how can we fix healthcare if ppl keep abusing the system?

[johnnyDoGood]

i just read a post where a nurse said that many ppl abuse the ambulance system by calling for cold symptoms and minor burns. how will we ever fix healthcare is ppl keep abusing the system causing the costs to rise? remember in the news the lady called 911 because Mickey D's would not give her the chicken nuggets she ordered?? i personally don't want to pay for health insurance for ppl like this.

[ZippyGBR, BSN, RN]

I think calling for prior authorization should be mandatory for non emergency ER visits. I have to pay more out of pocket if I do so, why doesn't the same apply for Medicaid pts?

:idea:which if you had a properly funded and provided urgent care and out of hours primary care system simply wouldn't happen or they would be streamed there from triage...

Not having / not having access to out of hours or being ignorant of the ways to access primary care is a major reason for less appropriate ED visits ...

well actually 2 pence ...

[JessicRN]

People wonder how we treat our frequent flyer patients. Tonight for example 4 patients all return customers in under 14 hours one 3 times in 12 hours. If they are violent which the patient who returned 3 times we put them in restraints. When they behave for 30 minutes we take them out. They get food and juices If they have anything medical we treat for the last patient who is violent we did a CT of the head for change in mental status (he has come 2 times a day for 10 days and has had 8 CT's so far one 2 times in a day.) The ones who live in a wet shelter, they get rides back to the shelter using one of the shelter vans ( they usually the others are on their own. We used to be able to section 35 them ( involuntary detox for up to 30 days but usually 2-3 days of late even for the most violent) if they came too often but the court now says they won't the last one is a violent pt who kicked 2 CNA's in the face and sprained this reporter's wrist when he grabbed on and squeezed all in under 3 months. He comes a minimum of daily but mostly twice a day and stays out maybe 11/2 hours between visits. If we call to have them sent to jail if they are violent and too drunk to leave the cops who are supposed to keep them for 4 hours minimum, literally pick them up then let them go a couple of blocks away only to have them return not 2 hours later after they have had a few more drinks. Because of EMTALA WE CAN REFUSE NO ONE. if they cannot walk steady we have to keep them. By the way none of these pateitns pay a dime they have no insurance even though they are supposed to have it here but who do you send the bill to?

[nursel56]

Wow, JessicRN. I knew it was bad, but not that bad. That's whatcha-call a thoroughly broken system. You said the man comes in every 1.5 hours as in 90 minutes?! Each time he has a new visit initiated with a new exam and work-up? How do you even have time to finish one up before he comes back again? Mind boggling.

I know that EMTALA was designed to prevent people from dying out on the street due to denial of access to ED services, but with this type of chronic illness, what is the complaint that has the facility concerned about compliance? Is it because the symptoms of intoxication might mean a head injury even if the man was there an hour before and was worked up at that time?

What is different now than from the days police would arrest someone for public intoxication and house them in a holding area for 4 hours or so? I know the police learned to expect a return visit from a number of their previous guests. The tx in the ED sounds like a phenomenal waste of money.

[360joules]

I think calling for prior authorization should be mandatory for non emergency ER visits. I have to pay more out of pocket if I do so, why doesn't the same apply for Medicaid pts?

Unfortunately, as long as a simple office visit with an x-ray or a blood test can cost the equivilent of a month's wages for the uninsured [CASH UP FRONT PLEASE], or visiting a "public" facility requires a 2-3 month wait, people will use the ER as a walk-in clinic because they have no other options.

The only hospital I've ever worked at that "got it" was a small one in rural New York that put about 75% of their resources (staff, rooms, etc.) into the Express Care side of the ER 18 hours a day and charged a reasonable fee for services. This left the ER side free to handle the "big" stuff. During peak periods resources shifted back to the ER if needed. A couple of nurse-practitioners worked in the Express Care, there was no drama if a patient was mis-triaged and needed to be moved to the ER, and every sore throat didn't involved a CT scan and 16 blood tests.

Wait times were reasonable, people didn't panic at home because they knew they could get reasonably-priced care, in a reasonable period of time, and everyone was happy.

This was accomplished by working in concert with the county, the health department, and some of the other government agencies to create a viable system. The hospital realized the problem of lack of affordable, available healthcare in the region just didn't stop at the edge of their parking lot, and enlisted others to make it work.

I can't say how this would translate into other regions, especially where the "my sandbox is the only sandbox" mentality is deep-rooted.