Healthcare Reform-ER

[latebloomer74, LPN]

Now that healthcare bill has passed, will it now be allowed to turn away the uninsured at the ER or will it stay the same?

[SoulSearcherRN]

I don't think that will change. I can't see them turning people away.

[ItsTheDude]

gonna stay the same (around 5% still aren't going to be insured), but the ER's aren't gonna get the same percentage of total hospital visits as they have been, it's going to go down, because the uninsured use ER's as their only medical plan. with more people insured, those that were once uninsured will go to doc offices and seek more preventive care instead, rather than waiting till the last minute to go to the ER.

[netglow, ASN, RN]

The plan is to eventually have everybody covered with insurance. If you are gainfully employed and refuse to become a part of any plan then supposedly there would be a financial penalty of some sort.

I think that this is fair. Not much different theoretically than being required to have car insurance (in my state). When you get in a car wreck, you can absolutely forever ruin the life of the one you hit, as well as everybody else paying for your bills: flight for life, level 1 trauma, surgery, intensive care, months in rehab.

The change for ERs will be that there will be payment (eventually) for services rendered where in the past there was none.

How this plays out, who knows. There will be good things, there will be bad things.

One golden rule to remember is that the insurance lobby will always win.

[GilaRRT]

You guys do realise many insured people use the ER when they cannot get in with their PCP?With a PCP shortage and a further exodus out of primary care, you honestly think ER visits will decrease?

[Lisa, MA]

You guys do realise many insured people use the ER when they cannot get in with their PCP?With a PCP shortage and a further exodus out of primary care, you honestly think ER visits will decrease?

Yes that is definitely a problem. I can't tell you how many times we have a patient who goes to the ER for minor issues and we question "why didn't you come into the office" and they give lame excuses like "oh it was easier to go to the ER" or "I didn't want to go in until later in the evening" etc etc etc.

Far too many people abuse the ER because they think of it as a "clinic".

Just the other day I had a parent take their child to the ER because they were sent home from school with suspected conjunctivitis!!!!! DUH!

[netglow, ASN, RN]

I don't really know what's gonna happen, but every insurance policy I've had has a penalty if you go to the ER for anything other than life threatening... you got to get approval or you are up the creek financially. So, one of the problems of course, is, those that already abuse the system (those who never intend to ever pay anybody for anything in life, but do have the income to pay) will simply still not pay for services. How to end this? IDK.

[Katnip, RN]

I really wish they had built some sort of penalty for ER abuse. Pay a hefty fee for using the ER instead of making an appointment. But then, all someone has to do to get around that is say they thought that acid reflux was a heart attack and the fee would be waived.

The key will be to have enough primary care providers available so the waits for office visits are better than what they currently are. I think that's one of the biggest problems. People feel entitled to isntant gratification and don't want to spend a moment of discomfort.

Another thing is people just have to get used to the idea that it's not life threatening to suffer a few hours or days of runny noses before being seen.

[Spacklehead, MSN, NP]

Actually, the majority of people who do use the ED are insured - whether it be through Medicaid, Medicare or private insurance carriers.

No, they will not turn potential ED patients away; they can't do it legally unless they make changes to EMTALA.

[firemed483]

I don't think things will improve until people understand the word "EMERGENCY" on the sign at the door. I am sure everyone has experienced the patients who arrive with a minor ailment that has been going on for several weeks or even months and they have to be seen today as they can't get into their PCP for 3 days. After triage they find they are down the list below the MI, diff breathing, abd pain, etc. and have to wait, so next time they come in with "Chest pain" and the minor ailment.

After a few visits this takes too long so they call 911 and get rushed through, all tests are negative "But while they are here can you look at this..?" Meanwhile the man in the corner of the waiting room wonders if he really needs to be here, since the place is very busy with all these really sick people and he only has some bad "indigestion" and a little shortness of breath.

I once had to tell an insistent patient "I am sorry, you are somewhere between the heart attacks and the hangnails, but you will be seen before the hangnails." Until we have patient patients our patients will try our patience.

[Medic2RN, BSN, RN, EMT-P]

Until we have patient patients our patients will try our patience.

Try saying that 5 times fast with a mouthful of crackers!!! LOL!!

[Anne36, LPN]

I was gonna say, dont you have people who get free healthcare abuse the system all the time?

I better be dying to go to the Er, because I have health ins and cant afford it.

When a medicade patient wants to go to the Er or DR, they go because they dont pay squat.