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It's Not Just Hospitals That Are Quick To Sue Patients Who Can't Pay

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  • #31
    Originally posted by Lordosis View Post
    Also from a patient standpoint it is a much better experience to come in for an outpatient appointment then to go to the ED.
    This is an interesting misconception.

    # 1 If you come see me at 9 pm on Saturday night you walk out at 11 pm having had an EKG, CXR, labs, and a CT scan. Results were all discussed with you and you left with a copy and the number of a specialist or PCP to FU with in a few days.

    # 2 Or, you can wait until Monday to see a PCP in clinic. Maybe you get an EKG. Perhaps you get your blood drawn that afternoon. You get the imaging the next day. Then the PCP calls you Thursday or Friday, maybe, and says it didn't show much, come in next week and we'll discuss what to do next.

    You tell me which is the better patient experience, but I can tell you this: there are a lot of patients out there who would select the first despite the higher price tag. Would you rather spend 2 hours or a week getting worked up? Which is more convenient? Which is safer?
    Helping those who wear the white coat get a fair shake on Wall Street since 2011

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    • #32
      Originally posted by The White Coat Investor View Post

      This is an interesting misconception.

      # 1 If you come see me at 9 pm on Saturday night you walk out at 11 pm having had an EKG, CXR, labs, and a CT scan. Results were all discussed with you and you left with a copy and the number of a specialist or PCP to FU with in a few days.

      # 2 Or, you can wait until Monday to see a PCP in clinic. Maybe you get an EKG. Perhaps you get your blood drawn that afternoon. You get the imaging the next day. Then the PCP calls you Thursday or Friday, maybe, and says it didn't show much, come in next week and we'll discuss what to do next.

      You tell me which is the better patient experience, but I can tell you this: there are a lot of patients out there who would select the first despite the higher price tag. Would you rather spend 2 hours or a week getting worked up? Which is more convenient? Which is safer?
      I completely agree with you when the problem is chest pain which is appropriate to go to the emergency room. But UTIs and upper respiratory infections do not belong in the emergency room.

      If somebody is having chest pain shortness of breath or any of the worrisome symptoms of course they deserve to be worked up immediately. I am talking about the lower acuity junk.

      This is the whole reason urgent cares have exploded. Low acutity problems but want treatment now.

      Comment


      • #33
        Strange discussion. Suspect you both agree..

        Comment


        • #34
          Originally posted by childay View Post
          Strange discussion. Suspect you both agree..
          You mean that teen girl that had bad cramps shouldn’t have called 911 for the ride to the ED?

          FYI, never got in and out of an ED in two hours. Never knew anyone that did either. Usually was minimum of 6hrs and more if admitted.

          Comment


          • #35
            Originally posted by The White Coat Investor View Post

            This is an interesting misconception.

            # 1 If you come see me at 9 pm on Saturday night you walk out at 11 pm having had an EKG, CXR, labs, and a CT scan. Results were all discussed with you and you left with a copy and the number of a specialist or PCP to FU with in a few days.

            # 2 Or, you can wait until Monday to see a PCP in clinic. Maybe you get an EKG. Perhaps you get your blood drawn that afternoon. You get the imaging the next day. Then the PCP calls you Thursday or Friday, maybe, and says it didn't show much, come in next week and we'll discuss what to do next.

            You tell me which is the better patient experience, but I can tell you this: there are a lot of patients out there who would select the first despite the higher price tag. Would you rather spend 2 hours or a week getting worked up? Which is more convenient? Which is safer?
            Are you really advocating for the ER as a model for primary care workup and treatment?

            Comment


            • #36
              Originally posted by Tim View Post

              You mean that teen girl that had bad cramps shouldn’t have called 911 for the ride to the ED?

              FYI, never got in and out of an ED in two hours. Never knew anyone that did either. Usually was minimum of 6hrs and more if admitted.
              Yes depends on ER, acuity, volume, time of day, etc etc

              Comment


              • #37
                Originally posted by childay View Post

                Yes depends on ER, acuity, volume, time of day, etc etc
                I like the part where they take ME to a separate room and say “Tell me what happened.”
                I really do appreciate the screening for elderly abuse. Broken nose, broken hand how do I know how an 80-90 cracks up . It’s all good, it adds time. Funny part is when you get called to the exam room and MIL keeps waving at the doc saying “bye,bye” and won’t let em touch. That’s when I tell them she doesn’t understand a word they are saying. Put her hands down and the doc can final touch. Grandma was saying “I want to go home. I don’t trust you.” Might be a patient problem there.

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                • #38
                  Originally posted by Tim View Post

                  You mean that teen girl that had bad cramps shouldn’t have called 911 for the ride to the ED?

                  FYI, never got in and out of an ED in two hours. Never knew anyone that did either. Usually was minimum of 6hrs and more if admitted.
                  Sorry your local ED sucks. Average door to discharge time in my ED is around 2 hours. Takes longer to get admitted on average.

                  Honestly, it's usually not an ED problem. It's usually a hospital problem. It can be amazing how long it takes to get someone out of an ED once the decision to admit has been made. If you do it in an hour you're rocking it.
                  Helping those who wear the white coat get a fair shake on Wall Street since 2011

                  Comment


                  • #39
                    Originally posted by ENT Doc View Post

                    Are you really advocating for the ER as a model for primary care workup and treatment?
                    Absolutely not. I'm explaining why patients come see me instead of their PCP. They can come any time without an appointment, I don't demand a co-pay at the time of service, and they get answers a lot faster. I do basic procedures (I&Ds, lac repairs etc) too. PCPs who don't get this are destined to do zero acute care in their clinics. Want to know why your patients go to the ED instead of coming to clinic? This is why. Even if it is discouraged with higher out of pocket costs (and it often isn't depending on insurance plan or lack thereof), some will still choose the higher out of pocket costs.
                    Helping those who wear the white coat get a fair shake on Wall Street since 2011

                    Comment


                    • #40
                      Originally posted by Lordosis View Post

                      I completely agree with you when the problem is chest pain which is appropriate to go to the emergency room. But UTIs and upper respiratory infections do not belong in the emergency room.

                      If somebody is having chest pain shortness of breath or any of the worrisome symptoms of course they deserve to be worked up immediately. I am talking about the lower acuity junk.

                      This is the whole reason urgent cares have exploded. Low acutity problems but want treatment now.
                      What do you mean "deserve?" We have a capitalistic health care system. We ration care based on how much money you have or how good you are at working the system.

                      But once you switch to a system that gives out care based on who deserves it, you have to have someone deciding who deserves it and who doesn't and that introduces even worse problems.
                      Helping those who wear the white coat get a fair shake on Wall Street since 2011

                      Comment


                      • #41
                        Originally posted by The White Coat Investor View Post

                        What do you mean "deserve?" We have a capitalistic health care system. We ration care based on how much money you have or how good you are at working the system.

                        But once you switch to a system that gives out care based on who deserves it, you have to have someone deciding who deserves it and who doesn't and that introduces even worse problems.
                        By deserve a mean that set of problems need prompt attention because they could be life threatening.

                        Comment


                        • #42
                          Originally posted by Lordosis View Post

                          By deserve a mean that set of problems need prompt attention because they could be life threatening.
                          “Warrant” is probably a better word choice in this case rather than “deserve.” But I got your point.

                          Comment


                          • #43
                            “Sorry your local ED sucks. Average door to discharge time in my ED is around 2 hours. Takes longer to get admitted on average.”

                            Might be location. SLC has some advantages. I actually think it’s a volume issue. Level 1 trauma centers seem to have a lot more of those life flights and gunshots and headon collisions that push a broken nose or wrist back a bit. I have zero problem going to a suburban ED, it’s not worth the wait .
                            Trauma, stroke, heart attack are lightning fast. I am very glad they get to cut in line.
                            https://projects.propublica.org/emergency/state/TX
                            Two hours is virtually impossible in a metro area of 6m. The county hospital is 8 hrs!
                            I don’t believe that insurance doesn’t make a difference in which ER an ambulance goes to.
                            https://www.hospitalstats.org/ER-Wai...n-TX-Metro.htm

                            Comment


                            • #44
                              Originally posted by MaxPower View Post

                              “Warrant” is probably a better word choice in this case rather than “deserve.” But I got your point.
                              Exactly. The emergency department is a integral part of our healthcare system and we could never do without it. But just like anything where there's limited resources triaging is key. I wish more primary Care doctors were able to accommodate more in their office to avoid unnecessary ER visits.

                              Comment


                              • #45
                                Originally posted by The White Coat Investor View Post

                                Absolutely not. I'm explaining why patients come see me instead of their PCP. They can come any time without an appointment, I don't demand a co-pay at the time of service, and they get answers a lot faster. I do basic procedures (I&Ds, lac repairs etc) too. PCPs who don't get this are destined to do zero acute care in their clinics. Want to know why your patients go to the ED instead of coming to clinic? This is why. Even if it is discouraged with higher out of pocket costs (and it often isn't depending on insurance plan or lack thereof), some will still choose the higher out of pocket costs.
                                Until 20% of your patients get hit with balanced billing.

                                Comment

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