Blue Cross and Blue Shield in Georgia is looking to employ a lot of lawyers.
At least that will be a pragmatic effect of the proposed policy to deny emergency room claims if they are not deemed to be emergency reasons. Via WABE:
Starting in July, health insurance provider Blue Cross Blue Shield will stop covering emergency room visits it deems unnecessary….
Fusile says BCBS wants patients to use urgent care, retail health clinics and their LiveHealth app, which are all cheaper than an ER visit….
Hockenberry says, in his research, he’s found many people often use the emergency room inappropriately, for urgent care rather than emergency care.“This is a real problem. Emergency departments are expensive; they’re there for a different reason. Blue Cross is clearly staking a claim here that we’re going to try to change patient behavior,” Hockenberry says.
Donald Palmisano, president of the Medical Association of Georgia, paints a different picture when it comes to this policy: Imagine a BCBS member has chest pains in the middle of the night. He thinks it might be a heart attack, so he goes to the ER. But it turns out that it was just indigestion. Under BCBS’s new policy, he gets charged for using the emergency room inappropriately. So the next time, he has chest pains, he thinks, in case it’s just indigestion, he won’t go to the ER. But this time, it’s a heart attack, and he dies.
Everyone in insurance, everyone in emergency medicine has stories to tell about wildly inappropriate emergency room presentations. But the problem is that the decision to go to the emergency room is fraught with uncertainty. Most people know that something is wrong and they don’t know if it is really, really wrong or mildly wrong. The symptoms are broad enough that likely low acuity events are counterbalanced by unlikely but non-zero high acuity events.
Even some of the non-urgently needed for treatment individuals are admitted for an inpatient stay.
1 in 23 of those triaged 'nonurgent' (which is not same as safe to go home) admitted. https://t.co/mq8Un0youH 1/2
— Ari Friedman (@AriBFriedman) June 1, 2017
Yes, there is value in reducing ER utilization. It is expensive, disjointed and minimally connected to the primary care universe. However it also serves a real need in addressing uncertainty. Better triage, better distance learning tools and better interventions on the very few people who are frequently inappropriate ER utliizers would all be great things. Retrospective claims review with denials is too blunt of a tool to deal with a scenario with explicit uncertainty and information gaps.
There will be lawyers if BCBS-GA actually tries to deny claims. If this is purely a marketing campaign, there might still be lawyers but far fewer of them.
aimai
What do you do if your doctor tells you to go to the ER? That happened to us–doctors will tell patients with severe problems to go to the ER in preference to trying to admit them to the hospital because of hospital rules about who can order tests and get those tests the fastest. And yet being sent to the ER by your doctor doesn’t seem to have any effect on your treatment while there–they run the tests they are going to run and if they kick you back out you aren’t any the less on the hook for those tests or the ambulance ride or whatever else your doctor told you to do.
Chyron HR
Seems to me if BCBS doesn’t want people going to the emergency room when they’re sick, they shouldn’t have backed the party that explicitly says everybody should just go to the emergency room when they’re sick. But that’s none of my business, I’m sure.
WereBear
Blue Cross Blue Shield denied payment on my diagnosis; which my doctor requested. Which turned out to be what I have.
But they said it’s not “medically necessary.” WTF?
Hunter Gathers
@WereBear:
You are obviously not thinking about the shareholders.
john (not mccain)
Is this really a new thing? Over 25 years ago, I went to an ER with what turned out to be a pinched nerve, which I’d never experienced before and was scaring the hell out of me. Humana refused to pay, but shortly thereafter I moved away and never heard another thing about it. The funny thing about it was it was a Humana owned hospital that ended up getting stiffed by Humana.
Bradley
David
Even a health policy and regulatory novice knows ER use with many root causes, not the least of which requires the newly insured and obligatory culture change, access, after hours, etc. This strikes me as a major bumble from an experienced carrier and more an aberration than a trend. They should know better. This issue is an incremental solve. Baby steps.
Brad
Gin & Tonic
I’m still annoyed about my ER visit in March. I went in with a broken arm – I knew it was broken and told them so, and it was obvious. I spent 5-6 hours there while they did x-rays and tried to somewhat set the bone (which a first-year med student could have told you needed surgical repair) and sent me home. So from a medical perspective they did nothing – I came in with a broken arm and went home with a broken arm. But got billed $6k. I have good insurance, so I don’t care, but that $6k, in terms of medical outcomes, accomplished nothing at all.
raven
Shit, we’re on BCBS-GA. When my wife broke her wrist in November we thought we were doing the right thing by going to and urgent care place. I called the BCBS support # at least ten times and did not get a person so we just went ahead. UC looked at it and then took us to x-rays in the same building. They confirmed the break and the UC PA said they couldn’t do anymore and sent us to an orthropod. The did their won X-rays and said it needed surgery and a plate put in. The scheduled us for the next day and I kept trying to contact BCBS. Finally I healed our HR person and they got the rep to call. The lady said “I am telling you that BCBS is NOT going to pay for the surgery down there”. WE cut our vacation short by 10 days and drove back home. We got lucky and got in for surgery the Monday before Thanksgiving. The claims started rolling inland BCBS started denying everything in Florida except the intial UC visit. The X-ray facility turned out to be a separate outfit and they mis-charged us $2000 for a set. After rousers on the phone with them I got them to see that had made a mistake on the bill. On our BCBS statement the $2000 bill has shown up twice and been denied twice. I have appealed everything in writing and BCBS insists that they only cover the UC of ER. I have one last shot to appeal under Obamacare but I am not encouraged, I still have never received any billing from the X-ray or orthopod that were denied. The moral is we should have gone to the fucking ER in the first place.
narya
Why not have an urgent care next door/nearby to do the triage? They capture all of the reimbursement that way, avoid at least some of the unnecessary ER visits, solve the problems that aren’t emergencies . . .
Baud
Wouldn’t it be cheaper for them to pay for a concierge in ERs who can advise people whether they should go somewhere else instead?
Baud
@narya: This too.
Capri
For some reason, this story reminded me of the gentleman who died of Ebola in the US – he was sent home from an emergency room with a diagnosis of the flu. There are some pretty clear public health threats that could follow this policy as well as individual tragedy.
But her emals!!!
Out of curiosity, how is Fran the Factory Foreman, Fred the Farm Laborer, Olga the Office Worker or Sam the Small Business Owner supposed to judge whether urgent or emergency care is the appropriate choice? Are we all supposed to get sufficient medical training to do basic diagnosis and triage?
dr. bloor
How does BC/BS classify guys showing up in the ER during regular business hours to have foreign objects dislodged from their rectums?
Asking for a friend.
aimai
@Baud: Exactly my thought when we were in the ER. IT would be cheaper to pay for a concierge to route people to different solutions than having them wait for hours to see the a doctor. It would also be very reassuring to patients who can’t tell where they are in line for the longest time and don’t know whether they will ultimately receive any treatment.
raven
@dr. bloor: Send them to “Master on None”!
Another Scott
@narya: I was going to suggest the same thing. It’s such an obvious solution to this supposed problem.
Instead of making people sit around in a waiting room for hours, send the walking wounded down the hall (or outside to the other building on campus) to the clinic. If they can be treated there, great. If not, send them back down the hall to the ER.
It’s insane what insurance companies put people through. Grr…
Cheers,
Scott.
Jager
After reading all the healthcare bullshit, all I can say is I’m happy I’m a Kaiser Permanente member.
BTW, I had cataract surgery last fall, the out of pocket? $345.00.
eric
@narya: ding ding ding. we have a winner.
ChicagoPat
I am an ER doctor. In my experience, the insured patient population isn’t a significant driver of inappropriate ED use, mainly due to copays. Not saying they don’t at all, just doubting this action will have a significant postive effect other than harming and pissing off their paying customers. The use of the ED by public aid/medicaid population really must be seen to be believed. I really is the first stop for almost any symptom or injury, no matter how minor. Ambulances are merely a means of transport to the hospital, not a conveyance for the critically ill. There rarely is any attempt to problem solve before coming to the ED, no OTC medication, no call/appointment to PCP (and most of my patient population, even on medicaid, have a PCP). It’s purely convienience. The ED is not allowed to turn them away. We have a propmt care IN THE SAME BUILDING as the ED I’m in, and I’ve heard patients with minor complaints refuse the offer of prompt care, because they didn’t want to walk across the building.
I don’t agree with what BCBS is doing, but the need for something to be done is undeniable.
David Anderson
@dr. bloor: If it is their head stuck up their ass — it is a pre-employment screening and the ER gets a referral bonus.
Anything else, either a good time gone bad or an emergency.
NorthLeft12
Up here in Canada we get told to go to the ER anytime you have a medical issue that you think is urgent enough to be looked at within twenty-four hours because you will pretty much never be able to see your own doctor quickly.
And I thought Dubya said that all Americans have accessible health care because they can just go to the ER?
I guess he was right, but you will damn sure pay through the nose for it! Insured or not.
David Anderson
@ChicagoPat: there is a cultural issue on urgent care. The focus groups that I have seen show profound mistrust of the urgent care system as a means of pushing people aside to what is perceived to be substandard care. We see the same effect on super aggressive end of life care paid for by Medicare when stratified by income and race. People who have been marginalized and now have access to almost anything will tend to go for the most aggressive treatment out of a fear that they would be getting screwed if they did anything else.
ChicagoPat
@narya: Something like that has been implemented in (of course) California, and seems to work well. I’ve talked to my administrators til I’m blue in the face for last decade to try to get it implemented where I work, but they are concerned it would be considered an EMTALA violation (the ED must see all patients that present to it and give a “screening exam”, regardless of ability to pay). What constitues a “screening exam” has continued to expand over the last 3 decades…
ChicagoPat
@David Anderson: Ironically, I’m in and out of the room with these folks in 2 minutes, as I have bigger fish to fry. The promptcare generally spends more time with them, and, truth be told, are more likely to order xrays, bloodwork and antibiotics that are probably unneccessary, thus blunting the cost savings a bit, while contributing to antibiotic resistance (but improving the all important patient satisfaction score!).
eric
@ChicagoPat: yes. the solution….a trivial amendment to EMTALA: “In the event that an Urgent Care Center is located no more than [Insert measurement here so that a patient crash can be timely treated] from the Emergency Room Treatment Center, then the use of Urgent Care prior to the Emergency Room Treatment Center shall not constitute a violation of EMTALA.” Sigh, back to paying work.
acallidryas
@narya: Why not have an urgent care next door/nearby to do the triage? They capture all of the reimbursement that way, avoid at least some of the unnecessary ER visits, solve the problems that aren’t emergencies . . .
True story, in my parents’ town the urgent care is across the street from the hospital. My dad went to urgent care many years ago thinking he’d aggravated an old chest and shoulder injury, but they followed procedure for a man with numbness in his left arm, ran the necessary tests, and it turned out he was having a minor heart attack. They sent him to the hospital, but per policy called an ambulance to take him across the street-because he was having a heart attack. But this was pre-Obamacare, and our insurance didn’t cover an ambulance! So his trip across the street cost about $550.
Just to note that the medical care and insurance industry is messed up and there’s no winning.
NorthLeft12
@ChicagoPat: I appreciate your take on this, but lets face it, a lot of people want their medical issues looked at and identified, and treated by a competent person fairly quickly. Others will ignore the symptoms and/or self medicate [probably incorrectly] causing themselves harm in the short, medium, and long term.
This is a difficult issue to address effectively and is made much more difficult by the lack of education and knowledge of the general public on medical issues. The internet can be helpful, but again is full of false information too.
As a Canadian I am not about to say that single payer would fix this, because it doesn’t. Long ER wait times and inappropriate use of the ER is a thing here too. A lot of people [me included] resist going to the ER because we know how long we will wait before seeing any medical personnel. I wish that ER personnel would do more effective triaging and inform patients when they arrive roughly how long they may wait and what their priority might be.
Gin & Tonic
@dr. bloor: A good friend of mine was an ER resident at St. Vincent’s Hospital in NYC in the late 1970’s/early 1980’s. Boy, did he have stories. (There’s a lot of between-the-lines info here for NYC folk.)
Barbara
@ChicagoPat: The mismatch between what people need and what our health care “system” delivers is at its most obvious when it comes to providing urgent care for relatively minor issues. People go to the ER because there is nowhere else to go, at least not during working hours. This is especially true for the uninsured and Medicaid populations, but it’s true enough even for well-capitalized people who just can’t take three hours out of their workday to visit a doctor, assuming the doctor will even see them on that day. The reason Steve Case got into the minute clinic business was because he couldn’t find a doctor to deal with his kids minor but still urgent issues over a weekend. If he can’t find someone what hope do the rest of us have? Why is this always presented as a “demand” problem (stupid consumers should know better than to bother ER doctors with stupid problems) rather than a “supply” problem (we really don’t give people what they really need for minor but still urgent issues)?
What would be better, still controversial, would be for BCBS to partner with preferred ERs to come up with a streamlined experience for minor issues and work out a negotiated payment rate for minor issues. Of course there are complexities. There are always complexities.
The Moar You Know
Kaiser CA (at least SoCal) has been doing this for years. It’s utterly unconscionable, as the net effect is that people put off going to the ER until it’s too late.
But then again, killing patients has never been much of a concern for Kaiser.
Ciotog
Urgent care also isn’t open at night, at least where I live. Shoot, I’m not even sure it’s open on Sundays.
Barbara
@Gin & Tonic: You want a New York story? My sister’s long time friend/ex-boyfriend’s primary care doctor was out of town when she visited him and found out that he could barely walk and was in a lot of pain. So she took him to an ER (a fancy shmancy ER at the insistence of his father), — specifically, Mt. Sinai — which duly did an examination that consisted of a CAT scan that showed nothing obvious. So they kicked him out. They threatened to call the police when my sister began arguing that he was still unable to walk and still in pain. Union member, great insurance — didn’t matter. In shock they called a distant doctor acquaintance who listened to my sister between sobs, who then directed them to an ER 45 minutes away and called the ER to tell them that he was on the way. Diagnosed kidney failure within 30 minutes, which turned out to be secondary to a terminal cancer. Don’t even try to tell me that Mt. Sinai was trying hard enough, or that it should ever require so much special pleading to get attention for something so serious. Our health care system — it is broken.
Anonymous At Work
David,
How would you factor in the legal costs associated with the appeals and lawsuits associated with keeping people from visiting the ER? Seems like a wrongful death suit or two would skew the figures as much as the $1 million/month person in Iowa skews those figures.
dr. bloor
@Gin & Tonic: Knew a few people in the ED when I was on staff there, and the stories were fabulous. Had another friend in the ED at Presbyterian on the Upper East, and he used to complain because all he got were broken hips and heart attacks.
EBT
@ChicagoPat: Having a GP isn’t the same as having a GOOD GP. I have had GPs that, quite frankly, should have come home in body bags instead of staying in medicine.
Barbara
@Anonymous At Work: I haven’t done a 50 state survey recently, but there is a good chance that this is being misrepresented, at least in part. Nearly every state amended their insurance codes to impose a statutory definition of emergency so that insurers could not refuse to cover visits to an ER for symptoms that a reasonable person would believe require immediate attention. So I don’t see how BCBS could just refuse to cover ER visits based on its own objective determination of the symptoms after the fact. That said, this so-called ER misuse has been seen as an issue for decades, and still, the solutions are inadequate. Of course hospitals are only too happy to charge a premium for using the ER, so they contribute as much to the problem as anyone.
ChicagoPat
@Barbara: I can’t argue with most of that. But like I said originally, you have to see it first hand to believe it. I’ve seen people come to the ER at 8 am, who have told me they have a doctors appointment for their URI sxl, etc , but “couldn’t wait”. People who have left their doctors office, scripts in hand, and come to the ER, because they wanted something for pain, and didn’t want to wait to fill the prescription. On, and on, and on. I think the problem is we now live in a point and click society, where “urgency” has less to do with need, and more to do with impatience.
Barbara
@ChicagoPat: A long time ago I had a boyfriend who was a medical student on the Southside of Chicago, so I do believe it. However, it’s really hard to characterize each of your anecdotes — maybe the doctor was asked and refused to give pain medication, which sets up a different kind of issue from failure to have one’s needs satisfied immediately. Maybe the UTI was intolerable or seemed so, and the person was forced to wait for days to see a doctor and really was at the end of their rope.
Another Scott
@Barbara: Too many physicians jump to instant diagnoses before gathering any evidence. I’m convinced that’s why women aren’t taken seriously when they have excruciating pain or have heart attacks and the like.
One of J’s father’s pulmonology docs visited him at the hospital and didn’t want to treat him because he was ~ 85 and “just look at him!” He also misinterpreted “life expectancy at birth” (~ 78) with “life expectancy at 85” (~ 87+). He knew his stuff, and was a well-regarded physician, but his bedside manner was atrocious once he made up his mind about something. (Joe lived to be 88 after being written off by many of his doctors when he was around 50.)
Cheers,
Scott.
(Who wonders if AI will help solve some of these human problems, but remembers GIGO…)
Greg in PDX
I live in a county outside of Portland that has no urgent care or retail health clinics. We have an excellent medical clinic with great doctors but they work by appt only and they simply will not accept last minute patients. They will tell you to go to the ER in Portland. What then?
The Moar You Know
@David Anderson: It is substandard care. I have never been to an urgent care place that provided any degree of useful medical assistance whatsoever. My impression is that the staff are utterly incompetent and the doctors (if they have one and most don’t, most have, at best, a PA) are waiting for their license revocations to finish the appeals process or waiting for their “real job” to start.
Last time I went to one will be the last time.
Barbara
@Greg in PDX: Start redefining what you mean by an excellent clinic and great doctors? They do this even for children? You see, that’s the tell for me — my kids’ pediatricians operate on the assumption they will need to make room for last minute urgent situations and operate their practice accordingly and they always have. For instance, they use a lot of physician extenders and nurse practitioners. Some of what you are describing almost certainly has to with a financial model that does not reimburse PCPs sufficiently to allow it to have an “overflow” person who can deal with the urgent walk-ins (it’s a huge issue with huge repercussions that most people barely understand), but it is possible to have a different model that is more convenient for the average person. They just don’t need to.
Mnemosyne
@ChicagoPat:
What time were they supposed to report for work? Did they have sick time, or was any time off to see a doctor coming out of their pocket? How painful was the UTI?
I think there are a lot more moving parts in these patients’ lives than you seem to realize.
Mnemosyne
@The Moar You Know:
You must have really crappy doctors in your area. I’ve gone to urgent care in the SFV a few times and, while the facilities were a little shabby, the doctors and nurses were very good. And when I was on Kaiser, they never even hinted at refusing to pay for any of my ER visits, even when my chest pains turned out to be pleurisy and not a heart attack.
ChicagoPat
@Mnemosyne: Sorry, I didn’t finish my thought in that sentence. They came to the ED at 8 am, when they had a doctors appointment at 9 am. And no, it’s not a “moving parts” issue.
Barbara
@Mnemosyne: Did they have a fever? Did they have back pain? Oh yes, the days of UTIs . . . What might a physician’s office do? Have the person drop off a urine sample and provide a prescription pending outcome of assessment. Again, “but we don’t get paid if we don’t actually see the patient.”
ChicagoPat
@Barbara: I trained at the University of Chicago, so I probably lived most of those anecdotes also. I hesitate to talk about inappropriate ED use, even with my wife, because there is an instant reflex to defend the behavior, as evidenced by the multitude of “that one time” stories. I’m not talking about every bad experience someones had in an ED. I’m talking about people taking the ambulance to the ER because that have a sunburn. Mosquito bites. looking for narcotics because their primary has cut them off for abuse/diversion. The right seems to take it as given that anyone on public aid/medicaid is a system abuser, but on the left there seem to be a belief that no one on public aid is guilty of this. I obviously lean to the left on this, or I wouldn’t be here, but this is a serious issue that must be addressed if the system is ever going to be fixed.
Shinobi
I think what’s odd to me here is that the default response is “We should change consumer behavior.” Why aren’t indeed hospitals, changing the way they staff their hospitals? Why isn’t there a 24 hour NON emergency clinic in every hospital? Why isn’t there a triage nurse who tells you which door to walk through when you arrive?
Right now if you have medical needs your choices are “Wait it out, until tomorrow when your doctor MIGHT be able to squeeze you in or you might have to wait several days for an appointment.Or even worse if you don’t already have a doctor no one might be taking on new patients right now and you might have to call 50 places before you find someone who can see you within the next week.” All the meanwhile wondering if whatever is wrong with you is a serious emergency and if your family member might find you collapsed with a phone in your hand.
Or go to the ER.
It seems to me that the issue is not “patients not understanding how the ER should be used.” It seems to me that the issue is that hospitals are ONLY set up to treat either emergency patients, or patients with a lot of time on their hands who don’t mind waiting an indeterminate amount of time to find out if their problem is even real.
More and more for profit “Urgent Care” clinics are springing up, so, why aren’t hospitals building those alongside their emergency rooms to handle overflow of non urgent patients and make sure patients have access to medical care?
It’s simply not reasonable to assume that most people can make appointments only available between 9-5 pm work, when they know it will be at least an hour of waiting.
Barbara
@ChicagoPat: Sure, of course. But when a lot of your life is lived as poverty induced pathology, you exhibit pathologic, maladaptive behavior. BF told me that he had a heroin addicted patient who gave the assembled team a better than textbook lesson in how to find and tap a vein. That guy’s primary problem is not that he shows up at the ER when he shouldn’t. These are problems that surpass ER misuse. And the drug seeking, really, that’s everywhere. My BF eventually did his training in North Carolina, and even he was shocked at the level of demand for pain medication (and this was before the opioid epidemic). But at least back then, these were people who would never dream of using heroin.
David Anderson
@The Moar You Know: I feel 100% confident taking my kids to the pediatric focused urgent care. Every time I have taken them, they either got the appropriate care or we were quickly told “I think it is problem X, we can’t do anything about problem X, which ER do you want me to call so you can jump triage?”
Barbara
@Barbara: Just wanted to add: The reason why the ER misuse is the problem that is identified is because that’s the problem for the so-called stakeholder. There was a great article in the New Yorker that talked among other things about an initiative of the Geisinger Health Plan to provide groceries and healthy cooking and eating advice to certain patients, which they estimated returned savings 10X the amount invested. So much of what we are seeing are not medical problems and we keep trying to impose “medical” solutions on non-medical problems. You can tell an indigent person all you want not to show up at the ER, but that won’t help her figure out how to visit a doctor without losing half a day’s pay. Making the system more convenient for her will help make it more convenient for everyone else as well.
Marci Kiser
@Shinobi: “I think what’s odd to me here is that the default response is “We should change consumer behavior.” Why aren’t indeed hospitals, changing the way they staff their hospitals? Why isn’t there a 24 hour NON emergency clinic in every hospital?”
Many of them have exactly this. Alternately, almost every ER now has a “fast-track” that is essentially an urgent care.
“It’s simply not reasonable to assume that most people can make appointments only available between 9-5 pm work, when they know it will be at least an hour of waiting.”
Urgent cares are open after 5pm, and many now offer call-ahead to place yourself on the list to be seen.
I know it’s easy to assume that there are obvious answers, but reality matters.
Also agree with @ChicagoPAT in #19: the Medicaid misuse of the ER is one of the biggest drivers of nonsense, and won’t be affected by this unfortunately.
(To throw in my favorite story, a patient of mine hurt his foot, went to one ER, was told the wait was three hours, walked home, and called an ambulance to take him to another ER with a shorter wait time.)
Mnemosyne
@ChicagoPat:
If the doctor’s appointment was set just an hour later, it sounds like there must have been some kind of moving parts issue. Most people don’t just wake up and decide they can’t possibly wait an extra hour unless something changes at the last minute than means that that time no longer works for them.
Mnemosyne
@ChicagoPat:
Part of the problem is that “that one time” stories include stories like that of Barbara Dawson, who died in the parking lot of the ER because the ER staff decided she was faking her shortness of breath and pain and called the police to take her to jail. In fact, she had a blood clot.
This happened in Florida in 2015, so we’re not talking about ancient history here. For every misuse of the ER story, there’s one of a patient who wasn’t taken seriously and ended up dying or becoming seriously ill.
So maybe the problem is the way our ERs are set up, not the people using them.
dr. bloor
@Mnemosyne:
This…isn’t accurate. And there’s a logical case to be made that minimizing the former will minimize the latter.
workworkwork
@But her emals!!!: Exactly this.
My wife fell in the shower on Sunday night. We didn’t realize that her urinary catheter had stopped draining as a result until Monday morning (Memorial Day).
Her PCP is closed. Her urologist isn’t available. It’s 7 AM and I have to decide between urgent care and the ER.
We ended up going to the ER, which turned out to be a good thing since they had the idea to X-ray her hip to make sure it wasn’t broken.
workworkwork
@Jager: Another happy Kaiser member here.
grandpa john
@acallidryas: Similar to my last ER visit. I was having severe chest pains that extend to my back. Went to local ER where they did EKG and cat scan couldn’t do MRI as I already had Stints. Local ER doc then called the regional Hospital Cardiology ER And talked to on duty cardiologist, they keep one on duty at all times and he has access to records.He had them transport me to their ER and they were waiting for me when we arrived. At that point I informed the doc that I had recently had a stress test with nuclear scan but it hadn’t been read because of computer malfunction. Since he was a member of the same practice I used he had access to my records.He went to look at them, came back shortly and told the ER crew,”prep him” so at around 11 pm that night I was getting a balloon angioplasty and 2 stints inserted and a 2 day hospital stay at no cost . I had a 99% blockage on top of one from a few years back. I am on medicare and have BCBS state plan supplemental so no hassle with Insurance
I have nothing but praise for both ER’s and the care I got that night.
Barbara
@dr. bloor: Right. There are many times the number of people who show up for minor ailments than people like my sister’s friend who was thrown out after the ER missed a potentially lethal condition. Or my dad, who was told to leave when he went to the ER with intractable pain that turned out to be terminal pancreatic cancer. Too many ERs see their role as shoving people out the door once they realize that they don’t have an acute condition. Where those people go or whether they have real problems that need attention, is just not their problem. It’s hard to feel sympathy for them because they have to take care of people whose problems don’t interest them or aren’t the kind of thing they went to medical school for.
grandpa john
@NorthLeft12: Last time I went to local ER, when I signed in and told them was having severe chest pains and back pain, they immediately moved me to the front of the line and had me taken directly to a cubicle and started an EKG. They ran test and even called the on duty cardiologist at the regional hospital who had me sent to them. AT 11 pm I was getting a balloon angioplasty and a coupe of stints’ I can tell you I have nothing but praise for both ER’s and their dedicated staffs
Barbara
@Mnemosyne: I don’t believe Ms. Dawson was in the ER. She was an inpatient when she refused to leave.
Chad
I’m curious if insurance companies could legally start looking at types of health issues when going to the ER. For example, a drug overdose. Would it be legal for an insurance company to deny coverage for a heroin overdose because its illegal activity? Just curious.
TenguPhule
@But her emals!!!:
No, Mr. Bond. You’re expected to die.
Greg in PDX
@Barbara: My doctor is with OHSU, the largest and most prestigious health care provider in Oregon. . And no, they do not have any space at all for last minute patients. This is per OHSU guideline which also limits the amount of time that they are allowed to allocate for each patient. OHSU has their own ER and that is where they generally recommend you go, but you are free to use another hospital if you wish. Since my insurance is through the state of Oregon, who works closely with OHSU, it is never a problem for me. Oregon Health Plan charges me no premiums,I have no deductibles and no co-pays. Oregon health care laws and general procedures are not at all like any other state in which I have lived (and I have lived in 8 states!).
Mnemosyne
@dr. bloor:
Sure, but you’re never going to be able to minimize incorrect ER usage simply by making it harder for patients to use the ER at all, because patients by definition are not trained to know what’s an emergency and what isn’t, and that’s even before you get to issues of mental health and mental capacity. Hospitals and medical centers are also going to have to adapt and change the way they operate.
Greg in PDX
When I lived in Sacramento I needed some last minute help so I went to one of those private urgent care places. I might as well have gone to the Medieval Barber or a witch doctor
Camembert
My experience with ERs is that they’re pretty solid for middle aged white dudes and Ground Zero for medical white supremacy and patriarchy.
Barbara
@Greg in PDX: While I hate to contradict you about your own experience, I cannot possibly consider them to be really high quality if they are sending you to an ER every time you need a same day appointment. The ER might or might not have access to your medical record (the OHSU ER might) and the doctor doesn’t know you or your history. And whatever they figure out at the ER doesn’t make it back to your original doctors. So if you are having an adverse reaction to a prescription drug, for instance, it is more likely to be missed and less likely to show up in your medical record (patients are notorious about forgetting which drugs they are taking). I am sure I am missing context, and I can’t believe they operate this way for pediatrics. It’s a prescription for uncoordinated, fragmented, and mediocre care.
Camembert
“And whatever they figure out at the ER doesn’t make it back to your original doctors.”
Can you imagine if we lived in some kind of insane world where a “computer” could generate a “document” which was “automatically” forwarded to a “doctor’s office”?
Mnemosyne
@Camembert:
Electronic medical records? Blasphemy! Get him, he is a blasphemer!
Applejinx
@But her emals!!!:
No, Mr. Bond, I expect you to die…
Applejinx
@TenguPhule: Dammit, Tengu ;P
dr. bloor
@Camembert: If the ER and the outpatient office are part of the same group, it’s not even being forwarded. The PCP and ED doc are entering stuff into the same file.
Barbara
@dr. bloor: That’s a big if. Seriously, it could be the case and increasingly I hope it will be the case. It certainly is the case at Kaiser, but it is not the norm. I still feel like I must be missing context on how his clinic operates because I find it hard to believe they send every elderly Medicare patient to the ER at the drop of a hat when they report a complication or problem arising out of a condition that this group is treating them for.