Than who's fault is it?

[iriska_meller]

So we've determined that we have nothing to do with it (sky-high cost of healthcare). Let's try to figure out who we should crucify. To start with, I'll give a couple of things that have been vothering me to no end.

A couple of months ago a went to an ED with, excuse me, an early miscarriage. I spent there a total of 3 hours, my work-up included an interview with an ER MD, not even a physical examination! not even a GYN!, standard labs - cbc, pt/ptt, basic, urinalysis, and a pelvic ultrasound (not even translady partsl, just abdominal). Guess how much the bill was.

$1,800. Good thing I have insurance, right? $500 of these were the MD's charge for spending all of 10 miunutes with me.

By the way, a nurse was not even involved in my care, an IV and labs were done by a PCT.

Another thing. On our med/surg geri floor we do tons of pressure sore dressings, and we use a variety of supplies, includig something called Aquacel, which is sort of like a special fabric that is aseptic and also absorbent and whatnot. I noticed that it works really realy well especially on smaller sores. Well guess what, little did I know, but a patient's caregiver told me that a 4-piece pack of this thing (pieces are about 3x4 inches big) costs..... 75 bucks. For a patient with 3 big stage 4 sores you need at least 4-5 pieces to do a decent dressing, and you need to do it twice a day cause it saturates.

Anything wrong in this picture???

[Not_A_Hat_Person, RN]

I've noticed this too. At one clinical, TEDS were $35 a pair, and an Aquanot (used to measure CO2) cost about $1000 (without tubing).

[BrnEyedGirl, BSN, MSN, RN, APRN]

I'm not sure I'm ready to "crucify" anyone,.but the problem is complex. The ER scenario you mentioned is a bit more straight forward. The ER is expensive because it's emergency medicine. It is staffed 24/7 with doctors, nurses, techs, lab, radiology, US, RT, etc for emergencies that may or may not arrive. You happened to need the services of the US tech and the doctor who read your US (a second doctor, not the ER doc). That US tech had to be there, the whole shift even if you didn't need her/him. If this person was also in charge of doing inpatient US, then they were expected to drop what they are doing to see an emergency patient. This is true of all the staff that run an effective ER. The other issue is that for every person with "good insurance" that comes in, 3 or 4 will arrive without insurance or on some sort of state aide. These services are either not paid for at all or paid pennies on the dollar. Someone has to make up for that.

As far as "a nurse wasn't even involved in my care" and "not even a gyn",..I hope you saw a nurse who assessed you at triage,.and if a PCT is a patient care tech,.I hope that isn't who started your IV. GYN docs are specialists. They don't work in ER's. Emergency specialists work in ER's and call in other specialists as needed. Imagine the costs if we were forced to keep every specialists in house 24/7!!

Of course there are also the many people who use the ER for a free clinic or who like the convenience of not making an appointment or planing ahead, and use the ER as a PCP. If all the ER ever treated were the true emergencies, and everyone paid their bills, the cost would go way down. The costs of medical supplies and medications is so high for many of the same reasons, and of course the high cost of litigation in this "sue happy" world we live in.

[kmoonshine, RN]

The cost of emergency services is high due to the need to staff 24/7 (lab, nurses, docs, radiology, etc). UA and preg, with CBC/BMP, RH, serum Hcg; abd. ultrasound to rule out ectopic - all finished in 3 hrs isn't too bad. I've delegeted things before to ED techs because I can't get into a pts room right away ("Beth, can you start a line in room 14 and draw labs for me?"). Its better than making a pt wait longer than they have to. Personally, I like to start all my IV's but when I'm strapped with resources and time, I need to prioritize (ie level 2 chest pain, level 2 overdose, level 1 SOB, level 2 head injury - so I definately need to delegate because I can't be everywhere at once).

Coupled with people who don't pay their bills, and state-funded programs that pay pennies on the dollar - the cost gets passed on to people who have private insurance and who pay their bills.

[CoffeeRTC, BSN, RN]

Yep....look at your own bills and then try to think about what your pts are being charged.

Wound care is awefully expensive. Depending on how your facility bills a lot of $$$$ just gets wasted. Think about the tape, 4X4s etc that you leave around...all that adds up.

Just had a kiddo in the ER and over night hospital stay for an asthma like episode Yikes!!!....Now that I'm pregnant, just starting to get some of my lab bills in too!!!!

Does it really cost 1200 to run those labs? 70 bucks for a U and A??

[llg, PhD, RN]

So we've determined that we have nothing to do with it (sky-high cost of healthcare). Let's try to figure out who we should crucify. QUOTE]

Looking at the big picture rather than any specific case ....

One of the main problems is that people try to simplify the problem as they examine it and try to fix it. People look for someone to blame ... something to fix ... etc. and use older, simplistic models to address the problems.

Those older, simplistic approaches will not work on the most complex, mulit-factorial problems. That's where the more sophisticated and more academically challenging approaches such as "complexity theory" and "chaos theory" come in. Unfortunately, there are not many people in the world with sufficient understanding of these newer, more sophisticated approaches to bring them to bear on our health care system. The development of these approaches is still in its infancy (or childhood?) and their use is still generally limited to "serious scholars only."

We are using "Stone Age tools" to address "Space Age problems."

[DeepFriedRN]

I don't think we can "crucify" anyone. But there are TONS of things and people that contribute to skyrocketing healthcare costs. A short list? People who abuse EMS; people who don't take care of their own bodies, and then want the medical community to "fix it"; people who seem to be unable to grasp that it is part of the cycle of life to die and that it is for the most part inappropriate to put their bedridden, dementia riddled grandma on dialysis to keep her alive; etc, etc. I could go on and on, but it's a downer. I wish I could identify solutions as easily as I seem to be able to identify problems.

[diane227, LPN, RN]

I have always wondered why supplies and equipment cost so much. Lots of people making big profits off the backs of poor people.

As for your ED visit, that just does not sound good. When I worked in a large inner city ED we used to give top priority to women with lady partsl bleeding, no matter what the source, they can bleed out a lot. Where was the nurse that was supposed to be taking care of you?

I had a similar experience in my own hospital where I work. Came in with severe chest pain and was admitted to the intermediate care unit. As I worked there, I filled out my own admit forms but there is still a part on there for physical exam. It was never done. When I pulled the record later, there was documentation all over the place that someone had performed a physical exam but I guarantee you that except for the ED, no nurse ever touched me. Very sad.