Pawlenty: Let ER's turn away patients to cut costs

Vader said:

Many doctors are very right wing and go out of their way to charge exessive fees. At one point and time there were to rates for medical services (a) Insurance rate; and (b) cash rate (which was usually less than the former).

Doctors did nothing when the insurance companies lobbied for laws that made this process illegal (because people were paying a cheaper cash price and they didn't like that.)

Some doctors charge $600.00 FOR A SINGLE OFFICE VISIT. This is bull****. It's excessive and it shows a lack of regard for the common working man. It makes care prohibitively expensive.

Doctors in this group deserve no mercy. Doctors in the other group do not usually find themselves on the receiving end of a lawsuit.

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Your anger is obviously misguided. Physician rates increase due to decreasing reimbursements from Medicare/Medicaid (by the way we're taking another 21.1% cut in these rates in two weeks). M/M is a government run entity, and if this is what we have to look forward to than we've got some serious problems ahead in terms of viability of healthcare in this country.
Malpractice insurance premiums are up 60% since 2000.

Right there: government and lawyers. To primary causes of healthcare cost increase. If physicians solely practiced medicine with patients covered by medicare/medicaid, they would be unable to pay office overhead and malpractice insurance and then take enough home as salary amounting to more than minimum wage base on a 50 hr work week. Just for reference, I work between 70 and 90 hours a week.

I agree, physician fees have gone up, but take home salary has dropped precipitously over the last 10 years. i.e. we make substantially less. However, payouts gained by plaintiffs in frivolous litigation has never been higher.

As a Minnesotan I would like to apologize for Pawlenty. We're not really sure how that asshole got into office.

Deuce said:

As a Minnesotan I would like to apologize for Pawlenty. We're not really sure how that asshole got into office.

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I would rather that you apologize for Al Franken. :tongue4:

Now back to the main topic . . .

ER visits aren't just costly to hospitals. They are also costly to patients. So, if there is a cheaper alternative to an ER, then why not direct non-emergency cases to the alternative?

Goyboy said:

I would rather that you apologize for Al Franken. :tongue4:

Now back to the main topic . . .

ER visits aren't just costly to hospitals. They are also costly to patients. So, if there is a cheaper alternative to an ER, then why not direct non-emergency cases to the alternative?

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Exactly.

The ER should be steered from and left free to deal with serious emergencies - if a patient that was directed to the neighboring walk-in clinic turns out to be an emergency then the ER is right next door to readmit quickly.

It should be In = paperwork, check you in = analyze you = directed to emergency or non-emergency area as needed.

Aunt Spiker said:

Exactly.

The ER should be steered from and left free to deal with serious emergencies - if a patient that was directed to the neighboring walk-in clinic turns out to be an emergency then the ER is right next door to readmit quickly.

It should be In = paperwork, check you in = analyze you = directed to emergency or non-emergency area as needed.

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Yep, exactly what they're doing at Michelle Obama's hospital - but because it's Michelle Obama's hospital, it's socialist patient-dumping death panels or whatever.

DiavoTheMiavo said:

I can see it too. A form of capitalism that would have lawyers camped out in ER parking lots trying to stir up malpractice law suits. Until poor people stop using the ER as a clinic, turning folks away would be a lawsuit waiting to happen.

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I disagree, there are plenty of "Doc in the Box" facilities around the U.S. that will happily serve these patients, and if they were being turned away from the E.R. to a clinic located in or near the hospital, the patients would likely use it.

misterman said:

Yep, exactly what they're doing at Michelle Obama's hospital - but because it's Michelle Obama's hospital, it's socialist patient-dumping death panels or whatever.

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I never understood the whole 'death panel' thing (why the comment was made and why people jumped on it like they did) - I've rallied for years that the ER shouldn't be stuck between a rock and a hard place because they are required by LAW to see every patient that comes in the door - they're not allowed to turned anyone away for any reason.

They're currently not even allowed to redirect someone to the walkin clinic even if it's just right next door, I don't think - if you GO to the ER you must be SEEN by the ER, which is bull****.

My mom works at a Children's Hospital and people complain all the time. . .this following quote is actually from an old review that was listed on yellow pages - it's since been bumped off the review list by several positive reviews that were posted after it, but it roiled my blood - I took personal offense and save it on my computer for this exact debate purpose.

ER & clinic lacks quality care‎ - Mary M.‎ - Jul 26, 2008
I have taken my kids to the clinic for ear aches or sinus infections and it takes forever to get in and out. They are sooo slow. I was not impressed by the ER doctors or care ...‎

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See - she took her children numerous times for non-emergencies and then has the balls to wonder WHY they had to wait to be seen!

This particular Children's hospital DOES have a walk-in non-emergency clinic. It's open 24/7 - I've taken the kids to it countless time. THAT is where she should take her children, you have to call ahead for an appointment but it is the place to go for adequate non-emergency care.

However, the ER cannot send patients next door, it's illegal.

It's bull****. The ER shouldn't be overburdened by sniffy noses and gooey eyes. That's what regular doctors and walk-in clinics ARE for.

Aunt Spiker said:

I never understood the whole 'death panel' thing (why the comment was made and why people jumped on it like they did) - I've rallied for years that the ER shouldn't be stuck between a rock and a hard place because they are required by LAW to see every patient that comes in the door - they're not allowed to turned anyone away for any reason.

They're currently not even allowed to redirect someone to the walkin clinic even if it's just right next door, I don't think - if you GO to the ER you must be SEEN by the ER, which is bull****.

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Could be a liability thing. What if it really was an emergency?

The ER people should be able to check a patient and THEN send them away after they determine they belong somewhere else.

misterman said:

Could be a liability thing. What if it really was an emergency?

The ER people should be able to check a patient and THEN send them away after they determine they belong somewhere else.

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That's where tort reform comes in. A lot of people are sent to the ER unnecessarily by doctors in a game of liability CYA.

Goyboy said:

I would rather that you apologize for Al Franken. :tongue4:

Now back to the main topic . . .

ER visits aren't just costly to hospitals. They are also costly to patients. So, if there is a cheaper alternative to an ER, then why not direct non-emergency cases to the alternative?

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No law requires them to treat them in the ER. So, they could redirect. However, many who are there wouldn't be there if they could pay, even a cheaper alternative. So, this about the ER actually meeting a need not provided by the market in any other venue. And there's no reason to think the market ever will. Remember, this isn't new. The problem was there even before laws that ERs couldn't turn away emergencies.

I wonder how effective it would be if the nurse told the patient "If you get your hurt finger treated at the emergency room, it will cost X, but if you go to this cheaper clinic, it will cost Y".

megaprogman said:

I wonder how effective it would be if the nurse told the patient "If you get your hurt finger treated at the emergency room, it will cost X, but if you go to this cheaper clinic, it will cost Y".

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If I'm not paying for it, wouldn't mean much.

misterman said:

Could be a liability thing. What if it really was an emergency?

The ER people should be able to check a patient and THEN send them away after they determine they belong somewhere else.

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That's the point - the current system is the problem ,there is not indepth adequate triage at most ER's. A few nurses are on staff to manage the incoming patients - but they ALL must be admitted to the ER even after they've determined their lives are not at stake at the moment.

Shadowfax8 said:

Your anger is obviously misguided. Physician rates increase due to decreasing reimbursements from Medicare/Medicaid (by the way we're taking another 21.1% cut in these rates in two weeks). M/M is a government run entity, and if this is what we have to look forward to than we've got some serious problems ahead in terms of viability of healthcare in this country.
Malpractice insurance premiums are up 60% since 2000.

Right there: government and lawyers. To primary causes of healthcare cost increase. If physicians solely practiced medicine with patients covered by medicare/medicaid, they would be unable to pay office overhead and malpractice insurance and then take enough home as salary amounting to more than minimum wage base on a 50 hr work week. Just for reference, I work between 70 and 90 hours a week.

I agree, physician fees have gone up, but take home salary has dropped precipitously over the last 10 years. i.e. we make substantially less. However, payouts gained by plaintiffs in frivolous litigation has never been higher.

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Don't take it personally, Vader tends to label everyone/thing that he doesn't like as fascist/reich-wing/evil.

Thanks for your contributions on this - it's always useful to have a physician's perspective on the topic. Welcome to DP! :2wave:

Shadowfax8 said:

Your anger is obviously misguided. Physician rates increase due to decreasing reimbursements from Medicare/Medicaid (by the way we're taking another 21.1% cut in these rates in two weeks). M/M is a government run entity, and if this is what we have to look forward to than we've got some serious problems ahead in terms of viability of healthcare in this country.
Malpractice insurance premiums are up 60% since 2000.

Right there: government and lawyers. To primary causes of healthcare cost increase. If physicians solely practiced medicine with patients covered by medicare/medicaid, they would be unable to pay office overhead and malpractice insurance and then take enough home as salary amounting to more than minimum wage base on a 50 hr work week. Just for reference, I work between 70 and 90 hours a week.

I agree, physician fees have gone up, but take home salary has dropped precipitously over the last 10 years. i.e. we make substantially less. However, payouts gained by plaintiffs in frivolous litigation has never been higher.

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This is a very good point.
Medicaid in my state only use to reimburse 15% of the actual cost for my children's dental visits (as just one example - that was 10 years ago).

15% isn't even enough to cover the cost of the fluoride, Novocaine or toothpaste used during the appointment. . . add to that exrays and other things ususally done at a checkup.

Not to forget that medicaid/care doesn't cover some procedures. My oldest son was born with a periodontal disease and medicaid refused to cover any part of his surgery. The overall cost for the procedure was over $5,000 and the hospital was nice enough to actually write it off.

Yes, it's true that medicare reimbursements are a problem, but so are insurance reimbursements. Take my recent colonoscopy. The procedure would be covered, as long as they didn't find anything. So, the doctor does it, and if he had found something, the cost would still be there, and it would be more than I could cough up, so he eats it because I need more care?

Doctors also complain about insurance company for this.

As for tort reform, haven't states already done this? And has tort reform actually not lowered costs? Doctors over test not just because of fear of being sued, but because we tend to want tests. I often tell the doctor no to tests I don't think are important, but he tells me most want the tests. Consumer based systems would tend to want to please the consumer.

Boo Radley said:

Yes, it's true that medicare reimbursements are a problem, but so are insurance reimbursements. Take my recent colonoscopy. The procedure would be covered, as long as they didn't find anything. So, the doctor does it, and if he had found something, the cost would still be there, and it would be more than I could cough up, so he eats it because I need more care?

Doctors also complain about insurance company for this.

As for tort reform, haven't states already done this? And has tort reform actually not lowered costs? Doctors over test not just because of fear of being sued, but because we tend to want tests. I often tell the doctor no to tests I don't think are important, but he tells me most want the tests. Consumer based systems would tend to want to please the consumer.

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:rofl @ the inanity of the insurance companies and their nerve to continue their bull**** practices - claiming that their menial 3% profit is acceptable.

What on EARTH is up with that crap? "We'll ONLY cover it if they don't find anything WRONG" - then what's the point of having the procedure done for assessment to begin with?

If they are just going to stiff you with the bill then they should just stiff you with it rather than pretending they're going to cover you.

danarhea said:

Before anybody starts making statements about Pawlenty being a heartless Conservative, let's set the ground rules for this discussion, and get it straight on what Pawlenty proposes. He is talking about minor medical conditions, which are not emergencies.

1) In that context, I don't see Pawlenty's proposal as heartless, but as a realistic idea. Emergency room care for minor conditions is one of the things that his bankrupting our medical care system.

2) But is Pawlenty's "realistic" idea actually realistic? I don't think so. Minor medical conditions frequently lead to major hospitalizations. So what is the better way to cut costs in the medical system? Turn away minor conditions, to have people admitted to hospitals for long and very expensive stays? Or to keep things as they are, and treat those minor conditions before they flare up and cost orders of magnitude more money? I believe that the second one is best, and ultimately more cost effective.

In the end, I don't see Pawlenty's proposal to be heartless at all. But I do see it to be poorly thought out, from an economic standpoint. Is there a third solution somewhere out there that we haven't looked at? Some would say that a public option would be that third option, but I disagree. Whatever solution we come up with must not take money from peoples' pockets without their consent. Or should it? If it does, then do we slide down the slippery slope to Socialism? If we do, then is this still America, or do we begin to say goodbye to a system of government that has has worked for more than 2 centuries?

These are all very perplexing questions, and I would like to hear some thought out answers from everybody on this issue. So, in regard to what I have posted, the discussion in this thread should be as follows:

Our health care system - Where do we go from here?

PLEASE - NO TROLLING. If you only come here to bash Bush, Obama, or anybody else, while not offering constructive ideas and / or constructive criticism, then please leave this thread, and do not post. I will be asking moderators to thread ban those who do not stick to the topic at hand, and the discussion on it, along with those who display disruptive behavior.

Article is here.

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My $0.02

Hawaii has a good plan. Theirs covers everyone at the expense of the tax-payer. I'm a fan because it keeps a social service within the realm of state governments (as mandated by the Constitution.) I wouldn't mind having states move in that general direction. Have an organization that sits outside the realm of the federal government that is a partnership among all these states.

Boo Radley said:

Take my recent colonoscopy. The procedure would be covered, as long as they didn't find anything.

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What? I've never heard of this and it doesn't seem to make much sense.

Boo Radley said:

As for tort reform, haven't states already done this? And has tort reform actually not lowered costs? Doctors over test not just because of fear of being sued, but because we tend to want tests. I often tell the doctor no to tests I don't think are important, but he tells me most want the tests. Consumer based systems would tend to want to please the consumer.

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Have states already do this? Well, that depends. Has there been meaningful reform with regards to malpractice litigation? I have yet to see a state take this reform seriously. While there have been "caps" placed on litigation claims falling under certain guidelines, there are enough loopholes in these caps that a motivated attorney can easily seek claims as if the tort reform had never been implemented. And why wouldn't an attorney be motivated when most insurance companies settle without trial regardless of the claim unless the policy includes "right to waive" on the physician's behalf (which the physician pays more for).
As a physician, at the very least I would like to see legislation implemented allowing a physician to recover defense fees and claims in lost income due to defense against suit if he is found not guilty. Therefore, the physician is more inclined to defend himself, and less likely to face litigation due to a plaintiff whose out to take advantage of the fact that most insurance companies settle regardless of the validity of the claim being made against the physician. Thus, patients with unintended outcomes due to physician negligence do not have to battle a cap to recover losses for the wrong extremity being amputated. And on the flip side, the physician is less likely to face frivolous suit... and if he does, he/she has the means to recover loss funds due to defense and lost income.

Boo Radley said:

Take my recent colonoscopy.

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No thanks, you keep it.

Shadowfax8 said:

Have states already do this? Well, that depends. Has there been meaningful reform with regards to malpractice litigation? I have yet to see a state take this reform seriously. While there have been "caps" placed on litigation claims falling under certain guidelines, there are enough loopholes in these caps that a motivated attorney can easily seek claims as if the tort reform had never been implemented. And why wouldn't an attorney be motivated when most insurance companies settle without trial regardless of the claim unless the policy includes "right to waive" on the physician's behalf (which the physician pays more for).
As a physician, at the very least I would like to see legislation implemented allowing a physician to recover defense fees and claims in lost income due to defense against suit if he is found not guilty. Therefore, the physician is more inclined to defend himself, and less likely to face litigation due to a plaintiff whose out to take advantage of the fact that most insurance companies settle regardless of the validity of the claim being made against the physician. Thus, patients with unintended outcomes due to physician negligence do not have to battle a cap to recover losses for the wrong extremity being amputated. And on the flip side, the physician is less likely to face frivolous suit... and if he does, he/she has the means to recover loss funds due to defense and lost income.

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While pundits and reform opponents rail against malpractice lawsuits, they are only a symptom of the illness: medical malpractice. According to the Institute of Medicine, as many as 98,000 patients die each year due to preventable medical errors, at a cost of $29 billion. And that doesn't include patients who are seriously injured by medical errors.

The Congressional Budget Office has concluded that the most dramatic proposed changes to tort law would cut health-care costs by only 0.5 percent. Meanwhile, they could worsen care and patient outcomes.

The savings would be paltry partly because medical negligence claims make up less than 1 percent of the nation's civil caseload. And researchers at Harvard found that 97 percent of cases involved verifiable medical injuries, debunking the idea that many suits are "frivolous." Restricting the rights of injured patients when medical negligence is so common would be at odds with the obvious need for higher-quality health care.

Furthermore, the current health-care proposals already address medical malpractice. Both the House and Senate bills offer incentives to states to initiate pilot projects focusing on medical negligence and patient safety. President Obama has directed the Department of Health and Human Services to launch similar projects.

Tort reform is a distraction | Philadelphia Inquirer | 03/04/2010

Since the 2005 reforms in Missouri, malpractice premiums at Hagen's practice have fallen 24 percent -- a decline he attributes to the reforms. Reintjes said his premiums have declined 30 percent.

But -- and here's where the debate gets sticky -- overall health care costs in Missouri continue to rise. The same is true in states that have enacted even more stringent tort reforms, such as Texas.

Which suggests that a tort system run amok is, at best, only a small contributor to the nation's health care costs.

Would tort reform make much difference in health care costs? Probably not: Analysis | National News - cleveland.com - cleveland.com

So show where trot reform has actually lowered costs.

RightinNYC said:

What? I've never heard of this and it doesn't seem to make much sense.

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That's exactly what I said to them. When we met with a representative, one employee quipped, I get it. It's good insurance if we don't need. Not worth a crap if we do.

Boo Radley said:

While pundits and reform opponents rail against malpractice lawsuits, they are only a symptom of the illness: medical malpractice. According to the Institute of Medicine, as many as 98,000 patients die each year due to preventable medical errors, at a cost of $29 billion. And that doesn't include patients who are seriously injured by medical errors.

The Congressional Budget Office has concluded that the most dramatic proposed changes to tort law would cut health-care costs by only 0.5 percent. Meanwhile, they could worsen care and patient outcomes.

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First off, you're copy pasting from the president of the "American Association for Justice," which is a plaintiff lawyer's advocacy group. It's like relying on the head of Phillip Morris for info about tobacco.

Second, 0.5 percent of $2.3 Trillion is a ****load of money.

Third, it's only 0.5% becase the tort reform that the CBO is looking at only deals with caps on pain and suffering, which doesn't really deal with the underlying issue. A program that enacted comprehensive reform of the entire process by which medical malpractice is addressed would have far greater effects.

http://perspectives.thirdway.org/?p=678

On the policy, “defensive medicine” now consumes 4 percent to 9 percent of the nation’s total health care spending. That translates to between roughly $92 billion and $207 billion annually that is wasted on unnecessary tests and procedures that doctors perform simply to avoid the threat of a lawsuit. Eliminating just half of this waste would be enough to cover all uninsured Americans.

...

By contrast, there is little about the current medical malpractice system that works. Only 2 percent of people injured by medical errors file a claim for compensation. The few winners must wait three to five years to see the money. More than half of it is siphoned off to attorney fees and court costs.

Democrats, however, often raise one major objection: caps on awards to injured patients. But they need not, nor should they, support this conservative idea as studies show that caps do little to reduce defensive medicine in the states where they have been enacted, according to the Congressional Budget Office.

Instead, Democrats should propose a health court, which can serve as the backbone for fundamental malpractice reform. A health court is a specialized system of courts similar to the workers’ compensation system that would handle only medical malpractice cases. Injured patients would simply fill out a form to receive compensation for common injuries. Disputes would be quickly handled in an administrative court run by medical experts, who would ensure that the same standards of practice are applied to all similarly situated patients. They would be able to reach many more patients who are deserving of compensation. And like workers’ compensation, the rewards would be fair and predictable.

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The savings would be paltry partly because medical negligence claims make up less than 1 percent of the nation's civil caseload.

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What does that have to do with anything? That's some of the worst logic I've ever heard, although it's fairly typical for a plaintiff's lawyer. That's like saying that murder isn't a big deal because it's only 1% of all crime.

Furthermore, the current health-care proposals already address medical malpractice. Both the House and Senate bills offer incentives to states to initiate pilot projects focusing on medical negligence and patient safety. President Obama has directed the Department of Health and Human Services to launch similar projects.

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The proposals direct the states to institute pilot programs and then provide a whopping $25 million to do so. Yea, real reform there.

Since the 2005 reforms in Missouri, malpractice premiums at Hagen's practice have fallen 24 percent -- a decline he attributes to the reforms. Reintjes said his premiums have declined 30 percent.

But -- and here's where the debate gets sticky -- overall health care costs in Missouri continue to rise. The same is true in states that have enacted even more stringent tort reforms, such as Texas.

Which suggests that a tort system run amok is, at best, only a small contributor to the nation's health care costs.

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That is just awful, awful logic. Wow. I just really don't know what to say about that.

Boo Radley said:

That's exactly what I said to them. When we met with a representative, one employee quipped, I get it. It's good insurance if we don't need. Not worth a crap if we do.

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No, I'm saying that the idea that the coverage for the test itself is predicated on the result doesn't make sense at all. No doctor that I've ever heard of would consent to perform such a test, since their receipt of payment could be conditioned on the outcome. That doesn't sound right.

On the site:
http://www.injuryboard.com/help-cen...d-the-effect-of-medical-malpractice-caps.aspx

I find this to be conflicting info...

"According to a recent article in the New York Times, physicians are flooding into Texas because of the state’s recent approval of a constitutional amendment limiting medical malpractice awards. Further, physicians noticed that the state of Texas experienced an average 21.3% decrease in medical malpractice insurance premiums during the four years following the tort reform legislation. "

Then on down the page it says...

"One report reveals that limitations on medical malpractice awards produced payout averages 15.7% lower than those of states without caps between 1991 and 2002. This statistic is true despite the fact that many of the states did not institute the limitations until near the end of the reporting period. Meanwhile, the median annual premium in states with caps increased an alarming 48.2%. Surprisingly, the median annual premium in states without caps increased more slowly: by 35.9%. In other words, the median medical malpractice insurance premiums were actually higher in states with caps. This is contrary to the goal of the limitations on medical malpractice awards."