Ill tell you why people want natl health care... [Archive]

Belmont31R

08-09-11, 18:48

Yesterday was the first time I went to a doctor since 2007. I went to a walk in urgent care center. Talked to a doctor who spent maybe 3 minutes with me, did some blood and urine tests. Doc says I need to go to the ER.

Go to the ER, and wait 3 hrs before I go back to a room. Before anyone even sees me this administrator lady comes back, and asks for a debit card to pay them 200. I told the lady Ive been here for hours, and have not even been seen yet. You can tell she feels bad so she says she will come back. Doctor talks to me for 2 minutes and before I can even explain all my symptoms he is out of the room and says I need a CT scan. Alright that might explain what has been going on for 3 months. Do more urine and blood tests. Ask nurse after waiting another 2-3 hours what the blood test results are. She says she will go get them and come back. Never shows back up. Go for CT scan and the tech says results will be back in 45 min to an hour. Wait another hour and doc comes in, says everything came back normal, and Im being discharged. Wait another 30 minutes with an IV in my arm...I start standing in the doorway. Finally nurse shows up, gives me my referral to a GI doctor, takes the IV out, and says "you're free to leave the building."

Let me guess the bill for this is going to be 2-3k and the total time someone spent with me was maybe 10 minutes half of that being the CT scan lady. Instead of trying to figure out what the problem is after a couple tests I just get shuffled out the door. Keep in mind this is a hospital where they do surgeries, births, and everything.

So yesterday I spent 150 at the urgent clinic and who knows how much at the ER for NOTHING. But when I called around ahead of time to find a specialist to see they won't see you without a referral, and won't even see self pay if you tell them you will pay at the time of treatment in cash or card. I hate the fact you have to spend hundreds of dollars with one doctor just for them to tell you to go somewhere else. This time it was 150 at one doctor to go see another doctor for likely thousands, and I still got told to go somewhere else. All told I spent 15 minutes with a medical professional yesterday...:rolleyes:

I will never go to his hospital again. In 2007 when my kid had his (first) fall we took him here, and the doctor assured us he was fine. 2 days later he was sitting on my wifes lap, his head rolled back in his head, and he spent 2 days at a childrens hospital for a brain bleed.

I just feel like its a sham, they want people in and out the door to rake up ER fees, and then just passing the persons issue onto someone else. This is not the first time this has happened. Next time I don't care if I have to drive 30 minutes to an hour for an ER.

To top it off since Im "self pay" I already got a call today from some sub contractor company asking about getting enrolled in low income assistance program to pay the bill. I haven't even gotten a bill, and that bitch was in the room asking for money before a nurse or doctor even talked to me. It just strikes me as being about $$$$ and not the patient. My wife is in home health nursing right now through a top 100 company and their company would NEVER treat patients like that. Next time Ill drive the distance to go to her company's hospital not this circus they have going on in this city.

pilotguyo540

08-09-11, 19:45

montanadave

08-09-11, 20:47

GermanSynergy

08-09-11, 20:51

I'm sure Obamacare will fix all of this.

GotAmmo

08-09-11, 20:53

sounds like a visit to the military hospital at duty station I just left without having to swipe my CC though

Rmplstlskn

08-09-11, 21:00

Both wife and I work in health care, so I see it from the inside...

For TRAMA CARE, we have the best system in the world. There is no where in the world I would rather be than in the USA if anything TRAMATIC happens...

We also excel in DETECTION of disease...

But after that, it goes downhill, mainly because it IS A MONEY MACHINE! It is all about the billables with as little "face time" as possible to keep up QUANTITY. Not that they don't care, as everyone I know of who deals with patients CARES and wants the best for their patient... But it is a meat market... Plain & simple. Even so bad that they keep rolling in TERMINAL cancer patients, some with days or weeks left, to get additional treatments (big $$$)... It is sad...

Worse, they treat the SYMPTOMS, not to core of DIS-EASE, which is CELLULAR MALFUNCTION. Dis-ease is a cellular SCREAM... The warning lights our Creator gaves us to tell us something is WRONG... But we cut, burn, radiate and medicate instead of solve the cellular dis-order.

Rant off...

Rmpl

Caeser25

08-09-11, 21:00

File a complaint with your health insurance company AND with the state.

ForTehNguyen

08-09-11, 21:14

if you think its expensive now, wait until its "free"

chadbag

08-09-11, 21:15

rob_s

08-09-11, 21:20

they call it "practicing medicine" for a reason.

Gunfighter.45

08-09-11, 21:29

Man Belmont I'm sorry you went through all that. Same reason I hate going the doctors.

Safetyhit

08-09-11, 21:31

Go to the ER, and wait 3 hrs before I go back to a room...Ask nurse after waiting another 2-3 hours what the blood test results are...Wait another hour and doc comes in, says everything came back normal, and Im being discharged. Wait another 30 minutes...

Not that you would need to fully disclose it here, but whatever condition took between 6.5 to 7.5 hours to diagnose and treat via an emergency room visit must have potentially been rather serious. Either that or they were overwhelmed that night...or then again you simply dealt with pure ineptitude.

I've spent some late nights getting fixed (usually stitched up) in the ER, but worse case scenario without being outright admitted was about 4 hours. But even then I clearly remember wondering where the fu*k the friggin staff was. Sometimes it seemed as though they all went into a designated nap room or to the local 7-11.

Belmont31R

08-09-11, 21:57

Speaking as the spouse of a nurse. There is a reason for this.

Most of the people who walk in the ER don't pay and don't have insurance to pay and the hospital easts the costs or gets underpaid by some government program that sets reimbursement rates at significantly below the actual cost of service for government program patients.

Because they won't usually end up getting paid for the service, they try and minimize their outlays in providing the service. Hence the crappy service. (That and the liability issue which has them order a lot of tests to CYA with and also because "outcome based medicine" is stressed where "best practices" are compiled and if a doctor is not following what some bean counter somewhere said is the normal response to a complaint, they are in trouble, so you get all kinds of expensive tests)

So the costs get shifted to the private citizen payer, who usually has some sort of insurance program through their job or their spouse's job. These insurance companies look at every higher costs so they have all sorts of programs set up to try and minimize costs (this referral BS etc). They scrutinize everything because they have to try and control their costs.

Lots of people, both citizens, and non-citizens, don't end up paying for their care, so they don't follow doctors instructions, take their meds, etc since they are not paying for it and they think they can go back to the hospital whenever something is wrong. Since they are not paying for it they don't care. So-called "frequent fliers."

The system is screwed up and at the root of it is government intrusion into the system.

At the "cash" place I went to...a blood test was 13 and urine test was like 10 or 11. I got see seen within 10 minutes of walking in the door.

I got asked at each step what the cost would be, and had to sign for it. I have no problem with that being a cash and carry type of patient.

I also have no problem with ER's being the same way. I think the mandatory treatment is BS, and just because of your job doesn't mean you should be forced to work for free.

If last night would have turned into chaos and Id needed surgery Id have made some arrangements, and handed my debit card over for it. I don't want to given the run around handing over thousands to doctors who don't know what they are doing, do all this shit, and then tell me to go somewhere else. In the discharge paperwork it says I need followup treatment within 3 days with this doctor they referred me to. Called this doctors office this morning, and I got the soonest appointment on the 24th.

Belmont31R

08-09-11, 22:14

Not that you would need to fully disclose it here, but whatever condition took between 6.5 to 7.5 hours to diagnose and treat via an emergency room visit must have potentially been rather serious. Either that or they were overwhelmed that night...or then again you simply dealt with pure ineptitude.

I've spent some late nights getting fixed (usually stitched up) in the ER, but worse case scenario without being outright admitted was about 4 hours. But even then I clearly remember wondering where the fu*k the friggin staff was. Sometimes it seemed as though they all went into a designated nap room or to the local 7-11.

I have both sharp and dull/burning pain in my stomach, feel weak, feel like passing out when I stand up. Varies day to day, though. Yesterday was "enough", and I told my wife as soon as she got home I was going. Felt like passing out multiple times yesterday AM, was shaking and trembling. Have had back pain mid to lower back with severe weakening off and on in my left leg. 2 months ago I was in Lowes and my left foot as asleep like as if you slept on it wrong, and woke up with a numb limb. Most of the time its like dragging my leg or if you just woke up and feel weak if you try to exert yourself. Daily diahrea within 20 minutes of waking up. Black spots in stool 1-3 times a week. My ab muscles feel constantly tired and sore like if you just did 100 situps and feel that burning pain. If I stretch my abs like arching my back the muscles feel sharper pain like post work out pain.

Started about 3 months ago with a pressure sensation in lower left abdomen. Got worse from there. Started feeling hot flashes and sweating within a few weeks for 1-4 hrs a day. Sharp pain mostly in lower left abdomen but occasional all over the front abdomen. If I sit down for 20 minutes, and then raise up my back will pop like popcorn.

Also had a couple cases of numb spots on the top of my left hand, left face, and left side of tongue/mouth. I initially got the numb spots in 2006 along with headaches. While at a FOB in Baghdad in late 2006 I had to get a shot of Benadryl in my ass to put me to sleep. Headaches 4-6 times a week through mid-late 2007. Back pain lessened. Had numb spots on my hand while deployed in 2006. In 2007 at Ft Lewis I got numb spots again on left hand and also back of head near neck/head line and up to my right ear. Went to clinics both in Germany and ft Lewis around 15 times and finally saw a PT lady. She saw me once, and said it was because of bad posture. Never went back. However most of that was limited to neck upper back area. Lately Ive had lower to mid back pain mostly on the left side. Right side feels "strong" and only in the last 2 weeks has the sharper stomach pains been going on with the right. The first 2 months was limited to all of my left side. So the stomach pain burning/sharp pains have only spread to the right side recently. I have good days and bad though. 2/3rds bad where I feel like crap and hurt. 1/3rd I still feel it but can move around alright. Today I did laundry, made food, cleaned up, put the trash cans out, ect. Yesterday I was thinking about passing out and going unconscious.

If you've red this far you got further than I got with either doctor yesterday. I said maybe 1/3rd of this and they were out of the room.

parishioner

08-09-11, 23:16

Black spots in the stool sounds like a GI bleed? Do you take a lot of NSAIDs like advil? These can cause peptic ulcers and bleeding.

Maybe lanesmith will chime in.

Ridge_Runner_5

08-09-11, 23:25

An associate was in a staff meeting with the physician who had been hired to spearhead the formation of a new comprehensive cancer center at a local hospital (a "nonprofit," no less) when he inadvertently referred to their future patients as "market share."

Kind of says it all.

Would have stood up right there and let that guy know that I'm not a market, I'm a human f'ing being, and that if they wanted my money, they'd damn well better treat me like one.

Sensei

08-09-11, 23:31

I have both sharp and dull/burning pain in my stomach, feel weak, feel like passing out when I stand up. Varies day to day, though. Yesterday was "enough", and I told my wife as soon as she got home I was going. Felt like passing out multiple times yesterday AM, was shaking and trembling. Have had back pain mid to lower back with severe weakening off and on in my left leg. 2 months ago I was in Lowes and my left foot as asleep like as if you slept on it wrong, and woke up with a numb limb. Most of the time its like dragging my leg or if you just woke up and feel weak if you try to exert yourself. Daily diahrea within 20 minutes of waking up. Black spots in stool 1-3 times a week. My ab muscles feel constantly tired and sore like if you just did 100 situps and feel that burning pain. If I stretch my abs like arching my back the muscles feel sharper pain like post work out pain.

Started about 3 months ago with a pressure sensation in lower left abdomen. Got worse from there. Started feeling hot flashes and sweating within a few weeks for 1-4 hrs a day. Sharp pain mostly in lower left abdomen but occasional all over the front abdomen. If I sit down for 20 minutes, and then raise up my back will pop like popcorn.

Also had a couple cases of numb spots on the top of my left hand, left face, and left side of tongue/mouth. I initially got the numb spots in 2006 along with headaches. While at a FOB in Baghdad in late 2006 I had to get a shot of Benadryl in my ass to put me to sleep. Headaches 4-6 times a week through mid-late 2007. Back pain lessened. Had numb spots on my hand while deployed in 2006. In 2007 at Ft Lewis I got numb spots again on left hand and also back of head near neck/head line and up to my right ear. Went to clinics both in Germany and ft Lewis around 15 times and finally saw a PT lady. She saw me once, and said it was because of bad posture. Never went back. However most of that was limited to neck upper back area. Lately Ive had lower to mid back pain mostly on the left side. Right side feels "strong" and only in the last 2 weeks has the sharper stomach pains been going on with the right. The first 2 months was limited to all of my left side. So the stomach pain burning/sharp pains have only spread to the right side recently. I have good days and bad though. 2/3rds bad where I feel like crap and hurt. 1/3rd I still feel it but can move around alright. Today I did laundry, made food, cleaned up, put the trash cans out, ect. Yesterday I was thinking about passing out and going unconscious.

If you've red this far you got further than I got with either doctor yesterday. I said maybe 1/3rd of this and they were out of the room.

I've been a practicing emergency physician as an attending for 6 years and I split my time between a busy community ED and a big academic center. Not trying to be nasty, but what you describe (multiple, seeming non-related complaints, lasting months, in a relatively young person who was sent to the ED by another doctor) is our nightmare situation because someone is enevitabily going home dissatisfied. This is mainly due to our poor skills at resetting a patient's expectations that are often more than what an ED can provide for most chronic problems (i.e. lasting more than 2 weeks).

That is to say, we are very good at identifying and treating acute (usually lasting less than 3 days in a young person) life threatening illness. For example, the ED is the place for you if you are shot, have sudden chest pain, a sudden severe headache, an asthma attack, abdominal pain worsening over 1-2 days, etc. Notice that these are single problems involving 1 or 2 organ systems that are worsening over a brief period.

We are not good with chronic problem not because we are stupid, inept, or don't care (OK, many times we don't if you are a frequent flyer). Instead, our tests are simply not sensitive for chronic illnesses such as migrains, fibromyalgia, chronic fatigue, chronic back pain, peptic ulcer disease, irritable bowel disease, etc. that require a good family doc or appropriate specialist to make the diagnosis with tests not routinly available in an ED.

So, people who sit on problem for months who finally decide "enough" are very likely not to have their problem diagnosed in the ED despite paying a fortune. They will get a medical screening exam to rule out a life threatening cause of the symptoms and some temporizing treatment until they can see a primary doctor. Although chonic problems rarely require expensive tests in the ED such as CT scans, patients are very likely to get these tests when they describe a sudden worsening, or mix in some new symptoms that are potentially life-threatening. Basically, expect to pay out the ass if you choose to use an urgent care or ED for a problem(s) that have been brewing for months.

Finally, I will apologize on behalf of my speciality for the poor communication. There is rarely an excuse for the level of feedback that you describe. I will say that I've dropped the ball in this department when faced with multiple critical patients, but I still try to treat the decent people with dignity and respect.

Smuckatelli

08-09-11, 23:31

OP, did they do a CBC? The current problems sound like a liver issue. What are your billirubin, ALT & AST counts?

Belmont31R

08-10-11, 00:00

I've been a practicing emergency physician as an attending for 6 years and I split my time between a busy community ED and a big academic center.

Understandable, and I realize Im probably not a priority in an ER. I ONLY went there because another doctor told me too. This was the FIRST time Id been to a doctor in over 4 years, and first time out of the military. Ive been with wife and kids but not me personally.

I really do appreciate the work health care people do, and as I said my wife is in home health nursing and hospice work. We've spent a lot of time and money getting her into and through school. Ive put off using my GI bill since 2009 for her because I was basically starting out fresh, and she already had her CNA and other classes done.

The communication and wait time was pretty lacking IMO but Im sure they have more important cases to see, and I can tell tell you if I have something to get done I want it done ASAP. I don't like sitting around looking at walls or twiddling my thumbs.

Luckily the GI doctor Im going to see has 50% off for cash patients. I don't know why more doctors don't do "cash n carry" services. My wife had to have a cervix biopsy and that is how we did it. Same hospital as the one I was just at just a different part. Went in for it, swiped my card, and that was that. Got told up front what the charge would be. It would be great is hospitals had "menus". Cash or charge on the spot.

Sensei

08-10-11, 00:02

OP, did they do a CBC? The current problems sound like a liver issue. What are your billirubin, ALT & AST counts?

The liver function tests that you describe are not in a CBC (complete blood count) which only includes hemoglobin, hematocrit, white blood cell count, platelet count, etc. The tests that you describe are found in a comprehensive metabolic panel (some places call it a Chem12 or chem16 depending on what is included). A CMP is fairly routine for most people presenting to the ED with undifferentiated abdominal pain (medical speak for pain without identified cause).

Personally, I would not recommend any more tests until you find a primary doctor that you like, who takes the time to listen to your concerns, performs a thorough exam, and recommends tests after explaining their cost/potential risks/benefits. FYI, it is usually very hard to be this thorough in an ED when the shit is hitting the fan.

Jellybean

08-10-11, 00:16

.........But after that, it goes downhill, mainly because it IS A MONEY MACHINE! It is all about the billables with as little "face time" as possible to keep up QUANTITY. Not that they don't care, as everyone I know of who deals with patients CARES and wants the best for their patient... But it is a meat market... Plain & simple. Even so bad that they keep rolling in TERMINAL cancer patients, some with days or weeks left, to get additional treatments (big $$$)... It is sad...

Worse, they treat the SYMPTOMS, not to core of DIS-EASE, which is CELLULAR MALFUNCTION. Dis-ease is a cellular SCREAM... The warning lights our Creator gaves us to tell us something is WRONG... But we cut, burn, radiate and medicate instead of solve the cellular dis-order.

Damn straight. Hammer-nail-head.
It's all about the money, and general people's general stupidity. Nobody wants to know why they're sick anymore- just give me a pill so I can FEEL better and go on my merry way. Or we'll just chop it out because you don't really need that useless organ.... Bollocks!

Anyway- OP, I know exactly what you're talking about, although I don't think I ever had it quite as bad as you describe....

Back when I was a lot younger I spent at least 5 hours in the ER for a simple broken finger- I waited about 2+ of those in the sitting room before anyone even realized we were there. I did not hear or see any sign of any severe trauma that would explain this, and the hospital did not appear crowded or busy.
Then when I was taken back to be seen, the damn doctor says the usual "let's see the finger", proceeds to give it a nice big YANK and says 'yep, it's broken'. NO SHIT!:rolleyes: They then sent me to the Xray tech (I never saw the doctor again, thank God) after waiting another inordinate amount of time. The only bright spot- those were the best xrays I've ever had taken in my life (guess which finger I broke...:D).
Afterwords they stuck a splint on it, and the nurse reffered me to a specialist 2 hours away to get it set/cast (which took a grand total of about 30 min.)- she actually told us not to come back to the hospital to have it taken care of, due to the demonstrated incompetence of certain staff.

More recently I have had some much more serious health issues ( I was set upon by an evil stomach virus that won't go away, and collapsed a lung multiple times). I won't bore you with all the details but I have since been to MANY different hospitals and doctors, and have gotten varying levels of the same ring-around-the-rosy at all of them.
Now to be fair, I have met a lot of really nice, skilled, caring people in this profession.
But then there are the folks like the doctor I mentioned that make you wonder how they even got there in the first place.
The first time I collapsed a lung and went to the hospital they had to admit me, and of course start an IV. The nurse I got apparently had no idea how to do it- long story short, she botched it so badly she bent the needle, blood was pouring out all over the place as she proceeded to twist it about trying to fix it, I almost passed out, and I swear she stuck it in to far because I still get occasional pain at that point on my hand. Apparently she must have been a graduate of the nursing program at the college I went to.:mad: I've never been a big fan of needles, but this was ridiculous-you'd have had to have been there to get the full effect. I'd rather have faced down a horde of jihadists with only a pistol than go back there again.

Sensei

08-10-11, 00:20

Understandable, and I realize Im probably not a priority in an ER. I ONLY went there because another doctor told me too...

One of the major causes of ED over crowding is the growing phenomenon of primary care referrals - i.e. people being sent to the ED by their PCP for problems that used to be handled as an out-patient or directly admitted to the hospital without going through the ED. Now, we get people sent to the ED for CT scans, simple procedures, pre-adission "stabilization" etc. Urgent care facilities are notorious for this, and I especially love it when they promise the patient that certain specialists will meet them in the ED or certain costly tests will be performed.

Even the jail dumps on us since the nurses have decided that they will not take any drunk blowing over 0.25 and they will not perform any blood draws. That's right, nothing soothes the atmosphere in the ED than a bunch of cops tazzing a DUI who is fighting a blood draw.

Hence the 'ol saying, "If your Momma don't love ya, and the cops don't want ya, then go to the emergency department."

Belmont31R

08-10-11, 00:24

The liver function tests that you describe are not in a CBC (complete blood count) which only includes hemoglobin, hematocrit, white blood cell count, platelet count, etc. The tests that you describe are found in a comprehensive metabolic panel (some places call it a Chem12 or chem16 depending on what is included). A CMP is fairly routine for most people presenting to the ED with undifferentiated abdominal pain (medical speak for pain without identified cause).

Personally, I would not recommend any more tests until you find a primary doctor that you like, who takes the time to listen to your concerns, performs a thorough exam, and recommends tests after explaining their cost/potential risks/benefits. FYI, it is usually very hard to be this thorough in an ED when the shit is hitting the fan.

I have an APPT with a GI doc on the 24th at 2PM. I already asked about costs, and they do 50% off if you pay at the time of visit. I asked what a general visit would cost and the clerk said 150-500 but with the 50% discout the most Ill pay the first time is 250.

Im amazed more people do not do cash and carry visits but was also amazed, prior to this, no one wants to see people without a referral or insurance. I told one lady at a specialist clinic I would come with a stack of 100's if she was worried about payment and they still would not see me without insurance. That was just to get a consult not for surgery or anything. :rolleyes: Both my wife and I were calling around to every clinic and office in Central Tx.

Ill try to get a copy of my records from the ER but at the clinic my white blood cell count was 14.6 when it said the normal range was 5-10 (? Might be off a few 1/10ths). Urine test was normal, and Ive had no change in urine outputs. At the hospital my WBC was 8.X. The ER doc said it can fluctuate hour to hour.

He gave me Bentyl 20MG 15X 3X daily.

Sensei

08-10-11, 00:32

Also, I'm glad that you were able to work out a payment plan. This can be hard to do in poor communities where many citizens try to cheat their bills.

My community hospital sees about 25% self-pay. The physician bill for emergency services recovers on average $16 for an ED visit for self-pays (contrast this with over $300 for private insurance). We only get this much because our physician group will send unpaid bill to collections and go after credit scores. The hospital sends only one bill but does not even bother sending unpaid bills to collections because the yield is so low.

Sensei

08-10-11, 00:41

I have an APPT with a GI doc on the 24th at 2PM. I already asked about costs, and they do 50% off if you pay at the time of visit. I asked what a general visit would cost and the clerk said 150-500 but with the 50% discout the most Ill pay the first time is 250.

Im amazed more people do not do cash and carry visits but was also amazed, prior to this, no one wants to see people without a referral or insurance. I told one lady at a specialist clinic I would come with a stack of 100's if she was worried about payment and they still would not see me without insurance. That was just to get a consult not for surgery or anything. :rolleyes: Both my wife and I were calling around to every clinic and office in Central Tx.

Ill try to get a copy of my records from the ER but at the clinic my white blood cell count was 14.6 when it said the normal range was 5-10 (? Might be off a few 1/10ths). Urine test was normal, and Ive had no change in urine outputs. At the hospital my WBC was 8.X. The ER doc said it can fluctuate hour to hour.

He gave me Bentyl 20MG 15X 3X daily.

PM sent.

armakraut

08-10-11, 05:19

If you don't earn 80-100k + a year, you're better off gaming the system.

The straight and narrow just doesn't pay anymore.

If you earned a measly 10-20k a year through your legitimate "job", you would be taxed very little. The quasi legal cash-only side work or drug dealing you do on the side would be tax-free. Because you'd be poor on the books you'd get all sorts of freebies. You'd qualify for your state's federally mandated "cost containment" healthcare system where you'd probably never see another medical bill in your life no matter how much you go to the doctor. Even if you call the ambulance to take a ride to the hospital, because the ambulance is free and the taxi is going to want money. You can also get your bridge card to pay for thousands of dollars worth of food you'd otherwise have to "earn money" to pay for. Additionally many states will give you a cell phone, or monthly vouchers for car payments (maintenance is free), if you take it to a shop for a non-safety item, they will write it up as a safety item and get you back on the road. Section 8 pays for what? 80% of your housing? Not a bad deal, probably much better than the "you pay for someone elses section 8 housing" deal you're getting right now.

Not only is being "poor" here better than actual poverty in other countries, it's better than actually working here.

Personally, I don't want shit for free, I just want certain sectors of the economy to return to a fee-for-service model where there is as much price discrimination as in the flat screen TV market, IE practically none.

Watrdawg

08-10-11, 08:06

Belmont, I've had a similar experience in the ER as you. I've also had the complete opposite in a different ER. About 3 years ago, on my birthday going to dinner with friends, I start experienceing severe pain in my lower back on the right side. We drop the kids off at my brothers and head to an urgent care center. I'm laid oout in the back seat of the care on the way there. We get there and spend about an hour in an exam room and they then send us to the ER. This is the worst pain I've ever felt in my life. We get to the ER and I have to be wheeled in with a wheel chair. Hurts too much to walk. Check in and then we end up waiting. By this time the pain is too much for me to sit down or stand up. I'm laid out on the cold floor moaning and groaning. The floor is the only thing comfortable, relatively speaking that is. 3hrs later we finally get seen. So I'm on the floor for 3hrs and NO ONE does anything to help me at all. When we get in they do X-rays and whatever else and then they tell me I have a couple of Kidney Stones and they start an IV with Dilaudid. Pain goes away in minutes. After that we get prescriptions for Percoset and a referral to a Urologist. So 4-5 hours later I'm finally home. Best Birthday present ever, Oh Boy.

Now it's a year and a half later. Here goes round 2. I'm at work and I call my wife and tell her to come get me I've got stones again. This time I tell her to take me to a hospital that is 45 minutes away from here in another county. I've been to this hospital many times with my Step Father because of his issues. Great people there. This ER is nicely carpeted, has rocking chairs in the lobby, big screen TV's and a bunch of different, very nice vending machines. The type of people living in this county and city that the hospital serves are very very well to do. I barely walk in and tell the attendent at the front desk that I'm having a kidney stone attack. Before i can go on she tells me that I'm a priority and if at possible to stand or sit over to the side and she will put me ahead of every one else. There were about 20 people sitting in the lobby. Within 5-10 minutes I'm on my way back to be seen. They put me in a exam room, do the prelim vitals check and ask me if I have any allergies to any meds or pain killers and then start up an IV with Dilaudid. My wife finishes the rest of the stuff with the nurse. 30 minutes later I have a referral with a Urologist in a practice right around the corner from the hospital. An hour and a half after getting to the ER we are in the Urologist office. I've already had X-rays done at the ER and the Urologist has all of my records from the ER. Within 3-4 hours at most I'm on my way home after stepping foot into the ER, seeing a Urologist and going through a complete workup with him and given a treatment plan and followup visit etc. The 2 experiences were like night an day. The only cost to me was my ER c-opay and office visit co-pay. Same co-pay's for both places and incidents but vastly different care. I think the difference is that one Hospital serves mostly well do do patients and the other sees a lot of non-paying fairly poor people who use the ER as an Urgent Care Center.

Smuckatelli

08-10-11, 08:28

The liver function tests that you describe are not in a CBC (complete blood count) which only includes hemoglobin, hematocrit, white blood cell count, platelet count, etc.

I'll take your word for that. Every CBC that they did on my son for over three years included liver function tests. The liver function was probably automatic because of the daily chemo for leukemia.

The spots in the stool, pain discription lead me to believe it might be a liver issue. Those symptoms that the OP described were indicators for us that the liver was having issues.

WillBrink

08-10-11, 08:36

I will never go to his hospital again.

Nor should you. Hospitals are like any business, they range considerably in quality, organization, staff, etc.

There's a small local hospital by me I have taken my GF to several times (against my advice...) and similar experiences were had. Me, I'd drive the extra 15 minutes to a much better hospital where experience was much better. GF has partially learned her lesson, but still insists on going to that POS place close to the house vs the world famous place an extra 15-20 minute drive.

The system is all screwed up on many levels to be sure, but it's also important to note all hospitals are not created equal.

usmcvet

08-10-11, 08:50

Sounds like a PITA.

I've had great luck with my local health center. I don't always see the same Doc or PA but they've treated me well and spend more time with me than I would expect, getting an excellent history and keeping it up to date. They offer cash deals too.

I went in and saw my PA in 2003 with shortness of breath. She did an exam and took x-rays. She pointed out my swollen lymp nodes in the X-Ray and told me I had Mono or Cancer. I went to the cancer Doc who drew blood, looked at it in house under the microscope and said I had Hairy Cell Leukemia but my blood work needed to be sent to the lab for an official diagnosis.

I wish you luck. It is frustrating trying to work with the huge system. I went to the pharmacy a few months ago and was told my scrip was 424. I said $4.24 or $424? It was $424, for a month of maintenance medication. I told her to keep it there was no way I could afford it. Through my local Health Center I bought the SAME Freaking Medication for $8 and change! I makes my head spin. With out my insurance there is no way I could have fought the cancer twice. The monthly bills were Scary Huge.

Belmont31R

08-10-11, 09:40

I'll take your word for that. Every CBC that they did on my son for over three years included liver function tests. The liver function was probably automatic because of the daily chemo for leukemia.

The spots in the stool, pain discription lead me to believe it might be a liver issue. Those symptoms that the OP described were indicators for us that the liver was having issues.

He said all my organs looked fine in the CT scan and blood tests.

VooDoo6Actual

08-10-11, 10:09

Good thread. You guys got it covered no doubt.

Sensei

08-10-11, 10:33

Generally speaking, urgent care facilities have a little more resources than a doctors office and are great for routine problems such as sore throats, sprains without limb deformity, small lacerations, back sprains in the young, etc. Many of these conditions are self-limited and require only symptom control. Urgent care facilities allow people the luxury of rapid evaluation of minor problems without having to schedule an appointment with a primary doctor - expect to pay more for this convenience.

However, urgent cares are not well equipped for chronic, progressive problems where a strong patient-physician relationship and continuity of care become important to establishing the diagnosis. Emergency departments often fall short in diagnosing chronic or complex illnesses because our tests and training is geared toward acute life-threats.

Sensei

08-10-11, 10:43

I wish you luck. It is frustrating trying to work with the huge system. I went to the pharmacy a few months ago and was told my scrip was 424. I said $4.24 or $424? It was $424, for a month of maintenance medication. I told her to keep it there was no way I could afford it. Through my local Health Center I bought the SAME Freaking Medication for $8 and change! I makes my head spin. With out my insurance there is no way I could have fought the cancer twice. The monthly bills were Scary Huge.

Many common conditions such as diabetes, hypertension, seizures, and asthma can be treated using generic medications that are $4 per month at Walmart. CVS has similar discount programs for generics. Keep in mind there IS NO DIFFERENCE between the effectiveness of generic vs brand name medications.

In addition, there will soon be a wave of medications coming off patent this year which will help with costs. Some of the "statins" that are commonly used for high cholesterol are on this list which is good news for many Americans.

usmcvet

08-10-11, 11:08

Many common conditions such as diabetes, hypertension, seizures, and asthma can be treated using generic medications that are $4 per month at Walmart. CVS has similar discount programs for generics. Keep in mind there IS NO DIFFERENCE between the effectiveness of generic vs brand name medications.

In addition, there will soon be a wave of medications coming off patent this year which will help with costs. Some of the "statins" that are commonly used for high cholesterol are on this list which is good news for many Americans.

Thanks Lane.

The price dropped at my health center because they are in a buying program. In this case I paid cash for $8.58, if I went through my insurance it was still going to be $200+ I have a $3,000 deductible so eight buck was a no brainier.

Suwannee Tim

08-10-11, 14:34

My experiences are contrary to Belmont's. I have good insurance and have had several major problems and a good many minor problems over the years. When I get sick I go to the doctor, if I do not know what is going on I do not wait for it to get worse. I learn about my condition and do what is required to get better. I have been blessed by being treated by many good doctors, only two I would not go back to. They have saved my life a couple of times. Some things I have learned: Much medicine is defensive, the docs are ordering tests to protect themselves from lawyers. Medicine is expensive, a physician's education is expensive, the machines are expensive, the liability insurance is expensive, regulations add cost and often, people who can pay have to pay for their treatment and the treatment of others who can't pay. When the hospital runs out of money it closes, they have to get paid somehow. The government and lawyers have distorted the market to the extent that few things make sense. The answer to this problem is not more government and more lawyers. The answer is for the government to get out of the way of the doctors, let them treat patients and set up free market incentives to grow a patient centered system of health care.

chadbag

08-10-11, 14:43

I am all for paying cash or using my HSA debit for medical services and avoiding the medical practitioners needing to bill the insurance company etc and waste all that time and effort etc IFF the insurance companies would accept my receipts when it came time to reaching the deductible.

We have a higher deductible catastrophic plan so everything gets paid by us in the end anyway as we normally don't get near the deductible (last year we did with my broken ankle and a febrile seizure in our daughter which was a 911 / ambulance ride that turned out to be nothing but it is the first time I can remember every hitting any deductible on any insurance that was not a birth year for a kid).

I would be happy to just pay fee for service if there were a way that I could substantiate my payments for services in case those payments got large enough to hit our several thousand dollar deductible and the insurance company would accept that.

The other big thing is that the charges are often less for someone covered by insurance due to contracts with the insurance companies and self-pay people get MSRP only type pricing.

I would just pay if I got the same price or better than the insurance company gets for the same service.

Sensei

08-10-11, 23:09

The healthcare problem in America (i.e rising costs) will only be solved when we follow the following steps:

1) Agree as a nation that access to healthcare will never be equal across the socioeconomic spectrum, and it is not the governments role to provide a basic level of care. That means that a larger portion of our individual income and estate will be used to fund our own individual healthcare needs.

2) Begin to bring the power of free market competition to the healthcare industry by increasing the financial responsibility of consumers that incentivizes individuals to conserve their healthcare dollars. While consumers will have to apply more of their disposable income toward healthcare, costs will be contained as providers must control their prices to compete in the marketplace. This is probably best achieved through expanded pretax flex spending accounts that can be invested when unused to create a type of healthcare retirement account (similar to a 401K).

3) Incentivise the development of low cost, catastrophic only insurance for rare illnesses that would exhaust healthcare savings accounts. These could compete across state lines and have no government mandated coverage.

4) Gradually phase out Medicare and significantly curtail Medicaid eligibility.

3) Pass meaningful liability reform but don't expect major savings until we fundamentally change how physicians are trained to use resources and technology.

Smuckatelli

08-10-11, 23:23

3) Incentivise the development of low cost, catastrophic only insurance for rare illnesses that would exhaust healthcare savings accounts. These could compete across state lines and have no government mandated coverage.

This would be great. I know many families that have been completely financially wiped out because of childhood cancer.

YVK

08-11-11, 21:19

The healthcare problem in America (i.e rising costs) will only be solved when we follow the following steps:

1) Agree as a nation that access to healthcare will never be equal across the socioeconomic spectrum, and it is not the governments role to provide a basic level of care. That means that a larger portion of our individual income and estate will be used to fund our own individual healthcare needs.

2) Begin to bring the power of free market competition to the healthcare industry by increasing the financial responsibility of consumers that incentivizes individuals to conserve their healthcare dollars. While consumers will have to apply more of their disposable income toward healthcare, costs will be contained as providers must control their prices to compete in the marketplace. This is probably best achieved through expanded pretax flex spending accounts that can be invested when unused to create a type of healthcare retirement account (similar to a 401K).

3) Incentivise the development of low cost, catastrophic only insurance for rare illnesses that would exhaust healthcare savings accounts. These could compete across state lines and have no government mandated coverage.

4) Gradually phase out Medicare and significantly curtail Medicaid eligibility.

5) Pass meaningful liability reform but don't expect major savings until we fundamentally change how physicians are trained to use resources and technology.

6) Early and persistent education, starting from elementary school, in regards to general health issues, smoking, nutrition, obesity...

7) Incentives for active commitment to healthy lifestyle, such as reduced fees for gym memberships, swimming pools...

8) Reduction of productivity-based reimbursement for physicians, or, at least, adjustment of productivity formulas to patient's outcomes.

Sensei

08-12-11, 01:19

6) Early and persistent education, starting from elementary school, in regards to general health issues, smoking, nutrition, obesity...

7) Incentives for active commitment to healthy lifestyle, such as reduced fees for gym memberships, swimming pools...

8) Reduction of productivity-based reimbursement for physicians, or, at least, adjustment of productivity formulas to patient's outcomes.

I believe that the free market should set gym prices. A direct fee for service system that has minimal 3rd party payors will fix the conflicts between physician incentives, excessive/unneeded testing, and compensation.

Thomas M-4

08-12-11, 03:06

In central Alabama there are more hospitals than you can shake a stick at I mean literally. The best advice I have been given by a nurse that I went to college with is that they special's in different things. If you have a gun shot you got to the shitty hospital because that's were all the thugs that get shot go too. If you have a general problem you go to the other hospital that does the wide range of problems, If you are having a kid then there is another hospital for pregnancies, If your kid has a problem there is a special world renowned hospital for the little ones none of the other hospitals will not even treat kids they will automatically refer you to the children's Hospital. If you have Gastronomical problem there is even a hospital that specializes in that.
I am probably missing one or two but you get the point.
Now when I was 20 yrs old I did a f*cked up thing that landed me getting surgery and a 40K doctor bill for a in and out surgery and at the time no hospital stay. And I had no insurance from the job I was working at that time. Fast forward 5 yrs later I was involved in a car accident and the car I was driving had a first generation ford air bag and those bustards are known to pack a wallop. The accident was actually minor the car wasn't even totaled it was just barely enough to trip the air bag . That bitch airbag gave me a KO punch ,I woke up just when the ambulance arrived. I get to the ER I am awake and have my were fair all with me. And communicating with people fine. The ER nurse's snatches my pants off with out telling jack squat and lifts my ball sack to stick a IV in the inside of my leg :eek: WTF I couldn't even control my self my 6'2'' lanky arms was hanging in the air fixing to KO that bitch that was going to stick that needle in that spot all the while me screaming you can stick it in my neck just don't stick it there :sarcastic: They didn't even tell me what they were up to thank God the doctor told them to stick me in the arm after he saw me raise up :happy: Any way there is a couple a stories that go along with that episode. I stayed in the Hospital 1 1/2 days and got one CAT scan and a IV [ THATS IT] which that hospital charged my insurance company almost 60k. All the doctor said was that I had a mild concussion that's it for the day and and half all I got was served was breakfast.. I didn't even get a prescription.

YVK

08-12-11, 08:59

I believe that the free market should set gym prices. A direct fee for service system that has minimal 3rd party payors will fix the conflicts between physician incentives, excessive/unneeded testing, and compensation.

If one looks at gyms as businesses, then, certainly, free market rules should apply. I try to look at promotion of a healthy and active life style as a public health measure.

I am not so sure about direct fee for service simply because my field costs a lot, even if one takes out hyper-inflated fees imposed on insured patients. Last I checked, an ICD device alone was about 25K, and it was 40K few years ago.

armakraut

08-12-11, 11:26

The best public health measure would be to simply not fund diseases brought about through lifestyle choices like obesity and substance abuse.

rob_s

08-12-11, 11:34

The best public health measure would be to simply not fund diseases brought about through lifestyle choices like obesity and substance abuse.

I don't disagree, but then you have to carry that out to the logical conclusion.

Do we, as a society, have the stomach (no pun intended) to watch these people die in the streets in the short-term? Remember that we've grown a populace accustomed to safety nets from Uncle Sugar. The fatties and the junkies will NOT believe that it is real until they watch their friends dying around them. And when they do, who pays to scrape up the bodies?

Who makes the call? I know of more than a few "skinny" people that are only so because of a very high metabolism. I was one of them for years until I hit 30. So without a good diet and exercise they will still appear "healthy" but may not be so. And is alcohol included? Smoking? If so does a pipe or cigar count? How many? If I get lung cancer will the fact that I smoked when I was 16 count? Or the fact that I have a cigar a week? What panel of government nincompoops makes that call?

and why stop at intake, what about dangerous activities? Ride a motorcycle to work? Speed in your car? skydive? Bungie jump? Hell if you cook a lot you are more likely to cut yourself than someone who has their meals prepared.

Ultimately the only solution that makes sense is to do away with insurance entirely, or at least phase it out. In this way everyone becomes master of their own destiny, and debt. Want to smoke and get lung cancer? Awesome, I hope you have a good savings plan to cover the costs of your cancer when you're 70, if you get there. If not, that cancer is going to run it's course damn quick.

YVK

08-12-11, 11:35

The best public health measure would be to simply not fund diseases brought about through lifestyle choices like obesity and substance abuse.

That's an over-simplification. For example, we have a threatening epidemic of childhood obesity - 100% responsibility of parents, not kids. That fat kid is gonna grow and develop obesity-related health issues in his 20s or 30s - and you are going to penalize him for something his parents are responsible for?

rob_s

08-12-11, 11:37

That's an over-simplification. For example, we have a threatening epidemic of childhood obesity - 100% responsibility of parents, not kids. That fat kid is gonna grow and developed obesity-related health issues in his 20s or 30s - and you are going to penalize him for something his parents are responsible for?

I don't buy that either. A fat 12 year old has only his parents to thank for it, a fat 30 year old has only himself. While it's going to be harder for him because he learned from a bad example, it is still his choice.

chadbag

08-12-11, 11:39

Ultimately the only solution that makes sense is to do away with insurance entirely, or at least phase it out. In this way everyone becomes master of their own destiny, and debt.

I fail to see how getting rid of insurance would be a good idea. Insurance is not the problem. It is the government meddling in insurance that is the problem: mandated coverages, not allowed to sell across state lines, a system that encourages work provided insurance, etc.

Insurance sold as real insurance, not a maintenance plan, is a useful way for someone to become master of their own destiny.

rob_s

08-12-11, 11:48

I fail to see how getting rid of insurance would be a good idea. Insurance is not the problem. It is the government meddling in insurance that is the problem: mandated coverages, not allowed to sell across state lines, a system that encourages work provided insurance, etc.

Insurance sold as real insurance, not a maintenance plan, is a useful way for someone to become master of their own destiny.

Disagree.

What is the incentive to stay healthy, when people at least have the perception that there are no repurcussions for their bad choices? now if you want to charge the fatbodies more for their insurance I'm ok with that. Or adopt a model like car insurance where rates increase as "accidents" (or in this case, visits) increase but with discounts for preventative care, then I'm ok with that.

Making people pay their own way makes them responsible for their own destiny. Whether it's insurance companies or the government, the core concept is socialist in nature in that I pay for other people's bad decisions.

YVK

08-12-11, 11:53

I don't buy that either. A fat 12 year old has only his parents to thank for it, a fat 30 year old has only himself. While it's going to be harder for him because he learned from a bad example, it is still his choice.

There is nothing here to buy, Rob. We see early coronary disease in patients age 18; in fact, we have seen it in these age groups in Western societies for at least 40 years, when rates of obesity were half of what they are now. If one is fat since childhood, by the time he/she is 18, they are already behind the curve - blood pressure, lipids, etc. Then you're 18, you have no money, you need to go through college and juggle a job on the side, then you need to work your ass off to get a reasonable permanent job. Reality checks in and it is not pretty. I see these people in my office nearly on daily basis and while some of them have made their own poor choices, many have been dealt a bad card from a get-go.

chadbag

08-12-11, 11:54

Disagree.

What is the incentive to stay healthy, when people at least have the perception that there are no repurcussions for their bad choices? now if you want to charge the fatbodies more for their insurance I'm ok with that. Or adopt a model like car insurance where rates increase as "accidents" (or in this case, visits) increase but with discounts for preventative care, then I'm ok with that.

Making people pay their own way makes them responsible for their own destiny. Whether it's insurance companies or the government, the core concept is socialist in nature in that I pay for other people's bad decisions.

I think you need to read up on what insurance is.

You are griping about the current system, which is not insurance, even though it is called that. The current system IS a socialistic forced transfer of wealth.

I explicitly said (in other terms) that the problem was that the current system has been corrupted by government meddling so that it is more a maintenance plan and not an insurance plan.

Insurance is used to cover the unexpected and very expensive oyt of the ordinary occurrence. There should not be any such thing as a "co-pay" and most doctor's appointments should be fee for service that you take care of yourself. The unexpected expensive disaster type thing is what you insure against. Things like huge accidents, cancer, etc.

We don't expect car insurance to pay for oil changes, new tires, etc. Why do we expect "health insurance" to pay for the analogs?

chadbag

08-12-11, 11:57

There is nothing here to buy, Rob. We see early coronary disease in patients age 18; in fact, we have seen it in these age groups in Western societies for at least 40 years, when rates of obesity were half of what they are now. If one is fat since childhood, by the time he/she is 18, they are already behind the curve - blood pressure, lipids, etc. Then you're 18, you have no money, you need to go through college and juggle a job on the side, then you need to work your ass off to get a reasonable permanent job. Reality checks in and it is not pretty. I see these people in my office nearly on daily basis and while some of them have made their own poor choices, many have been dealt a bad card from a get-go.

And? So what. Why is it MY problem to pay for this. It exists. But the solution is not socialized spreading of the pain to those who take better care of themselves and their families.

Things like food stamps and similar programs exacerbate this sort of health issue as well. The crap that people on welfare eats leads to this sort of problem. While I see fat people (me included) in every economic class, almost all the people I see buying crap with their EBT cards / foodstamps and similar programs are obese. Non scientific survey etc. disclaimer.

rob_s

08-12-11, 12:02

rob_s

08-12-11, 12:04

I think you need to read up on what insurance is.

You are griping about the current system, which is not insurance, even though it is called that. The current system IS a socialistic forced transfer of wealth.

I explicitly said (in other terms) that the problem was that the current system has been corrupted by government meddling so that it is more a maintenance plan and not an insurance plan.

Insurance is used to cover the unexpected and very expensive oyt of the ordinary occurrence. There should not be any such thing as a "co-pay" and most doctor's appointments should be fee for service that you take care of yourself. The unexpected expensive disaster type thing is what you insure against. Things like huge accidents, cancer, etc.

We don't expect car insurance to pay for oil changes, new tires, etc. Why do we expect "health insurance" to pay for the analogs?

So why have it at all? Save your money and deal with the "unexpected". What so many people find "unexpected" typically a blind man could have seen coming like a train down... well whatever avenue they say you can see a train coming down.

chadbag

08-12-11, 12:06

So why have it at all? Save your money and deal with the "unexpected". What so many people find "unexpected" typically a blind man could have seen coming like a train down... well whatever avenue they say you can see a train coming down.

Because people should be free to pool their resources against the unexpected.

There is no societal danger in real honest to goodness insurance that is not meddled in by the government.

Do you want to get rid of car insurance, home owners insurance, etc. too?

armakraut

08-12-11, 12:18

My grandfather was a physician from the 1930's until the 1960's in a major city. There were no bodies stacked like cord-wood in front of the Catholic hospital, and I don't think he ever had a tax rate of less than 80% either. Physicians have historically been more than willing to help out the less fortunate in their community, it's good business. I realize we're a whole lot better at doing last minute patch jobs on smoking/drinking/eating cases that would have been a "you've got a few months to live" back in the day. Physicians would of course also tell people who survived strokes and heart attacks that they could have any number of better years by changing their lifestyle. Again, we also have expensive patch job medications these days for people who won't put down the tobacco, ho-ho's and booze, all with varying degrees of horrid side effects. Healthy living still has no negative side effects.

Because we heap healthcare on those that do not deserve it, we end up-charging unfortunate regular people who by and large couldn't prevent their accident or illness. I've seen hospitals rape enough working people for unpreventable medical conditions that it makes me want to do a whole lot more than "watch" people who abuse themselves and expect others to foot the bill "wither away".

YVK

08-12-11, 12:51

Natural Selection? Yes.

Rob, I highly doubt that mankind in 21 century will accept a wolf pack's approach to life. In fact, this particular society (US) is leading the world in absolutely opposite direction, which is called rescue health care. We, Americans, spare no expenses on saving human life if that life has a face that one can look at or a name to call it by - whether it is a sick patient, a soldier lost behind enemy lines, miners trapped in mine (remember how we lost 6, and then lost 3 more in attempt to save first 6?), or child fallen into a well. Trauma, ICUs, cardiac cath labs on every corner, neonatology, easy dialysis access, experimental cancer treatments. Rescue care is a huge contributor to health care cost, and we're are the unanimous world leaders.
I am not passing judgment whether this is right or wrong. I am simply stating the fact that this is what current American society wants and demands, and I don't see how this would change much, let alone 180 degrees towards natural selection.

khc3

08-12-11, 13:49

armakraut

08-12-11, 15:01

The bolsheviks refer to us as "tax paying units", quite a step below either human cargo, human capital, or market share, all which acknowledge either your humanity or your potential to do something without coercion. We are the great big ATM machine between their super rich welfare rat buddies and their book-value "poor" welfare rat buddies. The enemies of all humanity, fully subsidized by our tax dollars.

chadbag

08-12-11, 18:45

An associate was in a staff meeting with the physician who had been hired to spearhead the formation of a new comprehensive cancer center at a local hospital (a "nonprofit," no less) when he inadvertently referred to their future patients as "market share."

Why is this a problem? Health care is a market. Doctors and specialists exchange their services for money, the same way we all do.

The problem is, not enough people understand and look at it that way.

Looking at future patients as "market share" in a staff meeting in no way means that the care would be less for those patients.

Moose-Knuckle

08-13-11, 03:29

Healthcare is a BILLION dollar business. Guess what, if they cure you they won't be in business very much longer. ;)

Belmont31R

08-13-11, 03:44

Why is this a problem? Health care is a market. Doctors and specialists exchange their services for money, the same way we all do.

The problem is, not enough people understand and look at it that way.

Looking at future patients as "market share" in a staff meeting in no way means that the care would be less for those patients.

Im not a mythology expert or even all that much interested in it but actually looked up the "medical symbol" with the two snakes winding around the staff which is called the Cadeceus. The staff with one snake is called the Rod of Asclepius.

Interesting to note, based on my limited research, is that one of the snakes on the Cadeceus is supposed to represent Hermes which represents commerce (among other things such as thieves and travelers).

Safetyhit

08-15-11, 21:24

Natural Selection? Yes.

Considering your recent past, this comment is almost unfathomable. Just read it moments ago, well after I sent the PM.

Bro your heart should be a little more accommodating to the harsh and often unfair realities of life by now, shouldn't it?

chadbag

08-15-11, 22:39

Considering your recent past, this comment is almost unfathomable. Just read it moments ago, well after I sent the PM.

Bro your heart should be a little more accommodating to the harsh and often unfair realities of life by now, shouldn't it?

I think you are kind of missing his point.

Why should it be my responsibility to have money stolen from me by governmental extortion to pay for someone else's healthcare that they are not willing to plan and sacrifice for themselves.

Being against government healthcare has nothing to do with not being compassionate or willing to help others.

I have my own family to take care of and plan for to make sure we have our needs taken.

DESPITE THAT, I willingly donate every month through our church congregation into a fund that goes to our local church members in our community (not just our congregation but all the congregations in our part of the city) who have need of food or medical needs or whatever. (The money is not sent to a central HQ but is used in our local community, 100% on the dollar, to help those experiencing need). It is not that we don't want to help. We don't want to have money stolen from us through state sponsored extortion to be given to others.

armakraut

08-16-11, 00:34

khc3

08-16-11, 09:05

Healthcare is expensive because of cost shifting.

If a specialist doctor makes 500k a year and works 5 days a week, you could conceivably rent him out for any given hour for $240. How little are others putting into the system for people to get 60k bills for a hospital ride, emergency care and a short hospital stay?

Too many people getting discounts on and off of our collective dime.

Exactly.

The reason there are is no low-cost "affordable health care" is because there's no market for it.

Any person under a fairly high means threshold will have someone else pay the tab.

Belmont31R

08-16-11, 09:20

Exactly.

The reason there are is no low-cost "affordable health care" is because there's no market for it.

Any person under a fairly high means threshold will have someone else pay the tab.

Thats why I go to the clinic I go to. Either your insurance pays for the visit or you pay in cash. No seeing a doctor and not paying the bills. Lab tests, X-Rays, and the visit is very affordable vs. places where they don't make people pay on the spot. They have the x-ray and lab in house so you get results within minutes.

Thomas M-4

08-16-11, 09:34

Healthcare is expensive because of cost shifting.

If a specialist doctor makes 500k a year and works 5 days a week, you could conceivably rent him out for any given hour for $240. How little are others putting into the system for people to get 60k bills for a hospital ride, emergency care and a short hospital stay?

Too many people getting discounts on and off of our collective dime.

Almost half of that 500k goes to malpractice insurance.

armakraut

08-16-11, 12:37

Ain't that the truth.

CarlosDJackal

08-16-11, 13:49

They perform a lot of tests for two main reasons:

(1) Because it's an easy way to rack up charges - you can thank bean counters for this.

(2) Because it provides them with the CYA documentation that they did all they can - you can thank the lawyers for this.

I have been seeing the same PCP for more than 10-years and she probably spends an average of 20-30 minutes with me with every visit. She tells me she is supposed to spend a lot less than that per patient in order for her to stay on track.

She tries to adhere to this schedule except when a long-time patient who only comes to see here either for a scheduled annual exams or when there is something legitimately wrong with him (IE: me). Then she ignores the time limits that they had set for each visit.

IMHO, our litigious society has made health care the way it is. A lot of country Doctors have closed their doors because they could no longer afford their malpractice insurance. When a Shock Trauma Surgeon, who works with patients who would have died without their care in the first place, has to pay more than a half million dollars in malpractice insurance premiums; we have a problem.

Suing a Shock Trauma Surgeon is like suing a Firefighter because he was not able to put out a grease fire in time to save the stove!!

Sensei

08-22-11, 11:06

I agree that cost sharing (i.e. covering expenses of uninsured care) and malpractice are significant contributors to rising costs. However, there are several others that are probably more expensive.

1) Technology. This is the one area where technology actually increases the cost of care dramatically. That is because there is no cost differential for using older technology. For example, you can buy a 27" LCD TV today for half the cost of that TV 6 years ago as today's expensive TVs are much larger with more features. However, you cannot get a less expensive CT scan with an older 32-slice scanner instead of the more expensive 64-slice machines because the older machines are rapidly replaced by new designs. In addition, we are use more technology to make diagnoses for conditions that were once diagnosed with physical exam or simple tests. This is manifest by the 10X increase in the used of CT and MRI over the past decade.

2) Prescription Drugs. Pharmaceutical companies have done a great job marketing new drug. On the other hand, Americans do a poor job of using less expensive generic drugs that effectively treat the same conditions.

3) Aging Population. The baby boomers are aging and entering the stage of life where parts wear out. This increase in demand results in higher costs.

The_War_Wagon

08-22-11, 12:47

I'm just gonna drop dead some day - take THAT, ObamaKare!!! :sarcastic:

Belmont31R

08-22-11, 13:27

So I got my bill today. $7300, and due date is on the 26th of this month. Statement date is the 16th. No itemization of costs at all.

Just called the hospital, got transferred to billing, and all that number does is go to a pre recorded message saying you can pay it online.

Redmanfms

08-22-11, 13:35

I hate hospitals too. I cant freaking stand the bull shit and condescension. The price tag is unbearable and unsustainable. Insurance companies are the medical equivalent of welfare these days, if I have my facts straight. My dad swears by the Mexican system of paying reasonable prices for services rendered, without hoops to jump through. My step mom was very ill from a lower GI blockage. They spent $400 in Mexico for 5 star service with a smile, and saved my step mom's life after dropping $2000 here in the US for some basic, inconclusive testing.

I think under government control, it will only get worse. Just my take.

That's nice. If American hospitals were able to get away with some of the things their Mexican counterparts are able to do (like cherry-picking patients on their ability to pay), service in the United States would dramatically improve. Too bad, by law, they cannot do that.

American hospitals are busy treating the 20,000,000+ illegals that Mexican hospitals would turn away because of their inability to pay. That's on top of the millions more legal folks here who don't have insurance.

As such, the people who can pay here have it stuck to them to try to make up the loss generated by treating tens of millions of people who can't (or more likely simply won't) pay.

People who believe nationalized healthcare (or as the Obongo Admin. has done, nationalized, forced insurance) will make this situation better are, quite simply, ****ing retarded.

Belmont31R

08-22-11, 14:09

That's nice. If American hospitals were able to get away with some of the things their Mexican counterparts are able to do (like cherry-picking patients on their ability to pay), service in the United States would dramatically improve. Too bad, by law, they cannot do that.

American hospitals are busy treating the 20,000,000+ illegals that Mexican hospitals would turn away because of their inability to pay. That's on top of the millions more legal folks here who don't have insurance.

As such, the people who can pay here have it stuck to them to try to make up the loss generated by treating tens of millions of people who can't (or more likely simply won't) pay.

People who believe nationalized healthcare (or as the Obongo Admin. has done, nationalized, forced insurance) will make this situation better are, quite simply, ****ing retarded.

Theres no good solution to this. I just posted they sent me a bill for what I got, and they are giving me 4 days to pay it.

There needs to be better structure to this, and I think a lot of it is because of hospitals own actions. Im not talking about the docs and nurses. Im talking about the administrators, owners, whatever.

Id rather them have a price list, and Ill gladly sign away any liability as long as I don't get stuck for 7300 for a CT scan and 5 minutes with a doctor. No wonder people don't pay their bills. I bet MOST of the population could not come up with 7300 dollars in 4 days. No other type of business operates with a scheme of people finding out after the fact what its going to cost them. Imagine if you took your car to get a part fixed, and they wouldn't tell you how much its going to cost. Then 2 weeks later you get a bill in the mail for 20k, and if you don't pay it within 4 days we'll put it on your credit report. Oh and if you call us all you get is a pre recorded message saying you can pay it online.

I think gov health care in this country is a terrible idea yet Im at a loss as to why hospitals are put out as victims when they are legally devoid of any free market capitalist controls consumers have in every other business in this country. The urgent care center my family goes to operates the right way where they will tell you what it costs to be seen, and at each step of the way. Blood test? That will be 13, and you pay in cash or insurance at the end of the visit.

Another thing that irks me is self pay people pay WAY higher rates than insurance. No wonder people don't pay their bills. A business can write those losses off on their taxes, and the more losses the more tax breaks.

Redmanfms

08-22-11, 14:11

Natural Selection? Yes.

Edited. Probably too harsh.

I don't think you truly understand what you are proposing.

BrianS

08-22-11, 14:13

Another thing that irks me is self pay people pay WAY higher rates than insurance. No wonder people don't pay their bills. A business can write those losses off on their taxes, and the more losses the more tax breaks.

Best way to do it is to get catastrophic insurance so you get the negotiated prices for services and drugs with a really high deductible through your insurance and then put the savings between the cost of that and regular insurance into a health care savings account. I ended up saving several thousand dollars a year going to catastrophic only.

Redmanfms

08-22-11, 14:23

Theres no good solution to this.

I agree, though lanesmith offered some very good suggestions.

Another thing that irks me is self pay people pay WAY higher rates than insurance. No wonder people don't pay their bills. A business can write those losses off on their taxes, and the more losses the more tax breaks.

That isn't entirely true, because most people never see the actual rate the insurance company is paying. Also, most insurance doesn't let you simply walk in to any healthcare provider and seek treatment, they have lists of plan providers with whom the company has negotiated a "group rate" of sorts. Buying in bulk counts in the medical world too. Doctors are usually more willing to work out lower rates that are still profitable for them since they are so used to uninsured folks stiffing them and being massively underpaid by Medicare/aid.

It sucks that government manipulation has brought us to this, but that is simply the way it is.

BTW, no offense, but even as a young relatively healthy man, you're being stupid not having insurance. Had I not had insurance a couple years ago when I had a serious bout of kidney stones my bill for the surgery to remove a 9.2mm stone that was blocking my ureter would have been nearly $30,000 (and that's what the insurance company was billed, might have been even more if I was uninsured).

Given this experience and that bill, you might consider investing in some insurance and chalk it up as a "teachable moment."

Belmont31R

08-22-11, 14:49

My wife has two kinds of insurance and my kids have insurance. Just not me.

Sensei

08-22-11, 15:30

Theres no good solution to this. I just posted they sent me a bill for what I got, and they are giving me 4 days to pay it.

There needs to be better structure to this, and I think a lot of it is because of hospitals own actions. Im not talking about the docs and nurses. Im talking about the administrators, owners, whatever.

Id rather them have a price list, and Ill gladly sign away any liability as long as I don't get stuck for 7300 for a CT scan and 5 minutes with a doctor. No wonder people don't pay their bills. I bet MOST of the population could not come up with 7300 dollars in 4 days. No other type of business operates with a scheme of people finding out after the fact what its going to cost them. Imagine if you took your car to get a part fixed, and they wouldn't tell you how much its going to cost. Then 2 weeks later you get a bill in the mail for 20k, and if you don't pay it within 4 days we'll put it on your credit report. Oh and if you call us all you get is a pre recorded message saying you can pay it online.

I think gov health care in this country is a terrible idea yet Im at a loss as to why hospitals are put out as victims when they are legally devoid of any free market capitalist controls consumers have in every other business in this country. The urgent care center my family goes to operates the right way where they will tell you what it costs to be seen, and at each step of the way. Blood test? That will be 13, and you pay in cash or insurance at the end of the visit.

Another thing that irks me is self pay people pay WAY higher rates than insurance. No wonder people don't pay their bills. A business can write those losses off on their taxes, and the more losses the more tax breaks.

The federal EMTALA (Emergency Medical Treatment and Active Labor Act) prevents us from offering a price list to most patients presenting to the emergency department. That is to say, we are required to provide a medical screening exam (which may include physical examination, lab tests, and any necessary imaging tests) to identify an emergency medical condition (any illness that risks life/limb or organ function) to any person requesting care. Allowing state malpractice laws to regulate the quality of the exam, EMTALA is vague about what that exam includes for a particular complaint, and only says that the exam must be fairly consistent with common practice for similar situations (i.e. I can't order a bunch of tests for the insured but only a few tests for the uninsured).

We must then stabilize any found emergency condition which may include admission to the hospital or transfer to an appropriate higher level of care. Although EMTALA allows us to collect billing information while the evaluation and stabilization is taking place, we cannot require payment or use previously unpaid bills as an excuse delay or stop the evaluation. This point is very important - we cannot delay the exam to collect billing information without being in violation. EMTALA has gone so far as to say that any hospital behavior that might discourage an uninsured person from seeking care such as publishing high costs or even encouraging excessive wait times (i.e. closing beds when staffing is available so that uninsured elope without care) is a violation. There have been instances of hospitals being in violation for publishing inaccurately long wait times (i.e. we can't seen you for 4 hours when the wait is actually 1 hour).

Therefore, we would be committing a violation to present you with a cost menu and withholding the exam while you decide what tests you want. That single violation is at least $50K and may threaten the providers ability to participate in Medicare/Medicaid - essentially ending their career in medicine. EMTALA violations come out of the doctors pocket and are not covered by malpractice insurance.

In your case, you presented with severe abdominal pain which opens the door to any number of emergency conditions such as appendicitis, abdominal aortic aneurysm, hollow viscous perforation, acute cholecystitis, etc. The hospital staff is then required to perform a medical evaluation that at most institutions will require labs, likely some imaging, and medications. Had the hospital presented you with a cost list and then waited for you to decide, they would be guilty of an EMTALA violation for delaying your medical screening exam. While the waiver that you describe may afford some state malpractice coverage, it offers no federal EMTALA protection for the providers.

If people with libertarian beliefs don't like this law and want to be consistent with their beliefs, then stop going to emergency departments for problems that have been brewing for weeks. Instead, save your money and go get the tests you need through a clinic that can offer a price list because they are not subjected to EMTALA. If you can't afford one of these clinics, then you should have made some better choices with your life and I'll see you on the other side. People who use the ED for their convenience are supporting an unconstitutional law and contributing to the rising costs of healthcare.

Belmont31R

08-22-11, 15:53

I know that, but thats part of the problem in my opinion. When you take away free market controls the consumer has as they do in any other business, and then allow hospitals to charge whatever they want its no surprise people don't pay the bills.

My $140 month Time Warner Cable bill as itemization down to the last cent. You'd think a $7300 bill would be able to do that, and that people would be able to know what they are getting into not weeks later. Its important to me to know what Im paying because not only have I heard from several people the bills are often wrong but we have a family friend who works at a local hospital, and has told us in the past to always check the bill. That many times they will charge for services and doctors visits that never happened, ect.

Im not disparaging doctors and nurses. My wife is in home health nursing field, and is working and going to school right now. Its all the laws, administrators, politicians, companies, and others that have got us to this point.

I have an appointment on Wednesday with a GI doc, and he does HALF price visits for cash patients.....:D

YVK

08-22-11, 17:59

The federal EMTALA (Emergency Medical Treatment and Active Labor Act) prevents us from offering a price list to most patients presenting to the emergency department. That is to say, we are required to provide a medical screening exam (which may include physical examination, lab tests, and any necessary imaging tests) to identify an emergency medical condition (any illness that risks life/limb or organ function) to any person requesting care. Allowing state malpractice laws to regulate the quality of the exam, EMTALA is vague about what that exam includes for a particular complaint, and only says that the exam must be fairly consistent with common practice for similar situations (i.e. I can't order a bunch of tests for the insured but only a few tests for the uninsured).

We must then stabilize any found emergency condition which may include admission to the hospital or transfer to an appropriate higher level of care. Although EMTALA allows us to collect billing information while the evaluation and stabilization is taking place, we cannot require payment or use previously unpaid bills as an excuse delay or stop the evaluation. This point is very important - we cannot delay the exam to collect billing information without being in violation. EMTALA has gone so far as to say that any hospital behavior that might discourage an uninsured person from seeking care such as publishing high costs or even encouraging excessive wait times (i.e. closing beds when staffing is available so that uninsured elope without care) is a violation. There have been instances of hospitals being in violation for publishing inaccurately long wait times (i.e. we can't seen you for 4 hours when the wait is actually 1 hour).

Therefore, we would be committing a violation to present you with a cost menu and withholding the exam while you decide what tests you want. That single violation is at least $50K and may threaten the providers ability to participate in Medicare/Medicaid - essentially ending their career in medicine. EMTALA violations come out of the doctors pocket and are not covered by malpractice insurance.

In your case, you presented with severe abdominal pain which opens the door to any number of emergency conditions such as appendicitis, abdominal aortic aneurysm, hollow viscous perforation, acute cholecystitis, etc. The hospital staff is then required to perform a medical evaluation that at most institutions will require labs, likely some imaging, and medications. Had the hospital presented you with a cost list and then waited for you to decide, they would be guilty of an EMTALA violation for delaying your medical screening exam. While the waiver that you describe may afford some state malpractice coverage, it offers no federal EMTALA protection for the providers.

If people with libertarian beliefs don't like this law and want to be consistent with their beliefs, then stop going to emergency departments for problems that have been brewing for weeks. Instead, save your money and go get the tests you need through a clinic that can offer a price list because they are not subjected to EMTALA. If you can't afford one of these clinics, then you should have made some better choices with your life and I'll see you on the other side. People who use the ED for their convenience are supporting an unconstitutional law and contributing to the rising costs of healthcare.

Excellent explanation for those who don't know what EMTALA means. I would only add that after our ED docs diagnose and provide initial stabilization, those of us who deal with emergent conditions are not in position to provide a price list with projected survival rates depending of extent of medical care chosen by a patient. We're legally obligated to provide an accepted standard of care irrespective of ability to pay; in my case, under the pressure of ticking clock. I've been doing what I do for a few years now and I am yet to see a patient who asked to see a menu for a heart attack treatment.

chadbag

08-23-11, 00:45

Write them a certified letter with a copy of their statement telling them you reject this and don't owe them anything. Tell them that if they have itemized proof of the debt you'd be willing to pay them. But that until they send you an itemized bill you don't owe them a thing. A statement is not a bill. It is merely a statement of account.

(I'd also try and tell them that you will pay them at whatever discount they offer to the insurance companies)

So I got my bill today. $7300, and due date is on the 26th of this month. Statement date is the 16th. No itemization of costs at all.

Just called the hospital, got transferred to billing, and all that number does is go to a pre recorded message saying you can pay it online.

chadbag

08-23-11, 00:55

That isn't entirely true, because most people never see the actual rate the insurance company is paying.

Sure they do (after the fact). You should get an EOB (Explanation of Benefits) for every insurance claim that is submitted by the doctor/hospital/caregiver. On that EOB it will show the original billed amount and the accepted amount that they actually paid according to their agreed upon fee schedules.

For example: say you get billed $100 for an exam of some sort by the physician. You get a bill from the physician with this amount, but the physician submitted it to the insurance company. The insurance company looks up the codes the doctor used to describe the exam, finds out that their fee scheduled they have agreed with the physician says that code is worth $60. So they send $60 to the physician, or send back the claim to the physician to say that is only worth $60 but you have not reached your deductible yet, so to send the bill to you for $60 (not $100), or they might send $48 and tell the physician to bill you $12 as you are on a 20%/80% plan. The EOB will say how much the insurance says can be charged for that service according to agreements, and how much of that amount is the patients responsibility.

After a while, you will get an updated bill from the physician showing the total bill was really $60 and a $40 "medical writeoff" or some other term to show what they wrote off due to insurance contracts. It will also show what they received from the insurance company and what you have left to pay.

Also, most insurance doesn't let you simply walk in to any healthcare provider and seek treatment, they have lists of plan providers with whom the company has negotiated a "group rate" of sorts. Buying in bulk counts in the medical world too. Doctors are usually more willing to work out lower rates that are still profitable for them since they are so used to uninsured folks stiffing them and being massively underpaid by Medicare/aid.

It sucks that government manipulation has brought us to this, but that is simply the way it is.

BTW, no offense, but even as a young relatively healthy man, you're being stupid not having insurance. Had I not had insurance a couple years ago when I had a serious bout of kidney stones my bill for the surgery to remove a 9.2mm stone that was blocking my ureter would have been nearly $30,000 (and that's what the insurance company was billed, might have been even more if I was uninsured).

Given this experience and that bill, you might consider investing in some insurance and chalk it up as a "teachable moment."

chadbag

08-23-11, 01:07

Best way to do it is to get catastrophic insurance so you get the negotiated prices for services and drugs with a really high deductible through your insurance and then put the savings between the cost of that and regular insurance into a health care savings account. I ended up saving several thousand dollars a year going to catastrophic only.

+100000

We have this sort of insurance (actually a pretty good version of it that pays for some preventative things up front) provided by my wife's job. They actually pay 100% of the premiums for us for this high deductible type plan. We could pay extra if we wanted the standard "maintenance plan" low deductible / copay type insurance but that would be several hundred dollars a month that we would have to pay. Instead, we take that money and put it into an HSA that we keep and administer. When we have a medical expense we pay for it out of the HSA. Only twice have we reached the deductible: once with a new baby and then last year where we had both an expensive ambulance ride and ER trip for my daughter, for what turned out to be a one-time febrile seizure related to a high fever she had (no neurological cause), and I broke my ankle and had an ER trip plus surgery -- all this in the same year, plus a couple hundred $ for the wife to check up on some things.

So, since we usually don't meet the deductible, we usually end up paying 100% of most things (some preventative checkups are included as are most vaccinations so they pay up front for a few small things), but we get the negotiated low insurance rates and we save hundreds of dollars a month on insurance costs that go into our HSA instead which is our money. And since most years we don't have that much medical anyway, we would end up paying out of pocket for most of it anyway since even the low deductible plans have a deductible of like $500/person or $1000 or $1500 a family anyway (numbers from memory and could be off by hundreds of $) and so we with a normal "maintenance plan" type health plan, we would be paying hundreds of dollars in premiums each month and end up paying most of our medical anyway due to deductible, even when low compared to our catastrophic plan.

So yes, for most people, the catastrophic type high deductible plan with payments into an HSA make way more sense than the normal copay/low deductible/high premium plans you normally see and people are used to. Even those times we hit the deductible or otherwise had very large medical expenses compared to normal, I figured out we broke even more or less once I subtracted out the savings we have monthly on premiums and then compared what was left with the high priced / low deductible plans deductible anyway.

I am convinced that the healthcare costs in the country would go drastically down if most people adopted a high deductible plan and HSA instead of the low deductible high premium plan they have now. Especially if things could be streamlined where they could avoid having to submit the claims to the insurance company first and just bill you the insurance rate up front and you pay it from the HSA and get a receipt, that you can use later if you need to by getting up to the deductible.

chadbag

08-23-11, 01:22

My wife has two kinds of insurance and my kids have insurance. Just not me.

You are more than paying for a high deductible catastrophic plan for yourself with this one incident.

Take this as a lesson and go find yourself a high deductible, catastrophic plan and pair it with an HSA. (Better yet, see if you can get something for the whole family that you can roll your other wife and kid plans into)

Next time this happens, your bill will probably be 1/2 or less (my whole broken ankle with ER visit, drugs, CT scan, many Xrays, physician bills from ER visit, doctors office followups, plus same-day surgery at the hospital, so more physician, anesthesiologist, drug, xray tech, and hospital OR fees, plus medical appliances (crutches, big boot thing) etc. cost me about $2850 or so, not including PT rehab, and the insurance company ended up paying a couple thousand I think, since we hit the deductible AND The max out of pocket because of some other issues in the same year. All $2850 came out of our HSA which had money in it that we saved instead of paying for high priced low deductible insurance)

(The PT rehab was a good deal as well. I had 22 visits at $20 a visit without insurance involvement because this office was not signed up with this insurance company, though their main office was, so they agreed to see me for just what a normal co-pay would have been -- they offered to see me for just the co-pay and I explained I did not have a co-pay on my insurance [it is strict 20%/80% after deductible until you hit max out of pocket] so we agreed to the $20 average co-pay)

What my pontification comes down to: go get yourself on a catastrophic type plan and you will probably end up saving money in the long run since you get the lowered insurance negotiated rates and if you have a real catastrophe, you get coverage once it gets ridiculously priced. This one bill of yours would probably have been enough less to pay for such a plan, ie, it probably would have paid for itself on this one trip.

Sensei

08-23-11, 01:28

Excellent explanation for those who don't know what EMTALA means. I would only add that after our ED docs diagnose and provide initial stabilization, those of us who deal with emergent conditions are not in position to provide a price list with projected survival rates depending of extent of medical care chosen by a patient. We're legally obligated to provide an accepted standard of care irrespective of ability to pay; in my case, under the pressure of ticking clock. I've been doing what I do for a few years now and I am yet to see a patient who asked to see a menu for a heart attack treatment.

Good point. I get a few patients asking me how much something will cost. This often happens when people with potentially serious symptoms (i.e. chest pain) and need a significant number of tests or observation admission. Only the hospital financial aid counselor (who works bankers hours) has access to this information on the spot.

On a related note, there is a growing trend where emergency departments provide a medical screening exam, and require a co-pay or flat fee if the problem does not meet the emergent criteria. This has taken hold in some busy ERs where a physician is placed in triage or at the entrance podium to see everyone as they enter to better identify subtle presentations of serious illness and reduce the number of people who elope from the waiting room without being seen. If the patient has trivial symptoms (such as dental pain, uncomplicated back pain, common cold, or ankle sprain), the physician can perform a quick screening exam to rule out serious conditions and then require payment for any further treatment since a reasonable exam failed to find a serious illness. Usually, the fee is about $250.

This can be an effective tool to redirect non-emergent patients to less expensive venues for their care. Not surprisingly, this strategy is most effective for the Medicaid patients who represent the largest growth in ER volumes. These Medicaid patients have no co-pay and get no bill for their ER services. They have every incentive to use the ER which will generally see them quickly rather that wait a week for a primary care appointment. Unfortunately, very few places are doing this due to a variety of liability and public relations concerns.

VooDoo6Actual

08-23-11, 09:16

imo, the bigger picture & bottom line is it's about control & ingress to RFID chipping that they want to do for control/tracking/monitoring. That is the end game make no mistake regarding the intention or direction under the guise & curtain of your welfare etc. The rest is all Political Prestidigitaion & drama all purposely done at a high rate of speed currently.

Make no mistake, the Wolf is at the door.

Hmac

08-23-11, 09:59

VooDoo6Actual

08-23-11, 10:04

Hmac writes: Huh? Who wants to do RFID chipping?

It's all there hidden in the contents of bill etc. It's purposely obtuse & vague. Of course most people today are Zombies and not paying attention. The dumbing down of our society. People would rather watch Ray Jay, Basketball Wives, Housewives of Whatever shithole etc.

If you actually take some time to watch people going about their lives most have no clue. Sad in reality. Interesting times ahead count on it.

H.R. 3200 section 2521, Pg. 1001, paragraph 1.
The Secretary shall establish a national medical device registry (in this subsection referred to as the ‘registry’) to facilitate analysis of postmarket safety and outcomes data on each device that— ‘‘is or has been used in or on a patient; ‘‘and is— ‘‘a class III device; or ‘‘a class II device that is implantable, life-supporting, or life-sustaining.”

What exactly is a class II device that is implantable? As you saw earlier, it is the device approved by the FDA in 2004.

Federal Food, Drug, and Cosmetic Act:
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuid…

Medical devices incorporating RFID
In 2004, the FDA authorized marketing of two different types of medical devices that incorporate radio-frequency identification, or RFID. The first type is the SurgiChip tag, an external surgical marker that is intended to minimize the likelihood of wrong-site, wrong-procedure and wrong-patient surgeries. The tag consists of a label with passive transponder, along with a printer, an encoder and a RFID reader. The tag is labeled and encoded with the patient's name and the details of the planned surgery, and then placed in the patient's chart. On the day of surgery, the adhesive-backed tag is placed on the patient's body near the surgical site. In the operating room the tag is scanned and the information is verified with the patient's chart. Just before surgery, the tag is removed and placed back in the chart.

The second type of RFID medical device is the implantable radiofrequency transponder system for patient identification and health information. One example of this type of medical device is the VeriChip, which includes a passive implanted transponder, inserter and scanner. The chip stores a unique electronic identification code that can be used to access patient identification and corresponding health information in a database. The chip itself does not store health information or a patient's name.

http://www.knowthelies.com/?q=node/4880

Surely you can't be that naive to think that that will not be modified/ratified by an Executive Order or Super Congress ?