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Tag Archives: Healthcare Access

My View

I started blogging because I enjoy telling stories. Always have, always will. I think that many people read what I write because they like reading stories. A recent comment by Max Kennerly, an attorney that frequently comments on this blog, made me sit back and think quite a bit. I don’t always agree with Max or with Matt, the other attorney whose comments drive me nuts sometimes, but I do respect their opinions. Another goal of this blog is to create an atmosphere of debate and debate runs deep on some posts. That’s a good thing. Max wrote: I still don’t understand your EMTALA obsession; the Chicago example makes quite clear an ER can cheaply and quickly comply, and still engage in profitable patient dumping. EMTALA isn’t a big deal from the policy perspective, you just find it personally annoying. Frankly, the ease with which you (and other physicians) conflate issues makes it very hard to take any of you seriously. Do you want to be treated like a private industry or like a public utility? In the same breath you complain that the state is not providing funding and that the state imposes too many limitations on you. Who you think you are, Wall Street? Normally, we do not give an industry state funding without substantial controls on it, including controls to ensure widespread availability of the industry’s services. But you apparently want the former but not the latter. Well, so do I. I want taxpayer money to go about my private business. Ain’t gonna happen. I, personally, favor the public utility route, and would be happy to pay the extra taxes to fund it. Where do you fall? After reading Max’s comment, I read back through my most recent posts on this blog (some imported to this blog – see Archives at right). Then I read back through the earlier posts on my old blog. Max is right. My mindset has definitely changed. Then I thought about why my focus has changed. I’m worried about health care in this country. I’m not worried for myself, but I am worried for so many hardworking people  who are denied health care or who have no access to health care. Policies like “never events,” agencies like JCAHO, misguided and medically unsubstantiated sites like “HospitalCompare,” and laws like EMTALA all start out with noble intent (I presume), but they all end up causing ripple effects that degrade the practice of medicine. So in answer to Max’s comment, my “EMTALA obsession” wasn’t intended to be focused on EMTALA. Rather, my focus is on the ability of every American citizen to access healthcare. I have several Google news feeds that arrive in my e-mail each day. One of them is for the term “emergency room.” I know. I know. I cringe when I type it, but people haven’t caught up with the times. “Emergency department” hardly gets any news … yet. Every day I read posts about how hospitals are closing or losing money because of unfunded medical care. At the heart of unfunded care is EMTALA. So many of my posts reference EMTALA because EMTALA is abused to the point that medical care in this country is doled out arbitrarily. Patients that need urgent care are often neglected or do not seek timely care because they cannot afford it while patients who want “free” pregnancy tests or narcotic prescriptions pillage the system. I have repeatedly said that a free market approach to medicine is the only way to save the system. Patients must have some “skin in the game.” Unfortunately there will never ...

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Down For The Count

Medical care in this country is rapidly heading for a K.O. Baltimore’s Bon Secours Hospital considers closing as it is getting crushed under the costs of providing uncompensated care. The hospital lost $22 million last year. Northeastern Hospital in Philadelphia is also preparing to close. Its emergency department usually sees 50,000 patients per year. The hospital lost $6 million last year and expects to lose $15 million this year. Charity care has increased by 33% in the past 12 months and more than three quarters of the patients at the hospital are Medicare or Medicaid – “insurance” plans which “do not pay the full cost of care.” State lawmakers and community activists are trying to force the hospital to stay open.  State Sen. Michael J. Stack stated that “closing this ER is going to have a devastating effect.” The article made no mention of how the good senator planned to fund his grand initiative . A Chicago Tribune “Watchdog” article criticizes “for profit” hospitals that pass the buck on uninsured patients, showing how for profit hospitals provide patients with an “EMTALA screen” in the emergency department, stabilize any emergencies, and then send indigent patients to public hospitals for further care – sometimes with directions on how to get to the public hospitals. The article quotes one University of Pennsylvania emergency physician as stating that the practice amounts to “legalized patient dumping.” No word on how much of a pay cut the emergency physician has taken to curtail such problems in his own state. Also no word on when the Chicago Tribune is going to stop “advertiser dumping” – a process that requires all advertisers to pay in advance for advertisements in its newspaper. A Naples Daily News (Virginia) article shows how communities are creating more and more “freestanding” emergency departments that cater to patients with the ability to pay. The article notes that out of 12,000 patient visits per year, the freestanding emergency department “is seeing very few people with no insurance”. Incidentally, wait times are 10 minutes in the freestanding emergency department and 5 hours in the traditional emergency departments. The manner in which healthcare providers fight for financial survival is causing rapid market adjustments. Hospitals that cannot afford to comply with the federal EMTALA laws are either curtailing emergency services or closing. Patients with public insurance or no insurance that depend on EMTALA laws to survive are being herded into larger public institutions where waits become untenable. Private physicians increasingly refuse to care for patients with public insurance due to low reimbursement and administrative hassles. Government-created market forces are pushing us toward a two-tiered socialized system at a dizzying pace. Those fortunate enough to have insurance will receive faster and likely more competent care, but care that will come at an increasing financial cost. Those patients without insurance will receive “free” care that is time-rationed and haphazard. Emergency medical care for all Americans will be less accessible because of continuing hospital and emergency department closures. We asked for it.

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I'm Not Paying For It …

Gramma WhiteCoat is getting foot surgery this week. She’s in her Golden Years, so her care is paid for courtesy of the Medicare National Bank. I spoke to her last week and she stated that she was examined by 4 different doctors, 2 nurse practitioners and 3 nurses for preoperative procedures. Her primary care physician (not one of the 4 doctors providing a preoperative exam) saw her about a month prior to her surgery, cleared her for surgery, and ordered preoperative labs. Because the labs were more than 3 weeks old, the surgeon wouldn’t accept the normal results and ordered a second set of preoperative labs. Grandma WhiteCoat’s response: “I know they’re doing all these exams and blood tests to pad the bill. But I don’t care — I’m not paying for it.” From the mouth of my own mother. Just another example of why any system in which the consumer has no stake in cost containment is doomed to fail. FREE = MORE Patients must have some skin in the game in order for any medical system to work.

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Many Doctors Opting Out of Medicare

This NY Times article notes that many patients who become Medicare eligible are finding that the “insurance rug has been pulled out from under them.” More and more physicians are dropping Medicare and patients can’t find physicians to take care of them. “The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.” There is already a shortage of internists in the US and the ones that are available are unwilling to accept new Medicare patients. Universal coverage doesn’t mean much if no one takes your insurance. The more I think about this, the more I wonder whether this is exactly what the feds are looking for. They keep taking 15+% out of everyone’s paychecks to fund a Medicare system that fewer and fewer doctors participate in – until everyone pays a lot of money to end up with little or no access to medical care.

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ED Abuse

From Statesman.com … Nine patients. Six years. 2,678 emergency department visits. $3 million in bills to the taxpayers in Austin, TX. And so many Americans won’t get basic health care because they can’t afford it. Something ain’t right. Ambulance Driver has some suggestions on a cure. 911Doc also beat me to the post. The fact that so many emergency medical providers are highlighting the article should tell you something.

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UTMB Closes ED, Opens Urgent Care Center

The University of Texas Medical Branch in Galveston trauma center was significantly damaged by Hurricane Ike in September 2008. After the storm cleared, UTMB kept its ED open only to treat patients with minor ailments or to provide stabilizing treatment and transfer to patients who needed higher levels of care. About 600 patients needed transfer since Hurricane Ike struck the area. UTMB’s program appears similar to a program at the University of Chicago that evoked public outrage not too long ago. According to an article in today’s Galveston County Daily News, UTMB stopped the “treat and transfer” program that it had been using since September. Instead, UTMB decided to close down its emergency department. Now no one has access to emergency care at the hospital. Everyone with an emergency condition must call 911 to be transferred to another hospital – apparently in Houston which is a 48 mile trip according to Google Maps. Instead of continuing to provide emergency services, UTMB is running an “urgent care center” out of the emergency department. For those of you who haven’t read my previous posts, urgent care centers don’t have to treat any patient that walks through the door looking for care. EMTALA laws don’t apply to urgent care centers. Oh, and by the way, the article states that “the urgent care facility will require patients to undergo financial screening.” I don’t know the hospital’s official policy, but that statement sounds like the urgent care center is doing a wallet biopsy on potential patients and triaging out those whose biopsies come up short. Sound familiar? The comments section to the article was a mixture of desperation from patients and disgust from some medical professionals. One person stated “Many of us have severe problems and are desperate.” Another asked “Why should Houstonians suffer with longer waits in the emergency room because Galveston and UTMB can’t get their act together? They shouldn’t have to.” One PA stated that he was “really ashamed that I graduated from UTMB and have to witness this travesty of medical care to the citizens of and visitors to Galveston.” It should be noted that UTMB stated that it plans to reopen its emergency department in 3-4 months – albeit with less services available. It should also be noted that, unlike the University of Chicago, UTMB is the only game in town in Galveston. I predict that the speed with which UTMB gets its ED functioning will be directly related to how well the urgent care center does financially. Welcome to the new face of medical care in this country, folks.

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