Tuesday, May 12, 2009


A FYI link sent to me lead to an MSNBC article that highlighted a situation in healthcare. ER AMA (Against Medical Advice) walkouts because of the cost of medical care. I don't know what our percentage is, but I know I've been questioned about the costs of care, items, and tests...and I really don't know the answer.

We watch the medical shows on the television, Hopkins, Rescue Me, ER, and think of the lives they are saving--maybe we ought to think about the lives that we are ruining. It would be an eye-opener if they had a running tab on-screen of the cost of treatment.

We have those who are brought in by EMS, which decline treatment from the start, who didn't want to go to the hospital, but were told they just needed to be "checked out."

Some patients see the back-up in the waiting area and don't want to wait. (Now, if it was serious enough to come to the ER, wouldn't you think that waiting wouldn't be the issue???)

And some that get a sense of the costs when they enter--when the Dr orders a battery of tests, sees the costs mounting and their savings dwindling.

The average cost of an ER visit, nationally, is $1,000.

Sure we have the regulars, those that appear on the ER doorstep at the faintest indication of discomfort. They are the ones that have virtually no out-of-pocket expense, whether from assignment or self-pay (generally no-pay).

The Austin Statesman ran an article about ER abuse, 9 people used the ER 2,678 times in a 6 year period. Costs: approximately $3 million. They either had very good insurance, or the hospital was getting hosed. If it was like Parkland, then the whole county paid for it. If it was like the University Medical Center in Las Vegas, then the shortfalls cause closure of services.

So, where does that leave us? With $75 aspirin. With $200 walk-in-the-door charges. To make up for the shortfalls. And that's why people leave AMA.


Anonymous said...

I read that article, they were all charity care/self pay/no pay visits. Really show's how a few people can break down a health care system.

Anonymous said...

Sadly this problem is nationwide, not just in your little corner of Texas. In the Austin case, all of the patients were low-income and/or homeless with no insurance, and most had mental issues and/or drug problems. These "frequent flyers" (let's call a spade a spade here) cost the good folks in Austin, the surrounding county, and Texas taxpayers a pretty penny just by showing up for "hangnail" issues. The problem is, should one of these frequent flyers get turned away for coming in with some imagined illness, and that person really gets ill or dies as a result, how much will the attorney's fees and lawsuit awards be?

Paris has its share of frequent flyers just like other facilities, and their trips to ERs across the country for not much of anything are draining the healthcare system dry, tying up assets and manpower that could be used to see patients with real problems.

This is an issue that has been around before Essent was ever thought of, and an issue that affects us everywhere. When hospital ERs turn into free clinics, just imagine the money flying out the door.

Does this sound a little mean? Yes, but imagine how ER personnel around the country feel.

Dee said...

What is the standard of care for waiting in an ER waiting room? Does it vary state to state? Are there any statistics on how often people die because the perception of ER abuse skews the opinion of the person doing triage there?

Anonymous said...

I have a friend that is a Medic that takes patients to PRMC. She tells me that people call 911 b/c they think they can get seen faster in ER if they go in by EMS. Not true is what she tells me. She tells of the regulars they pick up on a day to day basis for simple problems that patients doctor or clinic could see.

Anonymous said...

Every ER has them. When I worked ER (not MVH), we had our regulars, our Friday nighters, and our it's-Sunday,-so-I-need-a-work-excuse-for-Friday group.

The way around the length of time is to do the intake paperwork, but not room you until one is available. You'll be seen, but not really.

The woman in that NY ER was seen, but died on the floor, anyway.

The ones that don't pay are the ones that sue you, the doctor, and the hospital. They call an ambulance because they don't want to spend cab fare.

What's discouraging is the bottleneck created because of the "frequent flyers", which slows treatment for the more critical patients.

Dee Martin said...

How about third visit to er. first two - given prilosec and charged $1000. Third? One hour in waiting room, given oxygen bottle for breathing difficulty. Three hours later, roomed. Thirty minutes later? Dead. Pancreatic cancer, no one knew

Anonymous said...

Wow, this brings back such memories. I no longer live in Texas, but worked many years in Paris in the ED, and YES...it has its regulars. But they are in every ER. I drive my self nuts being so angry. I have had some medical bills, that have been beyond shocking! ( due to real illness with a EMS trip too) I just yesterday took care of a chick....dental problems, can you say....CRACK.....she wants antibiotics and pain meds. Well she has "special issues" and needs some Cleocin...but she wants a "shot" for her nausea, a first shot of antibiotic.....blah blah.....who the hell pays for it? You and I! I went to give the chick her shot, and I had to give in thigh cause her butt was adhered to the bone with scar tissue.
I owe 60 more dollars to the neurologist office, I can not be seen til then and so therefore I have been off my meds.......I am working 2 jobs, trying to catch up from horrible medical bills and you got scum sucking folks like this that is robbing our country.
We are being drained. We do so many danged CT's for free!!
I do not know the answers, but I know that how can hospitals keep giving crap out and stay afloat?
There is lot of money wasted on drug seekers and regulars, that can be used for someone needing treatment such as chemo that is having hard time.
Its just not a Paris thing, its just not a Texas thing.....I am way up north.....and lets talk about a pandemic....its here.....abuse of the ER!!!
Its so draining!!!!

Anonymous said...

Try having a patient brought in by EMS, bellowing that they were dying, and 15 minutes later sneaking out for a smoke.

Anonymous said...

I think it is a shame that the hospital has contracted with a group of ER doctors that their company does not accept Blue Cross/Blue Shield.

Anonymous said...

If the ER charged the price of a package of cigarettes to be seen for a non emergent problem the ER visits would drop by one half!The amount of ER abuse by medicaide patients in Paris is a major cause of the long waits in PRMC's ER. I have seen people who have had over 60 visits in a 6 month period ; none of which resulted in an admission (and most were carried by ambulance with their family following in the family car!!!!)