiate out any noncompetes. They like to churn doctors. They are probably kicking themselves for not forcing one on me, but they were desperate at the time. Gotta figure, if they treat the doctors like shit, with so much turnover, what makes you think they’ll treat the patients well? So I bailed after a few months, I can’t understand how people stand them. Well, I guess they don’t, the place was a revolving door.

But I would see patients all the time. 10-AM on a Tuesday, with a cold. “Why aren’t you at your regular doctor’s office?” “They said their next opening is two weeks.”

Even for emergencies. Amazing. I can’t believe how some of these clinics are run. Then again, they have two receptionists in front, two nurses in back, someone just doing Press-Ganey bullshit, middle managers and all that. Somebody has to actually earn their salaries, Lord knows they’re not doing it.

So Atlas shrugged and opened an independent office. Profitable at a third of their volume. The price I pay is, there’s a light out. I will install my own ballast and lights this weekend.

Good trade I say……..

By: Anonymous

Anonymous — Sat, 10 Oct 2009 00:19:33 +0000

Of our insured patients in our practices, how many are up to date on their health screening exams?

Wouldn’t the answer to this depend on the schedule of health screening exams, for which there often is not much of a consensus on frequency, or even whether to do certain screenings at all?

By: Nuclear Fire

Nuclear Fire — Fri, 09 Oct 2009 23:44:03 +0000

Thank you for this insightful article.

By: edwinleap.com | Decreasing emergency department visits? Unlikely…

edwinleap.com | Decreasing emergency department visits? Unlikely… — Fri, 09 Oct 2009 23:10:41 +0000

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By: BookstoreMD

BookstoreMD — Fri, 09 Oct 2009 21:48:23 +0000

When patient end up in a ER or hospital, it is usually failure of the outpatient medicine. I am not talking about mistakes in clinical judgement, but failure of the process. It could be non compliance with medication, failure to seek medical attention in time, inability to afford medical care.
Strengthening Primary Care and incentivising the general population to use it should hopefully go a long way in decreasing healthcare cost. Not to mention Tort reform to prevent wasteful test ordering.