Monday, February 20, 2006

E$$ENT, CO$TS, and CARE--3/4

Some people in Paris have been sending in commentaries about the ER bills they have received.

$6000 for treatment (for a fall) from one ER visit!
$300+ for a chest x-ray (not including reading! The imaging center charges about $100 all inclusive!)
Blue Cross-Blue Shield showing billing for the ER docs as out of network.
Blue Cross-Blue Shield listing the Pathology Lab that a kidney stone was sent (by the hospital) to as being out of network.
For Medicare and other insurances, they do not pay that amount. Medicare determines what is fair and reasonable, and then pays their negotiated amount. However, if a patient's co-pay for insurance is a percentage, then 20% of $300 is a bit more than 20% of $100. If you only carry catastrophic insurance, or you are self insured, you pay the entire inflated bill.

So, you might want to check out your options prior to an ER visit. In the off-hours, the Salas Clinic might not be able to treat a heart attack (if suspected, go straight to the ER), and they will freely admit it. If you go there and it is not in their scope of what they can handle, they will send you to the ER. But, if it is not a life-threatening emergency, it will be a more cost effective solution.

During regular business hours, your regular provider is obviously your best option. They have your history, and are not likely to be repeating tests which they have already explored with negative results. If they do send you to the hospital, they can give them a complete history.

The ER is starting from a blank slate, and only know what you or someone that is with you can provide. Do you trust your memory in a crisis?

Your best preparation for an ER visit is documentation. Have all your medications written down, with dosages. Have a full list of providers that you have seen and what for. If you have a living will, keep that with the lists. The least amount of guessing that the staff has to do makes care quicker and more effective. The time to do this is not as you are leaving the house--it's NOW. You are on your computer--pop up your word processor and list the items that you can remember. Then print it out and cross-check it with your medicine cabinet and your list of appointments. It's far more productive than blogging!


Anonymous said...

It truly amazes me that not a word has been printed in the Paris paper about ANY of this deplorable mess that is happening with Essent.........what gives on that. The usual reply of, "Well, it takes 30 days or so before your letter is printed." Okay.........Essent's been here two years, prices have been inflated, visits are more lengthy, patient care has been greatly WHERE are those letters to the Editor???? AND where the HECK are our elected officials, pretty quiet on the town front, don't you think folks?

fac_p said...

The Paris Snooze is able to run a piece on the lawsuit right after the ad from the radiologists came out, with quotes from an Essent rep. Obviously they can do it as expediciously as they wish.

The Snooze is in the business of selling ad space, Essent buys it, and as such holds a sway with the news. News is only a way of selling papers/ads...both entities are for-profit.

You will find very little except fluff reguarding PRMC. Don't expect it to change.

This blog started from the privatization of trash removal issue. Why should the influence of the largest employer in Paris be less than that of Waste Management Inc on elected officials? I would say that it isn't.

Anonymous said...

Heck, it's still dealing with "trash" removal!

Anonymous said...

So....if it's money that matters to the Paris News....can we start an anonymous acct at a local bank to fund both this website and some nice full page ads? As I empties out me piggy bank....

fac_p said...

Start a free blog and I'll hyperlink to it. Publish pictures, comments, etc. Out report the Snooze. Publish jokes. Whatever. If it goes outside of my moral bounds, I'll drop the link.

And, save your money, healthcare is going up here, and gas to anyplace else will cost you.

Anonymous said...

ER sucks u wait for 6 hours before receiving medical help. You receive 1 hour of agonizing paper work. Then you receive 1 hour of how your going to pay ur bill. Then u wait 3 hours before a Dr. looks at you. Then u spend 1 hour getting out. What a f###ed up system.

Anonymous said...



Darn, girl, tell us how you really feel!

Anonymous said...

Triage by the money or power in the hospital and or community instead of by airway, breathing and circulation?

If administration is making the nurses do it this way, OMG the law suits. I wouldn't do it. I've been faced with this, and I didn't do it. It's not worth your license.

Have you read whistle blower protection act?

Anonymous said...

You can also thank Shumaker for some of the great ER system. They came in and administration agreed with them how to make the ER more efficient.

I would love to see the average lenth of stay for an ER patient with Essent VS Christus.

I would also love to see the profit margins from then and now.

Pt. satisfaction and nurse satisfaction VS then and now.

Anonymous said...

This is how it works in ER. You have one Triage nurse, One charge nurse, 4 nurses for 16 beds, and usually one paramedic, a ward clerk and a doctor or 2.

(this is not counting ER2. There is a unit secretary, 1 nurse and 1 nurse practitioner for 6 patients, but the patients are supposed to be like clinic patients. Not always)

Ok so if everybody shows up and no one gets floated to another floor, you have 1 nurse for 4 patients, 1 doctor for 8 or 16 patients, depending on the time of day, and the paramedics help with drawing blood, ekg's, and that sort of thing.

It doesn't sound too bad until you take things into consideration. 1 big trauma pt can take 2-3 of your nurses for a while. While the rest of the nurses are trying to take care of the rest.

If you have a pt that needs conscious sedation, you have a one on one patient for the nurse and the paramedic (if you do it saftly, and the way it's supposed to be done.)

If you give TPA or TNK (Massive blood thinners, that are supposed to help stop heart attacks or strokes) This is a 1 on 1 patient as well. You start that medicine, you are supposed to stay with that pt until it goes to the unit, reperfuses, or goes to the cath lab.

A pt on a back board is supposed to be a 1 on 1 patient until their c-spine is cleared.

A pt who is a suicide risk is supposed to be a 1 on 1 patient. Those patients are usually at the hospital for 4 -12 hours until we can get a bed for them.

When you start to talk about standards of care, there are some problems. I have seen times when we had all of the above there at one time.

If you take away just one nurse, can you see some saftey issues? There have been times when we have been 2 nurses short.

Do you have an idea what it does to the nurse to be short? Do you see how it can effect her license?
Do you see why she may act ugly when your not dying, and she has another one that is. It's not the patients fault, she knows it. It's the staffing issue.

Not being able to do her job safely has her scared and frustrated, coupled with the I have not peed or eaten syndrome.

Administration, directors and charge nurses think that since their name is not on the chart, that they will be spared from the lawsuit that ensues.

They are dead wrong. A lawyer will find everybody working on that shift, the charge nurse, the director, the administration and the hospital, and they will all be sued. Because they didn't make sure the pt was safe, and the staffing was safe. They had a duty to that patient.

If there was breach of duty, damages, and they can prove that breach of duty caused the damages that case has merit, and everyone envolved is now under the gun.

The hospital will blame the nurse, the nurse will blame the staffing, and if the lawyers forgot to name somebody, everybody will blame that unamed somebody----So I can assure you, everybody in their dog will be named, because the lawyer can get into alot of trouble if he has missed anybody.