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

danarhea

danarhea

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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"On the Record with Greta Van Sustren" last night, Pawlenty said the federal law that mandates ER treatment should be repealed.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."
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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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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.
Click to expand...

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.
 
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.
 
danarhea said:
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?
Click to expand...

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.
 
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.
 
danarhea said:
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].
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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.
 
CrusaderRabbit08 said:
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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If hospitals were allowed to turn away non-emergency cases, I can easily see capitalism stepping into the void and filling it.
 
Catz Part Deux said:
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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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?
 
megaprogman said:
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.
Click to expand...

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 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.
 
Catz Part Deux said:
If hospitals were allowed to turn away non-emergency cases, I can easily see capitalism stepping into the void and filling it.
Click to expand...

Why wasn't that done before ER's were forced into this?
 
lizzie said:
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.
Click to expand...
There have been several urgent care facilities open in my area in the last few years and I believe they take some of the load off of emergency rooms, but not all.

They take cash, credit cards or insurance. Problem is, if one doesn't have cash, credit card or insurance they go to the emergency room and wait until they're seen.

The thing is we're not going to turn away an injured or ill person just because they have no money.
 
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.
Click to expand...


Mandating that hospitals accept cases where they can't determine whether the "customer" can actually pay for treatment is "tak[ing] money from peoples' pockets without their consent". When some of those people can't pay, the hospital makes up for it by overcharging others who can.

I don't think anyone here would accept the government mandating a shop to hand over goods to customers without being satisfied that they can pay. If hospital is a private business, it should be able to make sales decisions without coercion from the government such as the ER law.
 
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megaprogman said:
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.
Click to expand...

= Number of lawsuits ^ + malpractice insurance premium ^ + Doctors would be too scared of being sued if the person being turned away turn out to have something serious.
 
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Catz Part Deux said:
If hospitals were allowed to turn away non-emergency cases, I can easily see capitalism stepping into the void and filling it.
Click to expand...

And how do you see this happening? What will fill the void? Because in my experience, nothing replaces government provided free health care for the poor. If they can't pay, no private hospital will accept them. When the public hospital which is already under-equipped (and basically a lab for new medical students) turn them away, they take the person home to die.
 
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nonpareil said:
When the public hospital which is already under-equipped (and basically a lab for new medical students) turn them away, they take the person home to die.
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We not talking about emergency or critical cases here. It's the cases that should be in the clincs that are the issue.
 
nonpareil said:
Mandating that hospitals accept cases where they can't determine whether the "customer" can actually pay for treatment is "tak[ing] money from peoples' pockets without their consent". When some of those people can't pay, the hospital makes up for it by overcharging others who can.

I don't think anyone here would accept the government mandating a shop to hand over goods to customers without being satisfied that they can pay. If hospital is a private business, it should be able to make sales decisions without coercion from the government such as the ER law.
Click to expand...

Lives are generally considered to be more important than money. But for non emergency cases, people should be encouraged to use less expensive treatment methods, such as the county health department or some other public clinic if they are unable to pay a private practitioner.
 
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megaprogman said:
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.
Click to expand...

Those are some great ideas.

:thumbs:
 
megaprogman said:
Lives are generally considered to be more important than money. But for non emergency cases, people should be encouraged to use less expensive treatment methods, such as the county health department or some other public clinic if they are unable to pay a private practitioner.
Click to expand...

That doesn't solve the problem for after hours treatment. Not every non emergency can wait 12+ hours for the doctor's office to open. We need some type of after hours program to take the burden off the ER's.
 
danarhea said:
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?
Click to expand...

As a good number don't pay, what market caters to that customer base? Also, why hasn't the market done so already, as they know poorer people are seeking care? The need is there no matter what the ER's do.
 
danarhea said:
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?
Click to expand...

The hospitals themselves would likely fill the void if they knew they could turn patients away from the ER and charge a sliding fee.
 
CrusaderRabbit08 said:
Why wasn't that done before ER's were forced into this?
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I will have to check, but I don't think they are forced to take non-emergencies. I think they are just filling a need.
 
Boo Radley said:
I will have to check, but I don't think they are forced to take non-emergencies. I think they are just filling a need.
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They aren't; but in order to determine that, they'll waste time and money examining the patient.

Also, an earache isn't an emergency; but do you sending a screaming 2-yo old home without treatment telling mom to see her doctor in the morning?
 
CrusaderRabbit08 said:
They aren't; but in order to determine that, they'll waste time and money examining the patient.

Also, an earache isn't an emergency; but do you sending a screaming 2-yo old home without treatment telling mom to see her doctor in the morning?
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That's true. However, many hospitals have opened other screening avenues. And once the determination has been made, can begin discussions about cost, removing the patient from the ER, and making other judgments.

But as noted before, these conditions have existed long before federal legislation to cover emergency treatment and to this day. I don't understand why anyone would think the market would all of the sudden address it.
 
Boo Radley said:
That's true. However, many hospitals have opened other screening avenues. And once the determination has been made, can begin discussions about cost, removing the patient from the ER, and making other judgments.

But as noted before, these conditions have existed long before federal legislation to cover emergency treatment and to this day. I don't understand why anyone would think the market would all of the sudden address it.
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My hospital has after hours clinics. They stay open until about 1am or 2am.

I don't see the market addressing it either.

However it's handled, an after hours program is needed. EMTALA is an unfunded mandate and an unfair burden that's being forced upon on our healthcare system.
 
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