A solution to ER overcrowding: Direct care

Emergency departments in U.S. hospitals see copious patients who aren’t terribly ill, but don’t have insurance and need somewhere to go. I see some of these patients when I moonlight on nights and weekends at a local county hospital. Sadly, these patients run through a gantlet of expensive tests — I’m required by protocol to administer them. The reality is that 80% of what I see in the ER is “family medicine after hours.” I could just as safely see these patients in my own direct care practice, saving them time and money.

It’s not that hospitals aren’t aware of how silly these tests are, and what a waste they are for less endangered patients. But there’s not much they can do about it. In desperation, some 50% of acute care hospitals have begun charging a fee in the $100-$150 range for a patient deemed safe to be seen in a less acute setting remains determined to stay in the ED. This can even include hospitals with urgent care centers on-site. And that’s on top of the care that’s provided.

Let’s break some numbers. According to the American Hospital Association, in 2012 hospitals had uncompensated care costs of $45.9 billion, spread across about 5,000 hospitals (including both charity care and bad debt). That equates to 6.1% of their total expenses, the AHA reports.

So who’s ready to cut some red tape? For $150 I’m more than happy to see an urgent patient and give them a 3-month subscription to my practice.

You know how that one urgent care trip usually turns into two because your doctor is so harried that he or she can’t make a proper diagnosis? Yeah, that doesn’t happen with direct care. Instead, I’ll call you or text you or direct message you on Twitter (your call) and make sure everything’s going okay. And if it’s not, instead of ignoring my outreach and hoping the problem goes away, because you don’t want to pay another $150 for ten minutes with us, you can get all the help you need for free.

Oh, and you can come in and see me anytime for three months (if you’re between 18 and 44 years old).

And are you really, really short on cash? Remember that we’re a business, and we’re here to negotiate. The power of direct care is that bureaucracy isn’t looking over our shoulder extorting us to administer needless procedures just so they’ll pay us, which forces us to try to racketeer our uninsured patients.

No, here, in direct care, we do what we want to do. That means serving patients and keeping the lights on, without someone else’s oversight.

Josh Umbehr is founder, Atlas.md.

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