At shift change this morning, we got a walk up customer. Guy knocks on the door, says he needs an ammalance. Now, what dire medical emergency necessitated his desperate call for our lifesaving skills, you ask?
An earache.
Mind you, this is an earache for which he has already received an examination and treatment. Christmas night, he went to the ER with this earache, and received a $4 prescription for an antibiotic. A prescription he didn’t fill, by the way, because he either didn’t have $4, or had better use for the money (read: crack or booze).
So now he wants to go to the other ER across town, because he had to sit a few hours in the waiting room at last night’s hospital while they were, you know, treating legitimately sick people. And he’s pissed because the ER doctor didn’t wave his Magic Wellness Wand and make his earache disappear.
So now he wants an ammalance to take him to another ER, at a cost to the taxpayers of well over $500, where the ER doctor will listen to his tale, and likely as not tell him to go fill the prescription he got Christmas night.
And some people would have you believe we have a problem with access to quality health care in this country, and that’s why the current health care reform bills are so direly needed.
Horse shit.
No, what is needed is health care payment reform that 1) reimburses primary care physicians enough that caring for Medicaid patients like this isn’t a quick route to bankruptcy, and 2) allows medical providers to tell Earache Boy to go piss up a rope when he asks for an ambulance or goes to his second ER in 24 hours for a minor complaint.
Of course, the current bill will do neither, and in fact will make both problems much worse. This is something I, and every other EMS and ER provider in the United States, sees multiple times every damned day.
And as an additional kicker, while we were treating Earache Boy, there was a cardiac arrest less than a mile from the station. The next closest ambulance was at least three minutes further away. That’s 30% greater likelihood, at minimum, that the cardiac arrest victim will not be resuscitated successfully.
While the paramedics were treating a mother. fucking. ear. ache.
Finally, someone who told it like it REALLY is….Thank You!!!!!!! I am an RN and see this type of abuse of the Healthcare system every day I work……and it is getting worse than ever….I agree there needs to be Healthcare PAYMENT REFORM………People wake up, before it is to late to change this BILL sitting in Congress…..we are gonna go broke treating these type non-compliant people, who visit the ER bec. they know they CAN for BULLSHIT minor complaints…..
Not trying to get into a pissing match with you on this, but your recounting of the incident left me with the impression that the patient was not getting your best due to a pre-conceived notion as to what he did or did not need.
Until our system has some other options made available to us to offer patients like yours, we'll just have to deal with them. That doesn't mean we have to demean them in the process. Remember, any one of us could find ourselves in that position one day. Some choose that condition, and some may find themselves there through no fault of their own.
And for the record, I am very aware of what REfered pain is. My proof reading was obviously not up to par. I will also rearrange my keyboard and put more distance between the R & D keys to ensure this does not happen again…my bad.
Gate Keeper, I've no wish for a pissing contest either. Sorry if it gave you that impression, or if I took that impression from your comment. I didn't detail the assessment we did because I felt it was a given that we'd assess our patient, and it wasn't germane to the point I was trying to make anyway.
And you're right, we'll have to deal with them until our system changes. However, it's not going to change until we make it obvious just how much abuse is going on out there. The health care policy makers are shamefully disconnected from the realities of prehospital and ED care, and it's up to the people on the sharp end of the spear to make these issues known.
And I know all about fat fingers and small keyboards. They really need a sarcasm font on here.
911 non-emergencies a growing problem nationwide
http://www.denverpost.com/ci_14084125
911 non-emergencies a growing problem nationwide
http://www.denverpost.com/ci_14084125
So true. I'm an ER nurse and totally unerstand how people needlessly abuse the system…both on your end and mine. If it wasn't for the damn EMTALA laws that 'protect' everyone from being refused treatment or being dumped somewhere else I think alot of people wouldn't go to the ER. If they knew you guys or us could turn them away they may actually take some responsibility for their health!
From your description it seems unlikely that health care payment reform would have changed the outcome for the patient in either the short or long term. An individual who is an addict isn't going to suddenly turn into a responsible adult because of legislation passed by the Federal government. Are you really advocating the idea that there is Federal law that if passed would solve this issue?
Addicts in your community should be an issue for local (city, county/parish, state) legislators, community organizations, religious leaders, educators, and health care providers work together to solve. If you are aware of the legislation that needs to be written to enable individuals who are to incompetent, ill, mentally unstable, poorly educated, addicted to narcotics or alcohol, inexperienced (read young people), then by all means walk into the office of your local legislator with your petition.
Recent societal and medical history seems to point in the direction that there will always be a proportion unable or unwilling to take care of themselves, and that they rely on the benevolence/charity of society, and that every society must determine how benevolent/charitable they want to be.
Popular lore is full of fables like the Grasshopper and the Ant that are designed to encourage individuals to take the necessary steps to survive in the lean years, but it seems as though there will always be humans who have underdeveloped or damaged amygdalas. Economist love solving the “free rider” problem, but you've suddenly removed the medical providers from the equation and handed it over to bureaucrats.
The fact that your EMS district charges $500 per call seems to indicate that they believe in double taxation. They collect disproportionate amounts of revenue from the wealthier members of your community, and then bill their insurance providers for the call as well. These excessive fees are used to subsidize the patient care for those that are unable or unwilling to pay. Maybe resource management should be based upon the actual taxes paid by each neighborhood, with 20 stations in the richest part of the city, and just 1 station in the poorest. Want to cut to the front of the line in the ER, slip the triage desk $50.
From your description it seems unlikely that health care payment reform would have changed the outcome for the patient in either the short or long term. An individual who is an addict isn't going to suddenly turn into a responsible adult because of legislation passed by the Federal government. Are you really advocating the idea that there is Federal law that if passed would solve this issue?
Addicts in your community should be an issue for local (city, county/parish, state) legislators, community organizations, religious leaders, educators, and health care providers work together to solve. If you are aware of the legislation that needs to be written to enable individuals who are to incompetent, ill, mentally unstable, poorly educated, addicted to narcotics or alcohol, inexperienced (read young people), then by all means walk into the office of your local legislator with your petition.
Recent societal and medical history seems to point in the direction that there will always be a proportion unable or unwilling to take care of themselves, and that they rely on the benevolence/charity of society, and that every society must determine how benevolent/charitable they want to be.
Popular lore is full of fables like the Grasshopper and the Ant that are designed to encourage individuals to take the necessary steps to survive in the lean years, but it seems as though there will always be humans who have underdeveloped or damaged amygdalas. Economist love solving the “free rider” problem, but you've suddenly removed the medical providers from the equation and handed it over to bureaucrats.
The fact that your EMS district charges $500 per call seems to indicate that they believe in double taxation. They collect disproportionate amounts of revenue from the wealthier members of your community, and then bill their insurance providers for the call as well. These excessive fees are used to subsidize the patient care for those that are unable or unwilling to pay. Maybe resource management should be based upon the actual taxes paid by each neighborhood, with 20 stations in the richest part of the city, and just 1 station in the poorest. Want to cut to the front of the line in the ER, slip the triage desk $50.
Hey T4 – if by “other side of the ocean” you mean the UK (as opposed to Oz / Asia), then go take a look at a couple of AD's opposite numbers:
http://randomreality.blogware.com/blog
http://theparamedicsdiary.blogspot.com/
Both these guys work in the London Ambulance Service – Random is Tom Reynolds, who works in an ambulance, and Paramedic is Stuart Grey, who works on a fast response vehicle. Both show the huge abuses that go on against the NHS, requiring ambulances and paramedics to be taken away from those who are genuinely in need.
“From your description it seems unlikely that health care payment reform would have changed the outcome for the patient in either the short or long term.”
There is probably nothing that will keep this guy from attempting to abuse the system. However, reform that requires Medicaid recipients pay some sort of cash copayment for unnecessary visits or ambulance rides might discourage it quite a bit.
“An individual who is an addict isn't going to suddenly turn into a responsible adult because of legislation passed by the Federal government. Are you really advocating the idea that there is Federal law that if passed would solve this issue?”
Nope, what we need instead are repeals or revisions of the currently existing Federal laws that enable such behavior.
“Recent societal and medical history seems to point in the direction that there will always be a proportion unable or unwilling to take care of themselves, and that they rely on the benevolence/charity of society, and that every society must determine how benevolent/charitable they want to be.”
Unable to take care of themselves, I have no problem with helping. Unwilling to take care of themselves, I shouldn't have to pay for. Current laws do too little to address the former, and the health care bill before Congress will only serve to encourage the latter.
Fact: Medicaid and Medicare reimbursement is less than the cost of actually providing the services rendered. It's for that reason that increasing numbers of physicians refuse to take such patients, leaving them effectively without access to health care unless they seek the most expensive and inefficient routes – liking calling an ambulance to take them to the ER for their minor ailments.
Increasing the subscriber rolls without addressing the payment inequity and without making the current and new subscribers responsible for using their benefits wisely is only going to make that problem worse. Massachusetts has already tried the “free healthcare benefits for everyone!” thing, and it's failing miserably for the reasons I just mentioned.
“Economist love solving the “free rider” problem, but you've suddenly removed the medical providers from the equation and handed it over to bureaucrats.”
Nothing will SOLVE the free rider problem, but we can at least hope for laws that won't encourage it. And are you actually trying to say that the current healthcare reform bill leaves the medical providers with some say in how their services should be delivered, and not the bureaucrats?
“The fact that your EMS district charges $500 per call seems to indicate that they believe in double taxation. They collect disproportionate amounts of revenue from the wealthier members of your community, and then bill their insurance providers for the call as well.”
Horse shit. The Borg does not receive any taxpayer monies. They bill Medicare/Medicaid and private insurance, as does every other for-profit EMS provider in the country, and the majority of the taxpayer funded ones as well.
“These excessive fees are used to subsidize the patient care for those that are unable or unwilling to pay.”
Currently, the government reimbursement (Medicare/Medicaid) for such patients is well below the cost of providing the services, so yes, the private insurers and individuals get hosed with higher rates to help subsidize the shortfall.
“Maybe resource management should be based upon the actual taxes paid by each neighborhood, with 20 stations in the richest part of the city, and just 1 station in the poorest. Want to cut to the front of the line in the ER, slip the triage desk $50.”
Nice bit of populist trollery right there, but I ain't biting. You're the one trying to make this a rich vs poor argument, not me.
AD,
Thank you for making the time to reply.
A plan as outlined by you, of requiring the patient/victim to make a cash payment at the time of service might indeed cut down on the unnecessary visits. It seems unlikely that patient who is unwilling or unable to secure the funds as outlined in your example would somehow secure those funds in the future scenario, but that doesn't mean the idea is without merit. And this is where pilot programs would come into play to test out the economics of your model.
Under this example the patient wouldn't be treated for the toothache (because he had no intention of paying), and the disease might be allowed to progress and result in a more invasive and costly procedure at taxpayer expense at some point in the future. There does seem to be a link between tooth decay and cardiac injury. So at some point your MICU will respond to this patient's home.
Many of the problems you describe are related to public health issues, and maybe some of the focus should be on compensating health care providers for dealing with these issues in a prophylactic methodology, rather than an emergent one. It is cheaper to have a school district have PE that is taught well and enjoyable than it is to pay for diabetic children. It is better to
Actually, I couldn't really support requiring a cash payment before services are rendered, if there is no other means for that patient to seek the care needed. If there is no physician or clinic locally that treats indigent patients or accepts Medicaid, the ER is their only recourse.
However, they don't need a friggin' ambulance to get there.
What I think would work is that, for those patients who also receive other forms of public assistance, take the cash copayment out of their benefits if they utilized the ER or ambulance for a non-emergent complaint.
If a person who pays insurance premiums has to decide between groceries and an ER copayment, why not require the same level of diligence from people who get their benefits for free?
Got chest pain or difficulty breathing? Fine, call the ambulance and we'll treat you on the way to the ER, where likely as not you'll go to the front of the line, and the cost will be billed to Medicaid.
Need a pregnancy test, or choose to call an ambulance for the earache you've been seen for twice already? Fine, we'll take you to the ER, where likely as not you'll go to the very end of the line. And if you insist on treatment in the ER once your turn comes, also fine.
But also know that your welfare check or food stamp stipend will be $50 lighter next month because of it.
I think that's an equitable and common-sense approach.
AD,
Thank you for making the time to reply. I forgot that the “Borg” was a not a municipal entity, thanks for reminding me that everything is a little spicier in La.
Have you ever been at the ER, with a patient, and asked one of the on duty physicians to write you a prescription for medication for you or a family member? Did you pay the full cost of that request? Could you have taken care of that on your own time and through your primary care physician? The number of EMT-B,I,Ps who treat the ER as their primary care provider is shocking. And I bet we can even find medics who have had toothaches and had the script written by the staff of the ER. Maybe you aren't guilty of this, but there is some irony in accusing patients who behave in a similar way to the medics who make very similar demands. I don't mean this to be an attack, but merely a chance for honest self-reflection on human nature.
A plan as outlined by you, of requiring the patient/victim to make a cash payment at the time of service might indeed cut down on the unnecessary visits. It seems unlikely that patient who is unwilling or unable to secure the funds as outlined in your example would somehow secure those funds in the future scenario, but that doesn't mean the idea is without merit. And this is where pilot programs would come into play to test out the economics of your model.
Under this example the patient wouldn't be treated for the toothache (because he had no intention of paying), and the disease might be allowed to progress and result in a more invasive and costly procedure at taxpayer expense at some point in the future. There does seem to be a link between tooth decay and cardiac injury. So at some point your MICU will respond to this patient's home.
Many of the problems you describe are related to public health issues, and maybe some of the focus should be on compensating health care providers for dealing with these issues in a prophylactic manner, rather than an emergent one. It is cheaper to have a school district have PE that is taught everyday and enjoyable than it is to pay for diabetic children. It is better to have more parks and open spaces that are safe and accessible for all children than it is to have obese children.
Employers should encourage their employees to lead healthier lives through economic incentives and disincentives, since in the long run they cost less. Don't hire and fire employees who smoke. Set weight and height restrictions to receive employer provided health insurance, and enforce said restrictions.
Provide elementary school children with a toothbrush for their classroom and encourage them to brush their teeth during the school day. Eliminate sugary, high fat and salt foods from their lunchroom menus. Get rid of all drinks in schools but milk and water. Plant fruit trees on school properties.
Advocating that medicare and medicaid patients who can't/won't pay the additional cost for medical treatment should, or demanding that the Federal government increase the compensation to health care providers still doesn't seem to lower the costs of treatment.
A real problem with health care is that the pricing model is a mystery. I can check online for a flight to anywhere in the continental United States, and in a matter of minutes I can compare the cost of the flight, the time/connections required, the type of aircraft, even the class of service and amenities I want. I can even bundle that with hotel and car rental reservations to lower my costs. But I can't tell you what the cost of an MRI at various locations is in my major Texas city that has the largest medical center in the world.
A doctor wants a patient to get an MRI done. They go online and check out the costs, locations, and times available. It turns out that AD's MRI offers a 50% discount on MRIs after 9 PM. They choose to go there, because it matched the services with their own personal economics. A free market system in medical pricing wold do much to reduce costs.
You may choose to fly in coach with Southwest or on Singapore Airlines Royal Service, but you make the selection based on a more accurate economic model. You can choose to get your MRI done in a seedy part of town after 9 PM, or you can choose to visit your Harley Street physician in his walnut paneled surgery.
Ben Franklin advocated a system of national government where the number of representative grated to each member of the union was based on the amount of their percentage of taxes they paid. Members could elect to pay more or less, and their ability to control legislation at the national level was based on their contributions. Under our current system we already have a health care system where wealthier individuals can cut to the front of the line for medical treatment. Poor people can't do that, and although that seems unfair, it isn't necessary that needs to be corrected.
Please continue to address the issues of health care in this nation. It doesn't seem to be a one recipe solution, and in fact like many problems, it will probably be solved best at the local level. Each city and state must do what works for their population. In that sense we certainly agree.
All my best and a happy New Year to you and your family.
Actually, I couldn't really support requiring a cash payment before services are rendered, if there is no other means for that patient to seek the care needed. If there is no physician or clinic locally that treats indigent patients or accepts Medicaid, the ER is their only recourse.
However, they don't need a friggin' ambulance to get there.
What I think would work is that, for those patients who also receive other forms of public assistance, take the cash copayment out of their benefits if they utilized the ER or ambulance for a non-emergent complaint.
If a person who pays insurance premiums has to decide between groceries and an ER copayment, why not require the same level of diligence from people who get their benefits for free?
Got chest pain or difficulty breathing? Fine, call the ambulance and we'll treat you on the way to the ER, where likely as not you'll go to the front of the line, and the cost will be billed to Medicaid.
Need a pregnancy test, or choose to call an ambulance for the earache you've been seen for twice already? Fine, we'll take you to the ER, where likely as not you'll go to the very end of the line. And if you insist on treatment in the ER once your turn comes, also fine.
But also know that your welfare check or food stamp stipend will be $50 lighter next month because of it.
I think that's an equitable and common-sense approach.
AD,
Like everything in our great Republic, there will need to be compromise from all parties involved. Your plan is a good first step into helping educate adults (who need the education) about personal responsibility, and addressing the duality of personal/societal cost and need in health care.
Again, thank you for bringing up the issue, and a forum for it to be discussed.
Only if you get caught. But if you do get a complaint, which this is just the kind of asshole that will place that complaint, then you just explain to your boss what the “valued customer's” crisis was, and what a legitimate opportunity to positively intervene in someones true emergency in an expiditious manner was missed by wasting your time on him. Prob get a slap on the wrist and a headshake when you leave the office because your boss knows the truth, wether you can get them to admit it or not. I have told 'em we are just gonna give you an expensive ride. They don't give a shit. They know they don't have to pay, like they would a cab. BTW our base fee is $1500 here…LOL helluva write-off huh? Wonder why there is no money for raises?
Only if you get caught. But if you do get a complaint, which this is just the kind of asshole that will place that complaint, then you just explain to your boss what the “valued customer's” crisis was, and what a legitimate opportunity to positively intervene in someones true emergency in an expiditious manner was missed by wasting your time on him. Prob get a slap on the wrist and a headshake when you leave the office because your boss knows the truth, wether you can get them to admit it or not. I have told 'em we are just gonna give you an expensive ride. They don't give a shit. They know they don't have to pay, like they would a cab. BTW our base fee is $1500 here…LOL helluva write-off huh? Wonder why there is no money for raises?
I have only been hauled in an ammalance twice. Once for a violent football-related neck injury, and the other when I mangled my spine, spent a few hours crawling toward my car in amazing pain, eventually deciding that it would be better to let somebody scrape my decrepit ass off the floor and give me a ride to the hospital.
Do I get a cookie?:D
I have only been hauled in an ammalance twice. Once for a violent football-related neck injury, and the other when I mangled my spine, spent a few hours crawling toward my car in amazing pain, eventually deciding that it would be better to let somebody scrape my decrepit ass off the floor and give me a ride to the hospital.
Do I get a cookie?:D