Really this is just a racket. You can take a simple virus and run up hundreds, if not thousands of dollars, increasing the level of care and therefore, the level of reimbursement to the doctor. This is how ER docs make a lot of money these days.
In Washington state, the state government has decided they will no longer pay for medically unnecessary ER visits for medicaid patients starting April 1st. Of course, ER docs are very unhappy about this because the gig is up. They will no longer be reimbursed for all this unnecessary shit. THey will tell you that this is about control of thier practice, EMTALA etc., but its all bullshit. Their unhappiness is about the bottom line: MONEY. These people are a significant part of every ER's business. They will no longer be able to upcode and get more money.
So whats an unhappy ER doc to do? Take that cough (see Whitecoat)and make it pneumonia. Take that upset stomach and make it an ulcer. In other words, take this stupidity to a higher level to justify even more unnecessary tests and care. Coming to you ER soon.
And whats an unhappy medicaid patient to do when they can't use the ER as their clinic? It won't be long til every person with a cold has chest pain or shortness of breath. Every stomachache is having black stools. They will play the system even more than they do now.
In the end, it will probably cost more money. It will be abandanoned. Here's the thing, these politicians still think they can fix a collapsing system with bandaids. Its just another nail in the coffin of American health care as we know it.
In my group, we lose money on every Medicaid patient we see. So I have no incentive to "run up the bill" because doing more tests means I just lose more money. Medicaid does not pay enough money to cover the overhead. Now they will be paying zero, so I will lose more money per patient.
ReplyDeleteI personally have always felt that wasteful tests and treatments play a large part in rising insurance and healthcare costs. I also believe many MD's can and do make almost any treatment and/or test appear to be necessary. I also become irate when certain family members or other folks I know who are on medicaid use the ER for stupid chit just so they don't have to make an appt with their family MD and can go when ever the heck they feel like it. I have no idea why they don't seem to mind the wait in ER waiting room.
ReplyDeleteWhile I do feel that a lot of the testing we do is really unnecessary, I think less of it has to do with running up the bill and is more about covering your ass. An ER doctor really has to prove they did everything that could possibly before about this stupid headache you have twice a week, including scans and MRI to r/othe possibility of stroke or mass or a million other things that can cause a headache to ensure that they won't be sued. Ofcourse it can not possibly be your fault that you snort cocaine and have hight blood pressure and never sleep and don't take your BP meds that you have a headache.... That stupid DR must be missing something.... Right?
DeleteI had a severe eye infection and sinus infection when I went to the local hospital where we have our summer place. I just did not want to make the 2 hour trip home. So, the dr. On call for my own dr. Advised that I go to the urgent care. It was Saturday, so I called urgent care and they told me that they were only open from 9amto10am on Saturdays then you had to go to Fast Track at the hospital which opened at 10am. Well, the triage nurse decided that I needed emergency care not fast track! There things got much worse! As soon as the ER doc heard that I had gallbladder surgery 3weeks before, he did not even do a regular physical exam. He immediately ordered numerous blood tests, ekg's, iv 's, monitoring, etc. I refused because he never listened to me and never did a typical sinus infection physical exam . He let me leave without the exam and without an antibiotic! I wonder if he would have done that if the same if I did not have health insurance?
ReplyDeleteI had a severe eye infection and sinus infection when I went to the local hospital where we have our summer place. I just did not want to make the 2 hour trip home. So, the dr. On call for my own dr. Advised that I go to the urgent care. It was Saturday, so I called urgent care and they told me that they were only open from 9amto10am on Saturdays then you had to go to Fast Track at the hospital which opened at 10am. Well, the triage nurse decided that I needed emergency care not fast track! There things got much worse! As soon as the ER doc heard that I had gallbladder surgery 3weeks before, he did not even do a regular physical exam. He immediately ordered numerous blood tests, ekg's, iv 's, monitoring, etc. I refused because he never listened to me and never did a typical sinus infection physical exam . He let me leave without the exam and without an antibiotic! I wonder if he would have done that if the same if I did not have health insurance?
ReplyDelete