The below article appeared on the website of a local news station in Rock Hill SC. Some people in the community have varied opinions about this. For those of us "in the business", what do you think about this kind of policy? Do you think it will actually make a difference or is it just bad public relations or giving people a mixed message about a hospital's concern for it's community? What if a patient has no insurance and can't afford a doctor's office visit, where do they go? What do you think?
Local Hospital's New Policy Of Turning Patients Away Upsets Some
Posted: 6:28 pm EDT May 12, 2009
ROCK HILL, S.C. --
Diana Burgess of Rock Hill went to the emergency room at Piedmont Medical Center last month with severe pain in her side."The doctors came in and just basically said they weren't going to do anything for me," she said. The ER doctors determined that the pain Burgess was suffering was not an emergency and didn't require immediate care. President and CEO of Piedmont Medical Center Charlie Miller explained the policy this way: "it is an emergency room, not a primary care clinic." "We think it's had a positive impact on wait times," Miller said. "Two-hundred to 250 people a month are leaving to see their primary care doctor instead." Hospital officials also said patient care is better when they can see a doctor outside of the hospital and form a relationship, rather than using the emergency room as their doctor. However, people like Burgess, who doesn't have any health insurance, said she can't afford to see a regular doctor. "I just left there crying," she said. "I was hurting too. I was really feeling bad. "Miller said the hospital does what is required by law, which means doing a medical screening for every person who comes into the ER. Then doctors determine if their condition requires immediate emergency care.
I keep seeing over and over, articles that state that the EDs need to reorganize their system to reduce the huge wait times. But I never see them say that people have to stop going there for non-emergencies. That would probably be the single biggest way to reduce those wait times for real emergencies.
It really is an education issue. EDs are not viewed as "emergency" depts anymore. It is perfectly reasonable to come in for tooth ache x1 month at 0500 for pain meds because my dentist can't get me in for another month
Recently, there was a pt in the hallway who had "I'm doubled-over, moaning out loud" abd pain. A breather came in. RA sats 75%. 90% on 15L NRB. The pt saw me get the dr while her chart was waiting to be picked up, and she had the nerve to yell at me! I was at work, sick, and she hit the wrong flippin' nerve! So I yelled back at her! (Not my proudest moment...) "This person can't breathe! They're more important than you!" She yelled back, "But I've been in pain for a week!" Why are you here NOW then?!
Or what about the family in the room next to the code room who needs a warm blanket NOW for dad who's cold?... People running in and out. Everything is loud. We're really not ignoring you!
How do we compete when the lay public doesn't even comprehend what a true emergency is?...
I have to agree that using an ER for non-emergencies is just plain fiscally irresponsible. If you dont have insurance and cant afford a doctor, how can you afford an ER bill?? Geez.
I like this question a lot!
"Who's your PMD?"
"I don't have one. I can't afford one."
"So how do you intend to pay your ER bill? Which directly affects whether or not I get paid? You don't want me to work for free, do you? Because, I volunteer at a free clinic, which I'm cool with, but I need this job to pay me, so I can continue to pay my bills, so I can pay my dr's visit bills." :nuke:
There are not enough free or sliding scale clinics around. Then if perchance any workup is needed it is still faster done in an ER no matter how crowded it is. Then there are the local doctors who send their pts to the ER knowing we will get all these tests done quickly regardless of ability to pay. And get these patients admitted for them and they dont have to the work. It is the way our world works untill we get United Health Coverage for all.
We live in a Fast Food Nation. What else can we expect?
Oh, and Oramar - most of our docs wouldn't have the first clue where to look to determine if a patient has insurance or not. I don't see it as an issue, and woe be to the facility that gets caught doing such.
It's on their face sheet. I hear docs ask it all the time r/t which physician can/will admit them. After they've been medically screened, it's acceptable to ask about payment. There is no EMTALA violation then.
It really chaps my rear to hear patients tell me they can't afford their b/p meds/diabetic meds/tylenol for fever or pain, then see the cigarettes (or smell it on them) in the Coach purse, $300 Blackberry with bluetooth in the ear, kids playing PSP in $100 sneakers, hair and nails professionally done....I know we've all seen it. And yes, I've discharged many in w/c and brought them to the parking lot and seen the spouse's luxury SUV with spinner rims and expensive tires. It is all THAT kind of stuff the makes me mad. If you can't afford to pay me, sell that stuff.
Young guy in his 30s in HTN crisis. Said he couldn't afford his BP meds. Had high end watch, clothes, shoes, gold teeth
Young guy in his 30s in HTN crisis. Said he couldn't afford his BP meds. Had high end watch, clothes, shoes, gold teeth
How do we better educate lay-people?...
You have mentioned education a few times.
We are educating people. In fact we aren't just educating them, we are training them. They come in for trivial complaints, and they get prompt, professional serviice. Not only that, they get their perceived needs met better than if they went to a pcp/specialist.
I have a bug bite. I pulled a tick of my abdomen a couple of days ago. There is a 2 cm red spot, and it itches. If I called my pcp, I doubt they would re-arrange an appointment schedule to get me in. But... What would happen if I went to my ER (obviously, if I went to my ER, they would laugh their head off at me. Hypothetical visit. Though this bite is kind of itchy.) Barring any other pt's showing up in obvious acute distress, I would be roomed promptly. We don't have triage any more, immediate rooming. If the ER is busy, I would be hanging out in a room watching a flat screen TV. Pretty good chance I could get a soda and a nice warm blanket. If the ER is not busy, I would be in and out pretty quick. Either way, much faster than if I tried my PCP. And, nobody would even bother to chastise me for being an idiot.
Now, in my case, this would be cost prohibitive. I have a copay for ER, and PCP visits. To get this service, I would have to give up something- maybe a dinner out with my wife. I make decent money as a nurse, but money spent one one thing, cannot be spent on another. Given the expense, I'll probably just keep my eye on this thing, and make sure it doesn't get yucky. If the itching really bothers me, I could spring a couple bucks for a cream. If it does get yucky, I'll call my insurance company, and weight the cost benefit of an ER visit versus waiting for my PCP.
Compare that to most of the pt's who come into my ER for trivial stuff. most of them have a type of govt insurance with no copay. It's free. (Actually, its incredibly expensive, but it costs the user nothing.) Most of these folks do have a pcp.
Anybody reading this who doubts that a person would come in with a complaint like mine does not work in an ER. Anybody who thinks that pt's who do this would continue to do this if it cost them the equivelent of 1 days worth of smokes/beer/junk food does not work in an ER.
*Please note that in the post I am not asking for medical advice. I am sharing part of my experience in response to comments about low cost health clinics, and how people should use them, or something like them, rather than running to the ER because they can't afford primary care*
I receive my primary care at a sliding scale clinic because I am uninsured. I had an appointment today to check my thyroid levels so I can be able to fill my perscription for my Levothyroxin 200mcg, or to see if the dosage needs to be adjusted. From the lab results, the NP said that my "levels are low and that I am hyperthyroid and need to be taken off all thyroid medication." This makes no sense to me because in 2002, when I had Grave's disease and had my thyroid "killed" by radio active iodine, the endocrinologist said that I would be on thyroid medication for the rest of my life. And how could I be hyperthyroid if I don't have a thyroid (you don't have to answer that, that is what I asked her)? She really couldn't answer that and kept saying that my levels were low and that I was hyperthyroid. They are going to test my levels again and the results are supposed to be ready for next week. Right after I had the radioactive iodine the left me off thyroid medication to make sure my thyroid was dead. It was awful. I gained 25 lbs in one month. I don't want to be taken off again.
I will probably end up having to go see the internalist I was seeing when I had insurance (sigh). Good luck getting my husband to agree to pay for that. The actual visit probably won't be much, but I have no idea what the labs will cost.
And yes, I think people should try to visit clinics like the one I go to rather than knowingly wasting people's time at the ER. But I don't think I am getting the same care I would get if I was able to afford more than the sliding scale clinic.
Just in case you are wondering, I don't get my hair "done", I wouldn't get a gold tooth if you paid me, I have only had my nails done twice in my life (last time was almost 11 years ago, our van is on its last leg, you get the picture. My family is not running the government benefit gravy train dry while living the good life.
Not giving medical advice ... but where is the emergency in the above post? And does that answer your question re: why this is not something that will get solved in the ER?
Not giving medical advice ... but where is the emergency in the above post? And does that answer your question re: why this is not something that will get solved in the ER?
Hint -- TSH/T3/T4 labs take several hours to run.
Oh no, no emergency (I would never go to the ER about my thyroid) but the suggestion was that people who are going to the ER for conditions that should be handled by their primary care doctor should seek out a clinic, such as a sliding scale clinic. I was just telling you all what it is like at the one I go to, and that I, like others, still end up having to go to a doctor's office that we STRUGGLE to afford.
I will probably end up having to go see the internalist I was seeing when I had insurance (sigh). Good luck getting my husband to agree to pay for that. The actual visit probably won't be much, but I have no idea what the labs will cost.
And yes, I think people should try to visit clinics like the one I go to rather than knowingly wasting people's time at the ER. But I don't think I am getting the same care I would get if I was able to afford more than the sliding scale clinic.
Really at a loss for how this post fits in this thread, but....
This is exactly the kind of case a busy ER could turn away if they were prioritizing emergency care, as it is not, in fact, an emrgency, and would best be dealt with by the provider familiear with the patient.
My ER would not turn you away. At a guess, your bill would be between $500-$1000. Depending on how you presented, some docs might order more than a TSH, and you might be billed more. You would be seen by a skilled, competent provider, likely an MD.
This would be a great deal (for you) if either A- you had insurance with no ER copay, or B- you simply don't pay your bills. Though it would be a great deal for you, it would be a lousy deal for those of us who foot the bill for this type of visit. Given that you do pay your bills, it is fortunate that you have access to a reasonably priced clinic.
Regarding your belief that if you had more money, you might access better health care: Yes. Wealthy people can generally afford better cars, houses, health care, etc.... The best doc in the world might be working in a free clinic today, but generally speaking, those at the top of their field make more money. this is true in most fields.
Good luck with your thyroid problem. Hard to tell whether your provider truly did not understand how your low TSH, or whether there was a communication problem.
...and I am NOT suggesting that my problem should be solved by the ER.
"Hint -- TSH/T3/T4 labs take several hours to run."
The clinic drew blood to test my levels on May 4th. She gave me the results yesterday and drew blood to test again. My point is that low cost options exist, but many times people still have to find ways to pay for more expensive care anyway. I guess that is just the way it is.
...and I am NOT suggesting that my problem should be solved by the ER.
"Hint -- TSH/T3/T4 labs take several hours to run."
The clinic drew blood to test my levels on May 4th. She gave me the results yesterday and drew blood to test again. My point is that low cost options exist, but many times people still have to find ways to pay for more expensive care anyway. I guess that is just the way it is.
My point about the lab work relevant to your situation was that these are not labs that are resulted quickly, and therefore you would likely (pray - hopefully) be discharged from the ER even before these results were available.
imanedrn
547 Posts
It really is an education issue. EDs are not viewed as "emergency" depts anymore. It is perfectly reasonable to come in for tooth ache x1 month at 0500 for pain meds because my dentist can't get me in for another month
Recently, there was a pt in the hallway who had "I'm doubled-over, moaning out loud" abd pain. A breather came in. RA sats 75%. 90% on 15L NRB. The pt saw me get the dr while her chart was waiting to be picked up, and she had the nerve to yell at me! I was at work, sick, and she hit the wrong flippin' nerve! So I yelled back at her! (Not my proudest moment...) "This person can't breathe! They're more important than you!" She yelled back, "But I've been in pain for a week!" Why are you here NOW then?!
Or what about the family in the room next to the code room who needs a warm blanket NOW for dad who's cold?... People running in and out. Everything is loud. We're really not ignoring you!
How do we compete when the lay public doesn't even comprehend what a true emergency is?...