More patients flocking to ERs under Obamacare

[drdive 0]

Just my experience as a practicing ER Doc for 32 years. Yes - our volumes, and wait times have gone up. Many who now have "insurance" which is paying providers at Medicaid rates (pennies on the dollar) can not find a primary care provider that will take their "insurance" because their practices already have more Medicaid that doesn't even pay office expenses. Therefore the newly "insured" flock to the ER with problems that can mostly be handled in an office setting.

This is not a political statement, just an observation by someone in the trenches.

"We saved your gear. Now you can sell it when you get out of the hospital and upsize!!" "K-Dub"

"

[craddock 0]

Thank you for your insight. Where I live we have quite a few Urgent care facilities. I wonder where they fit in and if they would be covered by the insurance you speak of. If so they are still going to the wrong place. One of the Urgent Care's in my town is at the hospital. You go in the same door as the ER but go right for Urgent care and left for the ER. So they wouldn't have even gone to the wrong place, but just took a wrong turn.

The last two times I went to Urgent Care though they sent me to the ER. One was my stupidity for not going but wasn't thinking clearly I actually stopped by the ER a couple days after the last time I was admitted to thank everyone I was so impressed with their professionalism and compassion. I had everyone on the board in my room helping me and they were great. Have to love it when people actually love their job and are good at it.

Anyway, are the urgent care facilities not covered or are people just not aware of them? The one I am familiar with is run right with primary care in the same office. You either have an appointment or are a walk in. The problem in the larger cites in the US does not apply to many of the places I have lived though

That spot isn't bad at all, the winds were strong and that was the issue! It was just on the downwind side.

[airdvr 197]

kallend

Cheaper to pay the deductible than the entire cost of the care that they apparently need.

Your point is silly.

You are absolutely correct professor. However, you missed one critical point. The same folks who apparently aren't intelligent enough to know where to go to get their Obamacare aren't intelligent enough to understand how insurance works. When the government gives this crowd money for something the actual idea that they might have to pay for some of it is lost on them. It's another item on the list of things they can get from their Uncle Sam. Expecting them to actually pay a deductible is laughable. Why is it so difficult to see this?

Obamacare missed by a mile in doing anything that will reduce the out of control spending that is healthcare today. Ultimately that will be its legacy.

Please don't dent the planet.

Destinations by Roxanne

[turtlespeed 212]

airdvr

***Cheaper to pay the deductible than the entire cost of the care that they apparently need.

Your point is silly.

You are absolutely correct professor. However, you missed one critical point. The same folks who apparently aren't intelligent enough to know where to go to get their Obamacare aren't intelligent enough to understand how insurance works. When the government gives this crowd money for something the actual idea that they might have to pay for some of it is lost on them. It's another item on the list of things they can get from their Uncle Sam. Expecting them to actually pay a deductible is laughable. Why is it so difficult to see this?

Obamacare missed by a mile in doing anything that will reduce the out of control spending that is healthcare today. Ultimately that will be its legacy.

It was NEVER about reducing cost or price . . .
It was ALWAYS about making it a single payer system to insure that government had more control.

He and they didn't miss. It's just not as pretty a package since the wool came off of the eyes of the people they convinced it was.

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[drdive 0]

craddock

Thank you for your insight. Where I live we have quite a few Urgent care facilities. I wonder where they fit in and if they would be covered by the insurance you speak of. If so they are still going to the wrong place. One of the Urgent Care's in my town is at the hospital. You go in the same door as the ER but go right for Urgent care and left for the ER. So they wouldn't have even gone to the wrong place, but just took a wrong turn.

The last two times I went to Urgent Care though they sent me to the ER. One was my stupidity for not going but wasn't thinking clearly I actually stopped by the ER a couple days after the last time I was admitted to thank everyone I was so impressed with their professionalism and compassion. I had everyone on the board in my room helping me and they were great. Have to love it when people actually love their job and are good at it.

Anyway, are the urgent care facilities not covered or are people just not aware of them? The one I am familiar with is run right with primary care in the same office. You either have an appointment or are a walk in. The problem in the larger cites in the US does not apply to many of the places I have lived though

We have 2 urgent cares within one block of my hospital, and many patients with insurance still come to the ER for minor problems. And of course, many without insurance come to the ER instead of the urgent cares, because we can't by law turn them away. (ER docs are the only citizens not covered by the emancipation proclamation - we are still forced to work for free by government regulation - oh I digress) Education about care alternatives may help, but for many, the ER is the path of least resistance.

By the way, thank you for returning to the ER and thanking them for good service. That makes our day. We try to take good care of folks in a difficult environment. I worked my butt off last night to save the life of a young man losing his airway from a tonsilar abscess, then got crap from a patient with chronic back pain who was out of his hydrocodone because he had to wait. Retirement looms in the very near future.

Ed

"We saved your gear. Now you can sell it when you get out of the hospital and upsize!!" "K-Dub"

"

[turtlespeed 212]

drdive

***Thank you for your insight. Where I live we have quite a few Urgent care facilities. I wonder where they fit in and if they would be covered by the insurance you speak of. If so they are still going to the wrong place. One of the Urgent Care's in my town is at the hospital. You go in the same door as the ER but go right for Urgent care and left for the ER. So they wouldn't have even gone to the wrong place, but just took a wrong turn.

The last two times I went to Urgent Care though they sent me to the ER. One was my stupidity for not going but wasn't thinking clearly I actually stopped by the ER a couple days after the last time I was admitted to thank everyone I was so impressed with their professionalism and compassion. I had everyone on the board in my room helping me and they were great. Have to love it when people actually love their job and are good at it.

Anyway, are the urgent care facilities not covered or are people just not aware of them? The one I am familiar with is run right with primary care in the same office. You either have an appointment or are a walk in. The problem in the larger cites in the US does not apply to many of the places I have lived though

We have 2 urgent cares within one block of my hospital, and many patients with insurance still come to the ER for minor problems. And of course, many without insurance come to the ER instead of the urgent cares, because we can't by law turn them away. (ER docs are the only citizens not covered by the emancipation proclamation - we are still forced to work for free by government regulation - oh I digress) Education about care alternatives may help, but for many, the ER is the path of least resistance.

By the way, thank you for returning to the ER and thanking them for good service. That makes our day. We try to take good care of folks in a difficult environment. I worked my butt off last night to save the life of a young man losing his airway from a tonsilar abscess, then got crap from a patient with chronic back pain who was out of his hydrocodone because he had to wait. Retirement looms in the very near future.

Ed

What are your thoughts on Free Standing Emergency Centers?

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[drdive 0]

<<>>

I would love to work at one. Lower stress, and real sick ones you just ship to the hospital based ER who can't refuse anything.

However I would rather work at the urgent care in Puerto Rico that was mentioned by an earlier poster!! I am considering getting out of the rat race soon, and doing lower stress/acuity stuff, and maybe some locum work in cool spots like that.

"We saved your gear. Now you can sell it when you get out of the hospital and upsize!!" "K-Dub"

"

[turtlespeed 212]

drdive

>>

I would love to work at one. Lower stress, and real sick ones you just ship to the hospital based ER who can't refuse anything.

However I would rather work at the urgent care in Puerto Rico that was mentioned by an earlier poster!! I am considering getting out of the rat race soon, and doing lower stress/acuity stuff, and maybe some locum work in cool spots like that.

In Texas the FEC are licensed.

I am in the middle of negotiations for developing some.
It's pretty interesting learning chapter 131.

Fun Reading

Gimme about 4 Mil and I'll give you one of these.

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[kelpdiver 2]

drdive

Anyway, are the urgent care facilities not covered or are people just not aware of them? The one I am familiar with is run right with primary care in the same office. You either have an appointment or are a walk in. The problem in the larger cites in the US does not apply to many of the places I have lived though

We have 2 urgent cares within one block of my hospital, and many patients with insurance still come to the ER for minor problems.

Doc, I think Craddock's question is meaningful for at least some of the traffic you see. Where is the dividing line between Urgent and Emergency or for that matter, regular care? I think for many, the known choices are wait in the ER, or schedule an appointment for next month.

This question is very fresh on my mind this week. Monday night my girlfriend did not sleep, vomitted frequently, and had become very dehydrated. She had been suffering, she thought, from acid reflux on and off the past week. So come morning when it wasn't settling, I had to figure out what to do, looking at the urgent care and ER options (quite a few in San Francisco). I had hoped it could be as simple as an IV bag to stablise her, and to make sure it wasn't appendicitis. Turned out to be gallstone pancreatitis.

I found one ER had the ability to schedule appointment slots, so she wouldn't have to wait indeterminately in uncomfortable waiting room chairs. But when I put in a description on the web form with works like "abdominal pain," it said go straight to the ER, and you're locked out from scheduling for 24 hours. Either very impressive language parsing, or it aggressively rejects most for fear of someone not coming in fast enough. But maybe it could be the way to shunt a lot of cases to urgent care instead. Happily, the scheduled time was only an hour away, but when we got there 25 minutes later, there was no wait at all.

For the larger hospitals with each, I think I'd like to see a single intake point for those who think they may need ER care, and the obvious no's could be directed to the right. But I won't be surprised for you to say it's not that simple - true ER cases may not have the time luxury for that sort of triage.

[Calvin19 0]

I don't know if my story belongs here, but here it is.

I won't get out of bed without health insurance. I have multiple pre-existing conditions from a paragliding crash in 2006. I was insured, of course, 75$ a month premium and a $10,000 deductible. Awesome worst-case plan and I used every bit of it with over $800,000 in medical bills over 3 weeks coma ICU, 3 months in a hospital and 3 more months doing daily outpatient care and surgeries and the like. I kept the plan until 2012. The underwriter changed and I didn't notice that the auto-payments had stopped. I'm sure my spam folder was overflowing and the mailbox was filling up but I'm bad about getting the mail unless I'm expecting a check or a toy. The plan lapsed, and I was dropped. My fault.
Well, shit. I have multiple pre-existing conditions, but no claims in 6 years. No one wanted me. They would laugh when I called to discuss my application. Finally I found CoverColorado, they were doing something to help people like me get worst-case coverage and that's all I want. I can give myself stitches, cure my cold with regular OTC drugs and even set a friends' tibia that may have been displaced to avoid his un-insured ass the 80k$ surgery to set the bone. But the hell if My family sells their house to pay for my dumb mistake and I rack up a hospital bill like the first.
The story continues, Obamacare light goes on and I apply online, took about an hour going back and forth through screens to make sure everything is correct, and then a quick phone call and BAM. I have baddass insurance again. I'm an aspiring black market weed sales associate in the heart of Boulder, CO where they sell that stuff to anyone, from a store. ALL DAY LONG.
I'm not rich, my jobs are many and sometimes pay very well, others I eat macncheese and tortillas for a month until I get my paycheck that goes entirely into fixing my house. Anyway, my friends at the IRS think I deserve a bit of money from obamacare. My premium is $400, I pay $144 a month. Rich people pay my other 256$. Thank you. It helps. Now, for my first doctor visit in a year, I show up thinking I'm going to have to give up my hard earned mixed-value bills in my pocket. I'm still broke(ish) but I can pay for gas to go paraglide and teach. And my cat's food and poop box sand, and bring my awesome girlfriend a sculpted red/white lettuce statue that we both decide is way better than flowers and sushi.

But,,, back to obamacare. I have been sick for a month now, i started feeling down about 3 days before I left for a BASE/Rigging stunt for a commercial shoot in Panama City, Panama. I load up with the normal cold medications and stuff that covers up the symptoms so I could work 7 days in full sunlight rise-set and a few after that, then sleep in a 5 star hotel for a few hours, then go at it again at 4am. I can't say that only mucinex and robotussin pushed me through this gig. Being close to columbia has its benefits.
OK. back to the story.
Shoot went great, better than the producer and director wanted. All the shots were made, did 37 jumps in one day, and Devin loves the shots. I work one more commercial stunt as the rigger and stunt coordinator and then bam, back to the states. I'm feeling pretty sick, coughing painfully and lethargy all along. I try to power through it with the usual, mucinex and robotrippin but the symptoms don't stop. and as of monday I was still sick. So, I suck it up, get out my nice new insurance card, and take the moped to the doctors office one block away.v(i like riding mopeds.)
I walk in with no apptment, and ask the front desk ladies if I can see Dr. Frollenson soon. I filled out the paperwork, handed the clipboard back, and the doc had an opening he could squeeze me into. Turns out there is a strain of phenmonia causing little buggies to multiply an find new hosts. I guess they found me and now I'm sick. Doctor was very nice, looked into my problem, samples, took about an hour. He comes back with a folder of scripts for me, we shake hands (I'm sure he washed his right off.)
Anyway, I go back to the front desk and ask the ladies what I owe, for the visit. 'nada sir, your plan has 0$ on all outpatient visits. Score! I am now happy with Obamacare, (I was wishy washy for a while.) I plug on over to the pharmacy to fill my cash crop of prescriptions- doctor-signed drug tickets. They are filled in five minutes, and I bring them to the counter, The lady asks me to sign the electronic pad, "but I haven't given you any card. Her reply :"no charge man. Your insurance company takes care of the first 500$ per month of medications. you just have to confirm you received the meds and understand the risks"

Double score the day. Totally free checkup, extra tests, genuine conversation about the cold as well as where I have been the last few months. Then totally free drugs, treatments, and antibiotics. win one for OBC.

I would say my experience has been great. I get an awesome plan for 140$ a month. It's just me, one story. analogous, almost. But I doubt i'm alone.

[freethefly 6]

Quote

I would say my experience has been great. I get an awesome plan for 140$ a month. It's just me, one story. analogous, almost. But I doubt i'm alone.

Fox News hates you.

"...And once you're gone, you can't come back
When you're out of the blue and into the black."
Neil Young

[turtlespeed 212]

I am glad that my tax dollars can help a guy that travels the world doing 5 star hotels.

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[BartsDaddy 4]

Well I assume if everyone had the majority of their premiums paid for them. More would like it. Until they realize they are now paying it in their taxes unless they are one that doesn't have to worry about taxes either.

Handguns are only used to fight your way to a good rifle

[turtlespeed 212]

BartsDaddy

Well I assume if everyone had the majority of their premiums paid for them. More would like it. Until they realize they are now paying it in their taxes unless they are one that doesn't have to worry about taxes either.

Absolutely.

Everyone loves free stuff. Well, not everyone, I like paying my own way and not depending on others to supplement my income.

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[Calvin19 0]

turtlespeed

I am glad that my tax dollars can help a guy that travels the world doing 5 star hotels.

Hey... I didn't pay for it. But like I said, thank you.

Last year I had zero withheld income. All contract work. Big check to write a couple months ago. I'm satisfied with my financial contribution.

[kelpdiver 2]

Calvin19

I kept the plan until 2012. The underwriter changed and I didn't notice that the auto-payments had stopped. I'm sure my spam folder was overflowing and the mailbox was filling up but I'm bad about getting the mail unless I'm expecting a check or a toy. The plan lapsed, and I was dropped. My fault.

maybe, but I have a strong suspicion they didn't try to hard to tell you, either.

This is really besides the topic, but I've been somewhat reluctant to accept pleas from financial companies I use to go to their all email options. I see the benefit for them, but I'm less convinced that it's in my best interests.

With paper bills, I have to open them and scan them. Any notifications have to be included or sent separately. But email notifications "you have a new statement" are often ignored. I simply go online, see the balance, review the transactions, and pay. If they insert a notification block that only shows up in the statement pdf, I may not see it. And then you have the companies that only keep 6 or 12 or 18 months of statements, as if the kilobytes of data are somehow precious. if they're not going be make them available for the 3-5 years I retain the paper copies, I'm not switching over.