Healthcare Crisis: 9 Patients Made Nearly 2,700 ER Visits

[LaxBuddy21]

I just want to know how people can complain about our access to health care in this country when a homeless person can be treated once a week by trained medical staff....

[Larry]

well, despite your attempt at sarcasm, virtually none of those items appear to have been needed for the cases in question.

But those costs are part of the overhead cost of that room, whether they were used or not.

I have no doubt that there's a law, some olace, that says that there must be 1 RN on duty for every X ER beds, and 1 LPN for every Y beds, and 1 CNA for every Z beds.

There has to be an x-ray machine, and a radiologist on staff, and technicians to run it, 24x7.

-----

My "medical experience" consists of being an EMT trainee on a volunteer rescue squad.

I spent a lot of time sitting around the fire station watching TV with the firemen who were sitting around watching TV.

You have to have firemen, because when you need them, you need them quickly. But that means you have to pay them to sit around and wait.

Which then gets into my other observation that the "cost" of an ER visit is a really slippery number. How much does it "cost" to treat a hangnail in an ER, when the staff in the ER don't have any more important patients than the one with the hangnail? They have to all be there, anyway, just in case something important comes in.

Edit:

BTW, I'm not trying to say "heck, the ER should have treated those people for free, because they didn't have anything better to do, anyway."

(Although I am pointing out that the mere fact that they did treat them means that in the medical opinion of the medical staff on duty at the time, that patient was the one with the worst injuries in the waiting room.)

My primary point is that, because "cost" is such a fuzzy number when we're talking about ER visits, anybody who wants to can play with the numbers and come up with a "cost" that reflects their agenda. It means the cost number, to me, has virtually no credibility.

The article claims a cost of $2M.

If those 9 people had been on Medicare, would the hospital have taken $600K and been happy?

[PeterMP]

well, despite your attempt at sarcasm, virtually none of those items appear to have been needed for the cases in question.

I like Larry's take of the pricing structures and the dependancy on "who pays".

An experienced triage nurse could have easily determined the root of the visits and modified what was needed early on, thus avoiding much of the expenses.

I wouldn't be shocked if different tests were run just to make sure w/ respect to law suits. You walk into an ER and complain of chest pain, they are essentially automatically going to AT LEAST hook you up to an EKG machine because if they don't, and then you actually have a heart attack, they are looking at a pretty major lawsuit, pretty much independent of how many other visits you've made complaining about chest pain.

[PleaseBlitz]

Which then gets into my other observation that the "cost" of an ER visit is a really slippery number. How much does it "cost" to treat a hangnail in an ER, when the staff in the ER don't have any more important patients than the one with the hangnail? They have to all be there, anyway, just in case something important comes in.

Those costs are jacked up because they have to charge paying customers with insurance a huge markup so that they can afford to treat deadbeat crazy people like these without becoming insolvent.

I understand your point about suck costs, but you get an itemized bill and a shot of cortizone is like $400.

[Larry]

Those costs are jacked up because they have to charge paying customers with insurance a huge markup so that they can afford to treat deadbeat crazy people like these without becoming insolvent.

I understand your point about suck costs, but you get an itemized bill and a shot of cortizone is like $400.

The customer with the insurance gets charges considerably less than the "cash price".

You get a bill, and a shot of cortizone costs $400.

Then you get a letter from your insurance company that says "our standard payout for cortizone is $87, and since the Hospital has signed our contract, they've agreed to take whatever we give them."

[PleaseBlitz]

The customer with the insurance gets charges considerably less than the "cash price".

You get a bill, and a shot of cortizone costs $400.

Then you get a letter from your insurance company that says "our standard payout for cortizone is $87, and since the Hospital has signed our contract, they've agreed to take whatever we give them."

Actually, my bill said they paid the $400. :whoknows:

[twa]

I think it's a great idea.

I think it'd be great if they were open 24x7, too.

How many of y'all have gone to an ER, simply because your problem wasn't really an emergency, but it was too important to wait for normal business hours and then call for an appointment some time next month?

They are opening more and more of those here,as well as Urgent care centers(lower regs and services than ER)

The ER's here are a mess with people coming with minor illnesses/injuries

PeterMP is right,with chest pains it is automatically EKG and blood gases workup...along with a urinalysis (wifes made two trips this yr)

[RedlightG20]

well, despite your attempt at sarcasm, virtually none of those items appear to have been needed for the cases in question.

I like Larry's take of the pricing structures and the dependancy on "who pays".

An experienced triage nurse could have easily determined the root of the visits and modified what was needed early on, thus avoiding much of the expenses.

I don't see where there was any sarcasm...

Anyway, I don't understand how those things DON'T come into question here. No, the patients in this story probably did not need care for head trauma, but my point was that the ER costs can be thought of as an umbrella of sorts, to cover the costs of anything and everything. Like you said, most nurses can handle most situations, but the costs also cover when there is something they can't quite handle without a doctor.

Say a patient came in complaining of chest pains. The patient has asthma and is short of breath. After evaluation, it is determined that the case is of low severity and the patient is discharged. $1000, please.

Now the next day, another patient comes in complaining of chest pains as well. Same symptoms, also has asthma. After four hours of being in the ER, the patient is sent down the hall for an ECG and blood tests. Soon after, it's determined the patient has a pulmonary embolism, and is deemed severe enough to be life threatening. The patient is sent to the ER for a procedure to hopefully repair it. $1000 (probably way more with the included tests and what not, but let's just keep this hypothetical simple).

I'm not a doctor and this probably isn't the best example, but bear with me.

So what I'm saying is, the inflated costs can be seen as an "insurance" for the cases when one case is more severe than the next. The ER needs to have the funding to properly supply and equip itself for all types of medical emergencies. If each patient was charged by the ER on an hourly basis, based on their diagnosis, the ER would run out of money, because it won't cover the costs of slow times during the day when you're fully staffed, but only working at 10% capacity.

[SnyderShrugged]

I don't see where there was any sarcasm...

Anyway, I don't understand how those things DON'T come into question here. No, the patients in this story probably did not need care for head trauma, but my point was that the ER costs can be thought of as an umbrella of sorts, to cover the costs of anything and everything. Like you said, most nurses can handle most situations, but the costs also cover when there is something they can't quite handle without a doctor.

Say a patient came in complaining of chest pains. The patient has asthma and is short of breath. After evaluation, it is determined that the case is of low severity and the patient is discharged. $1000, please.

Now the next day, another patient comes in complaining of chest pains as well. Same symptoms, also has asthma. After four hours of being in the ER, the patient is sent down the hall for an ECG and blood tests. Soon after, it's determined the patient has a pulmonary embolism, and is deemed severe enough to be life threatening. The patient is sent to the ER for a procedure to hopefully repair it. $1000 (probably way more with the included tests and what not, but let's just keep this hypothetical simple).

I'm not a doctor and this probably isn't the best example, but bear with me.

So what I'm saying is, the inflated costs can be seen as an "insurance" for the cases when one case is more severe than the next. The ER needs to have the funding to properly supply and equip itself for all types of medical emergencies. If each patient was charged by the ER on an hourly basis, based on their diagnosis, the ER would run out of money, because it won't cover the costs of slow times during the day when you're fully staffed, but only working at 10% capacity.

sorry if I misinterpreted the sarcasm. It just seemed as though it was there to me. Please forgive my insinuation.

My main point is that the services renderred could be mitigated if sound triaging could be done. Of course there are unavoidable expenses for any ER visit, but I think $1K is a bit high when these individual cases are considerred.

[Larry]

Of course there are unavoidable expenses for any ER visit, but I think $1K is a bit high when these individual cases are considerred.

I also observe that the article says "The average emergency room visit costs $1,000.". That average includes all patients, not just the folks with hangnail who can't afford to go anywhere else.

(Although I'll also observe that these nine people are, shall we say, disproportionately represented within the "average emergency room visit" statistic.)

[Special K]

Gee, I'm shocked People would abuse the system we have set up? Noooo. This happens all the time folks. Maybe not to this extent, but repeat patients come in all the freaking time for absurdly inane, non-emergent problems.

This is why our set-up needs to be changed. I'm a huge proponent of screening ER visits and outright referring non-emergent patients to Medicaid clinics with PCP's....or Urgent Care clinics. I would like to see the whole system revamped.

It also begs the question as to why mundane conditions and seemingly hypochondria should cost an average of $1k+ per visit?

Yes, the crazy amount of visits is atrocious, but why does each visit cost that exhorbitent amount in the first place?

Because an emergency room is just that, an emergency room. It is equipped to handle....emergencies. When someone comes in with chest pain (as was reported to be the case many times with these mental issue patients), they are going to do a full work-up...everytime. Or else, the one time they don't (besides the fact that that would be sub-standard care not to), they might actually miss something and get their asses sued. This is the reason ER visits are so expensive.

So, where else do y'all suggest that they go?

How many of y'all have gone to an ER, simply because your problem wasn't really an emergency, but it was too important to wait for normal business hours and then call for an appointment some time next month?

Yeah, I'm sure this was the case with those 1000's of visits. :doh:

Your hypothetical doesn't work with this. Maybe other ER threads, but this was clear abuse. It's infuriating and it highlights the massive flaws we have in our system.

[PleaseBlitz]

If i rolled in some dirt, put on a tattered jacked, didnt carry my liscense, and spoke through my friend the sock puppet, could i get free healthcare at the ER?

[Predicto]

I just want to know how people can complain about our access to health care in this country when a homeless person can be treated once a week by trained medical staff....

If being able to go to an emergency room is the only criteria for judging a health care system, you might have an argument there.

But it isn't close to the only criteria, so you don't.

[Larry]

Gee, I'm shocked People would abuse the system we have set up? Noooo. This happens all the time folks. Maybe not to this extent, but repeat patients come in all the freaking time for absurdly inane, non-emergent problems.

Yeah, I'm sure this was the case with those 1000's of visits. :doh:

Your hypothetical doesn't work with this. Maybe other ER threads, but this was clear abuse. It's infuriating and it highlights the massive flaws we have in our system.

:secret:I didn't say I was referring to these patients.

(The words "How many of y'all" was a clue.)

See, I don't know why these people went to the ER. (I have suspicions. Which may well agree with yours. But that's another matter.)

See, only one of us is making declarations about the medical conditions of people we've never seen.

:secret:It isn't me.

[Larry]

If i rolled in some dirt, put on a tattered jacked, didnt carry my liscense, and spoke through my friend the sock puppet, could i get free healthcare at the ER?

Yep.

And if you stole my identity and my health insurance card you could, too.

Therefore . . . ?

[Special K]

:secret:I didn't say I was referring to these patients.

(The words "How many of y'all" was a clue.)

:secret: If it's not pertinent to the cases, then there's no reason to ask a completely unrelated hypothetical question.

See, I don't know why these people went to the ER. (I have suspicions. Which may well agree with yours. But that's another matter.)

:secret: It doesn't take a rocket scientist to figure out this was above and beyond necessary use of an ER facility.

See, only one of us is making declarations about the medical conditions of people we've never seen.

:secret:It isn't me.

:secret: See, only one of us is utilizing a little God-given common sense here.

:secret: It is me.

[Larry]

:secret: If it's not pertinent to the cases, then there's no reason to ask a completely unrelated hypothetical question.

:secret:The words "how many of you" means that it isn't a "hypothetical question". It was a request for actual information.

:secret: It doesn't take a rocket scientist to figure out this was above and beyond necessary use of an ER facility.

And yet, aparantly, it was beyond the ability of those medical personnel who's job is to assess the patients needs, and who had actually seen the patients.

See, every single time the nurse at the reception window said "Mr. Doe, the Doctor will see you now", that person has made a medical decision, based on actually seeing the patient, that this patient's need (whatever that need is) is greater than any other person in the waiting room.

That's the rule they're supposed to use: They treat the person with the greatest need, first.

:secret: See, only one of us is utilizing a little God-given common sense here.

:secret: It is me.

"Common sense". Is that the term that's popular, now days, for "making things up"?

Somebody made the decision that these people had a medical need for whatever treatment they needed. And that person actually saw the patients involved. (And knows what treatment they received.)

Heck, even that famous Psychic Doctor, Bill Frist, had to watch 17 seconds of edited video of Terry Schiavo before offering a medical opinion.

-----

Some observations (and maybe suggestions):

I really haven't offered a judgment on this "case". (Actually, "cases".)

There isn't enough information here to make one. I've tried to point out why I think the broader, general, issue is a complicated one. I've made some suggestions for things that I think would help the problem. (The problem in general. I don't know if any of my ideas are even applicable to these particular patients.)

I've been having rational, reasonable discussion of the problem with that noted commie liberal, SnyderShrugged.

However, you've decided that what this thread really needs is for you to chew me out for daring to ask a question that you don't like, because you've decided that my question somehow implies a disagreement with the conclusion that you've jumped to.

If you'd like to discuss the question of how our society should handle the medical needs of various people, and of how our ERs should be run, I'd love to discuss it with you. If you'd care to bring some information to the discussion that increases my knowledge (which shouldn't be that hard to do, given my very limited knowledge) then that's even better.

If, however, what you want to do is to attack me because I dared to ask a question that you don't like being asked, then too bad.

[Special K]

And yet, aparantly, it was beyond the ability of those medical personnel who's job is to assess the patients needs, and who had actually seen the patients.

Weren't you an EMT or something? Do you not know how this works? People who come in to the ER MUST BE SEEN. Even if they are complaining of a friggin hangnail, ER medical personnel MUST see them.

See, every single time the nurse at the reception window said "Mr. Doe, the Doctor will see you now", that person has made a medical decision, based on actually seeing the patient, that this patient's need (whatever that need is) is greater than any other person in the waiting room.

That's the rule they're supposed to use: They treat the person with the greatest need, first.

Actually, that's not the entire "rule." Patients are triaged, yes, but once put into to lower/non-emergent category, they are seen based upon entrance time, in order.

"Common sense". Is that the term that's popular, now days, for "making things up"?

Somebody made the decision that these people had a medical need for whatever treatment they needed. And that person actually saw the patients involved. (And knows what treatment they received.)

No, I'm not making anything up, I've been discussing this case in a healthcare administration class last night and today.

A patient is always attended to when they check in complaining of a certain symptom. No matter if that patient is making up that symptom or not (say, chest pain from anxiety), they are required to be CHECKED and stabilized by medical personnel upon admittance to the ER.

Heck, even that famous Psychic Doctor, Bill Frist, had to watch 17 seconds of edited video of Terry Schiavo before offering a medical opinion.

Tangent. Again.

I really haven't offered a judgment on this "case". (Actually, "cases".)

I know. That's very much in line with your typical of your posting style. You attempt to ride the fence on any issue while throwing out those :secret: emoticons in an effort to essentially put down other posters for saying something stupid or obvious.

I've been having rational, reasonable discussion of the problem with that noted commie liberal, SnyderShrugged.

Don't know what's up with the reference to commie liberal when talking about SS, but okay.

However, you've decided that what this thread really needs is for you to chew me out for daring to ask a question that you don't like, because you've decided that my question somehow implies a disagreement with the conclusion that you've jumped to.

Never chewed you out. I did make a reference to common sense however when saying 1000's of visits to an ER are a clear case of abuse AND breakdown of our system.

If you'd like to discuss the question of how our society should handle the medical needs of various people, and of how our ERs should be run, I'd love to discuss it with you. If you'd care to bring some information to the discussion that increases my knowledge (which shouldn't be that hard to do, given my very limited knowledge) then that's even better.

I actually did respond to what I think should be done in regards to ER's in a previous post.

If, however, what you want to do is to attack me because I dared to ask a question that you don't like being asked, then too bad.

Again, not attacking you, just trying to figure out why a question like that would be asked in this thread when you say you aren't trying to make a point in relation to this particular case.

You say you weren't implying anything, fine.

[da#1skinsfan]

It also begs the question as to why mundane conditions and seemingly hypochondria should cost an average of $1k+ per visit?

Yes, the crazy amount of visits is atrocious, but why does each visit cost that exhorbitent amount in the first place?

I think at this point that aspect is beyond repair.

However 8 of 9 being drug abusers and 4 being homeless....get real. This is an atrocity.

[Larry]

No, I'm not making anything up, I've been discussing this case in a healthcare administration class last night and today.

Excellent. Somebody who actually knows about the cases.

What medical condition were the patients treated for?

(I assume that there was more than 1. Could you pick one or two that, in your opinion, represent the "typical" conditions that these nine people were treated for?)

Then maybe we can have some actual facts to throw back and forth at each other, instead of our opinions.

(Do you happen to know anything else about their cases, like who actually paid for their treatment, and how much? Right now, just about any actual facts would help.)

-----

I know. That's very much in line with your typical of your posting style. You attempt to ride the fence on any issue while throwing out those :secret: emoticons in an effort to essentially put down other posters for saying something stupid or obvious.

My post:

How many of y'all have gone to an ER, simply because your problem wasn't really an emergency, but it was too important to wait for normal business hours and then call for an appointment some time next month?

Your response:

Yeah, I'm sure this was the case with those 1000's of visits. :doh:

Your hypothetical doesn't work with this. Maybe other ER threads, but this was clear abuse. It's infuriating and it highlights the massive flaws we have in our system.

Wow you're right. I can certainly see why you're offended by my use of smileys to attack other posters for aspects of their posts that I find deficient.

-----

Never chewed you out.

My post:

How many of y'all have gone to an ER, simply because your problem wasn't really an emergency, but it was too important to wait for normal business hours and then call for an appointment some time next month?

Your response:

Yeah, I'm sure this was the case with those 1000's of visits. :doh:

Your hypothetical doesn't work with this. Maybe other ER threads, but this was clear abuse. It's infuriating and it highlights the massive flaws we have in our system.

-----

I actually did respond to what I think should be done in regards to ER's in a previous post.

I just went back through your posts, so I could prove you wrong. And saw your suggestion. (Which sounds like a very workable suggestion, to me.)

Apologies.

[jbooma]

well for those that are not in healthcare the term "emergency" means they need to be able to handle any issue, so you need drs, nurses, cnas, lpns, x-ray machines, anesthesiologists, surgeons, etc.........

which is why it costs money

now what you have seen more and more that has started to reduce the costs are emergency clinics, urgent care facilities, nurses on call, most insurance cards gives you a nurse to call when you have certain symptoms, so if you do have some type of chest pain they can give you information based on your answers about what the condition might be etc.....

technology is going to be the key to drive down costs, now that this hospital is aware of this they can educate these people to not use it all the time the way they have

we have a long way to go, but we have also come very far