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

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

    Emergency rooms should be able to turn patients away to cut costs, Minnesota Gov. Tim Pawlenty (R-Minn.) said last night

    Appearing on Fox News's "On the Record with Greta Van Sustren" last night, Pawlenty said the federal law that mandates ER treatment should be repealed.

    "Well, for one thing you could do is change the federal law so that not every ER is required to treat everybody who comes in the door, even if they have a minor condition," Pawlenty said. "They should be -- if you have a minor condition, instead of being at the really expensive ER, you should be at the primary care clinic."
    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.
    Last edited by danarhea; 02-25-10 at 08:03 AM.
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    Re: Pawlenty: Let ER's turn away patients to cut costs

    Quote Originally Posted by danarhea View Post
    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.
    The only thing that I can really think of that would allow this is if we start having more clinics that are separate from hospitals to treat for minor conditions. People would pay for the care they get at the clinic and do so separately from the care they get at the hospital. That way, a clinic would be built and designed around providing emergency care and minor care. Should a patient require more involved treatment, then they can then be taken to a hospital.

    On the other hand, this doesn't really address the costs of treatment - it just shifts the burden of the costs from the hospital to the clinic. On the whole, I'd prefer public option plans run by the states. I think we should let the states compete for providing health care to their citizens and have it paid for by taxes. Maybe a lump sum in federal revenue should be given to the states but mandated that money be spent in the state health care system.

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

    Having been to the emergency room at least 15 or 20 times in my life and 4 times last year I know a little bit about how they work.

    The triage system evaluates treatment based most in need and likely hood of benefiting and recovering from immediate treatment.

    This is the time people with a minor condition such as a splinter or other problem treatable at home should be given instructions on how to deal with the issue and sent on their merry way. Those people are the ones who find they get to wait hours and hours for a band aid.

    If you show up with shortness of breath and chest pains your wait will be less than a few minutes guaranteed. I know this for a fact.

    But you still have the issue of what happens when the person who decides who is really in need makes a mistake and sends the wrong person away. Many problems that appear to be minor on the surface can be complicated by problems that are not readily visible at a certain point in time.

    In that case the cost to the hospital is going to be very high indeed.

    Pawlenty has an idea I just don't see it as the cure to high costs, and the current plans under consideration as I have said over and over fail to address the real issues at all.

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

    Quote Originally Posted by danarhea View Post
    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?
    Is it really taking money without our consent? After all; if enacted into law, it was with our consent.

    The cheaper option is to establish after-hours urgent care clinics.

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

    Actually, it may not be a bad idea to give the doctor or nurse the ability to look at a case and say "this can wait until you go to your family doctor, it is not something that needs to be treated right now."

    Or maybe another way to approach this would be "here's a $1000 surcharge for wasting our time and insurance won't cover it." fee.

    Whatever the method is, I wouldn't mind if emergency rooms had the ability to turn away minor cases. However, it means that it will fall on the facilities to ensure accuracy in their diagnosis.

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

    Quote Originally Posted by danarhea View Post
    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? [/URL].
    Creating low cost preventive care health clinics that do not require health insurance. Most health departments offer these but they are strictly limited on the basis of income and usually have long wait times to be seen. Hospitals should be let off the hook for treating patients with non-emergencies, and a system of referrals to existing clinics should be expanded and utilized.

    I mean, for real, most cities have doc in a box clinics that people can go to where treatment is not super expensive. People go to the ER, instead, because it's free.

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

    Quote Originally Posted by CrusaderRabbit08 View Post
    Is it really taking money without our consent? After all; if enacted into law, it was with our consent.

    The cheaper option is to establish after-hours urgent care clinics.
    If hospitals were allowed to turn away non-emergency cases, I can easily see capitalism stepping into the void and filling it.

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

    Quote Originally Posted by Catz Part Deux View Post
    If hospitals were allowed to turn away non-emergency cases, I can easily see capitalism stepping into the void and filling it.
    True that, but there would be a gap in between hospitals ceasing to treat non emergencies and the market filling the void. What do we do in the meantime?
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    Re: Pawlenty: Let ER's turn away patients to cut costs

    Quote Originally Posted by megaprogman View Post
    Actually, it may not be a bad idea to give the doctor or nurse the ability to look at a case and say "this can wait until you go to your family doctor, it is not something that needs to be treated right now."

    Or maybe another way to approach this would be "here's a $1000 surcharge for wasting our time and insurance won't cover it." fee.

    Whatever the method is, I wouldn't mind if emergency rooms had the ability to turn away minor cases. However, it means that it will fall on the facilities to ensure accuracy in their diagnosis.
    I tend to agree, but the vast minority of incorrect triage will cause law suits and potentially put the hospital out of business. Take for example my neighbor:

    55 year old white male, truck driver, smoker but in relatively good health. Has chest pains during the night and indigestion. In the morning he sees his general practitioner who does a full check-up, EKG, blood work, etc. The Dr. sends him home with a referral to a cardiologist, but nothing significant is found on the EKG or through the Dr's. review. The Dr. tells him to go to the hospital or call 911 if it gets worse or more painful and makes the appointment with the cardiologist to be safe, within 2 days. He goes home, and within 2 hours, has a massive heart attack and dies on his kitchen floor, and is found 3 hours later by his daughter coming home from school.

    In the case where the hospital turns away minor issue which may look like a virus, but turns out to be spinal meningitis - or turns away a mild case of indigestion and it turns out it was a major cardiopulmonary and the person dies or infects others, or whatever --- law suits will be flying and tort reform be damned.

    Bottom line - hospitals cannot afford to turn away minor cases because a minuscule amount of cases will not be minor - mistakes will happen, and hospitals will be sued out of existence. Therefore, treat everyone ... and we still have the same issues around cost. If the hospital can send the person to a clinic or to a 24/7 doctors office instead of sending them home or providing a referral, that may be an alternative solution.
    I think if Thomas Jefferson were looking down, the author of the Bill of Rights, on whats being proposed here, hed agree with it. He would agree that the First Amendment cannot be absolute. - Chuck Schumer (D). Yet, Madison and Mason wrote the Bill of Rights, according to Sheila Jackson Lee, 400 years ago. Yup, it's a fact.


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

    I used to to work in a hospital that did employ this to a certain degree. When a patient came in the ER and their malady was not an emergency, they were asked to pay a fee up front. The patients were triaged, a social worker was consulted, and it stopped alot of the clinic traffic in the emergency room. There are many minor emergency clinics where you can be seen for much less than a hospital emergency room, where the base cost is about 250 dollars, as opposed to 50-75 dollars for a minor emergency clinic.
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