>> -----Original Message----- >> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On >> Behalf Of Deborah Harrell
>> While good primary care should be able to greatly >> reduce need for ER visits in many (perhaps even most) >> cases, there are, frex, brittle diabetics who - >> despite best medical care and best patient >> participation in their own health - will require >> emergent care. >Why don't they save money by educating people better about when to head for >the ER and when to go to a clinic? Kaiser solves this by keeping a clinic >open most of the time and redirecting people from triage to it. I think Kaiser had an incentive to do this since all people coming through their doors were their subscribers, and this kept all the paying members happy. Several things that may help those without alot of ER exposure on this one- -more than half the people in the ER can't pay for their care/have no insurance -to keep up with the poor payment in the ER area, prices are usually higher to compensate for people that don't pay -hospital ER waits are generally 4-6 hours -hospital administrators can get bonuses in some cases (where the wait has become "excessive") to decrease the wait in the ER, however the time is usually no lower than 3-4 hours so people "don't get used to using the ER as an MD office" -limiting the number of Medicaid reimbursable visits to an arbitrary number has really limited effect on public hospitals since they must accept any member of the public having an ermergency, however it may be a scare tactic/detractor for the individuals (the catch-22 to all this is the lack of payment that will now only exacerbate the ER reimbursement situation). Who does this really hurt/effect in the long run. -some hospitals have opened an "urgent care" type division of the hospital for after hours care for people who have certain insurances (to keep their wait time down since they are on "xyz" priveledged/large scale insurance plan/s). Almost the reverse of what Nick said above interestingly enough. >I guess there's part of me that's slightly sympathetic. When I was a >paramedic, a couple of decades ago, it was fairly unusual for people to call >911 for a clearly non-emergent situation. These days, it seems far more >common. When we got rear-ended on the freeway a few years ago, I was fairly >sure that our injuries (whiplash that troubled me for years afterwards) >didn't require immediate care. But the highway patrol officer who showed up >urged us to go by ambulance so that we wouldn't have to wait for hours at an >ER or clinic. Walk in and wait, come by ambulance and go to the head of the >line. > >This policy is like "teaching" hungry people a lesson by withholding food. > >Nick Two situations come to mind as examples for how waiting rooms are overly burdened because basic healthcare/access is not available- 1) children who have asthma and get prescriptions for inhalers/etc that can be important in life threatening situations, however the family can't afford the inhalers/meds so the situation hovers until the next crisis/ER visit. 2) people who have BPs of 180/105 (normal is 120/80 and standard "high" is 145/95) who do not have insurance to cover a MD visit. Of course it doesn't help that state/federal programs have cut back on payment for these services and many providers/physicians are opting out of medicare/medicaid programs. (There is a growing trend for providers/physicians to have 'cash' only business and accept no insurances at all.) Community health centers can't keep up with demand any more than the VAs seem to be able to. How do we mandate provider participantion in serving the under-insured/non-insured. One part of managed care that "tickled" me was that the traditionally lucrative teachers health plans in many states were supposed to be paired with Medicaid so that in order to bid on being a provider for the lucrative plan, you had to accept the not so lucrative participants. I thought this was a great way to balance things, but it seems to have gone by the wayside. Dee _______________________________________________ http://www.mccmedia.com/mailman/listinfo/brin-l
