80 people went to Dallas emergency rooms 5,139 times in a year

[Nice Guy Eddie 13529]

3 hours ago, TwiceHorn said:

It does appear that people that enter the system via ER never pay for medical care and are rarely if ever denied it.

Can a person receive treatment for a chronic disease, let's say diabetes or arthritis this way?  Crohn's?  Cancer?

Emergency depts are basically required to evaluate anyone seeking help.  If they accept Medicare at the hospital, they have to follow this rule. And all standard EDs accept Medicare.   Believe this is a law from the mid 80s.

The hospital has to examine the patient and determine if they are experiencing an emergency medical condition.  If they are, then the hospital must resolve or stabilize the patient.   I wouldn’t think cancer itself would be an emergent event.  

The patients ability to pay cannot be taken into consideration for any of the above. Sure the hospital is going to create a large bill for the patient, but they aren’t going to waste further resources trying to get the patient to pay the $5k bill.  Perhaps they might try to get a few bucks out the person at the time but once again it’s not worth chasing it.

overall this is a good rule for public health but it sucks how a small minority abuse the system.  Some pointed education to some of the abusers might help.  Or maybe not. 

[woohorn 1131]

What about all the crappy little strip center for-profit "ERs"? I know TX law requires an ambulance bay. Surely they aren't required to take indigents, are they?

[Bullneck 19230]

6 hours ago, Anastasis said:

300,000,000 > 80

 

One of the telltale signs of people who "don't get it" is over reliance on anecdotal information.

Edited May 29, 2019 by Bullneck

[UTGrad98 2282]

The answers to solving our healthcare cost crisis are ones that no one wants to say out loud.

[Guest]

nm

Edited May 29, 2019 by slorch

[Guest]

2 minutes ago, UTGrad98 said:

The answers to solving our healthcare cost crisis are ones that no one wants to say out loud.

Just have the folks who are working to pay more.

 

But funnel it through multiple agencies and providers so the actual benefit leveraged to raise taxes/ costs is so minuscule, it becomes trivial at best.

[SuingToGetAMessageBoard? 3861]

59 minutes ago, Bullneck said:

300,000,000 > 80

 

One of the telltale signs of people who "don't get it" is over reliance on anecdotal information.

We’re not saving the world.  We are trying to fix an overtaxed system. Those 80 people in Dallas are using the ER resources of, what, about 25,000 average people?  I’d be interested at seeing what level you’d have to get to before to thought it might be worth looking at. 

[Onboard 2.0 9083]

1 minute ago, SuingToGetAMessageBoard? said:

We’re not saving the world.  We are trying to fix an overtaxed system. Those 80 people in Dallas are using the ER resources of, what, about 25,000 average people?  I’d be interested at seeing what level you’d have to get to before to thought it might be worth looking at. 

And it's not just happening in Dallas. It's a nation wide issue, always has been.  It was one of the main things the ACA was supposed to curb to help reign in costs.

[Bigbend1812 12942]

10 hours ago, bschoolprof said:

pardon my ignorance, but he gets charged something for going to the ER, correct?  And he just doesn't pay these bills?  Can't they garnish your wages for unpaid medical bills?

Bwahahahahahahahahahahahahahha!

[TwiceHorn 31600]

Whether it statistically amounts to a problem or not, the whole thing is remarkable and unfathomable, both that people are so ignorant and that essentially lonely people would or could go to the ER every other day for a year.

[Anastasis 23469]

1 hour ago, Bullneck said:

300,000,000 > 80

 

One of the telltale signs of people who "don't get it" is over reliance on anecdotal information.

The observation that a small number of super utilizers disproportionately consume certain healthcare resources is not anecdotal.  It has been reproduced in a number of datasets and populations, large and small, and is generalizable to the broader population.  There is a whole body of research and programming targeting super utilizers.

 

[smuggs 9353]

10 hours ago, thestud said:

Dallas tried that about 6-7 years ago and it was going well until one of those system abusers called 9-1-1 and it was tagged as a low priority call. Turns out her motorized wheelchair was overheating. It ended up catching fire and she died in it. They had to pay some $ on that one

 

 

 

 

[Nice Guy Eddie 13529]

From reading the OPs story, you can see that social workers helped the guy, who has been quoted in this thread, find better healthcare resources than the ER.  The result was that his ER visits dropped dramatically.

you can never hope to fully eliminate people that abuse any service but with some work you can drastically lower it.  And putting in controls to prevent a small percentage of abusers could end up costing more than just accepting some of them will abuse it.

[Anastasis 23469]

1 minute ago, Nice Guy Eddie said:

And putting in controls to prevent a small percentage of abusers could end up costing more than just accepting some of them will abuse it.

The math, at a few grand per ER visit, easily supports high touch interventions targeting super utilizers. An effective program would cover both chronic diseases such as diabetes and cardiovascular disease as well as behavioral health comorbidities. That is the profile. 

[Bigbend1812 12942]

10 hours ago, TwiceHorn said:

 

Can a person receive treatment for a chronic disease, let's say diabetes or arthritis this way?  Crohn's?  Cancer?

Yes.   I see the same flunkies in the hospital every few weeks or months for the same chronic issues. They choose to not follow -up in the “free” clinic because the wait is too long.  Just go to the ER. 

[TwiceHorn 31600]

3 minutes ago, Bigbend1812 said:

Yes.   I see the same flunkies in the hospital every few weeks or months for the same chronic issues. They choose to not follow -up in the “free” clinic because the wait is too long.  Just go to the ER. 

Seems inconceivable that a wait could be longer anywhere other than the ER if you aren't exsanguinating or seizing.

[RollLeft 5045]

We should build a wall...

[Nivek 16997]

Not trying to be an ass, but I'm not seeing how that passage relates to white privilege or any privilege, except that Michael Johnson, 57 yo from Dallas, Tx might be dumber than Forrest Gump. It is surprising that he can rent a home working a fast food job.  Maybe he's a manager, but then how does he not know the first thing about how to access healthcare?  

For some people, having a job and paying bills is the best they can manage.

[Skipper 6210]

13 hours ago, thestud said:

 

 

Dallas tried that about 6-7 years ago and it was going well until one of those system abusers called 9-1-1 and it was tagged as a low priority call. Turns out her motorized wheelchair was overheating. It ended up catching fire and she died in it. They had to pay some $ on that one

 

 

If I was on a jury and defense showed long term systemic abuse of the 911 system by the 'victim', I would categorize it as play stupid games win stupid prizes.

[HRSchenker 2275]

None of this surprises me. We have a few frequent flier patients who use the emergency room as their primary care. Occasionally we'll have to deal with drug seekers and there are a few who go from ER to ER to ER getting their fix. One time when I was working near downtown Dallas I ran across a young woman who tried to fill at my store and when I pulled up her PMP report from the state it showed 30 prescriptions for tramadol in the last 30 days. She's going to the ER once a day, every day, for months at a time. It's just crazy.

I agree that these patients need some kind of punishment or just a way to be held accountable. If I go to the ER right now it's going to cost me my max out of pocket $7,500 plus a $150 ER deductible. Is this an educational barrier? Financial barrier?

[El Diablo 4232]

6 hours ago, Onboard 2.0 said:

And it's not just happening in Dallas. It's a nation wide issue, always has been.  It was one of the main things the ACA was supposed to curb to help reign in costs.

I think ACA is reigning in costs pretty well. Prolly king of costs.

[Anastasis 23469]

13 minutes ago, HRSchenker said:

None of this surprises me. We have a few frequent flier patients who use the emergency room as their primary care. Occasionally we'll have to deal with drug seekers and there are a few who go from ER to ER to ER getting their fix. One time when I was working near downtown Dallas I ran across a young woman who tried to fill at my store and when I pulled up her PMP report from the state it showed 30 prescriptions for tramadol in the last 30 days. She's going to the ER once a day, every day, for months at a time. It's just crazy.

 I agree that these patients need some kind of punishment or just a way to be held accountable. If I go to the ER right now it's going to cost me my max out of pocket $7,500 plus a $150 ER deductible. Is this an educational barrier? Financial barrier?

Do ER docs have access to the PMP system, or is that only at pharmacy point of sale? 

[Bama Chick 28596]

I work for a hospital and we just completed a $30 million brand new ED.

We incorporated a “Minute Clinic” within the ED that is staffed with CRNPs. The NPs are supervised and collaborate with the ED physicians on staff but they pretty much run the show in the clinic.

When a patient comes in and gets evaluated, if they are there for something non-life threatening , they get triaged to the Minute Clinic.

It’s away from the actual ED and they don’t waste the time of the physicians and staff who are dealing with real emergencies - heart attacks, strokes, car accidents etc.

They get their strep test or flu swab or whatever, get any treatments they need, get their prescriptions, and GTFO.

It’s been great at keeping the ED for real emergencies and it gets coded and billed as a clinic visit with a NP so it’s reduced our lost cost and the patients get a lower bill. It’s reduced the complaints about wait times, actually reduced wait times, and we’ve had better compliance from patients actually seeing a PCP to follow up.

Every day I’m amazed at the ridiculous stuff that goes on in hospital administration but this has been a big success for us.

[HRSchenker 2275]

10 minutes ago, Anastasis said:

Do ER docs have access to the PMP system, or is that only at pharmacy point of sale? 

They will be required to access it beginning September 1, 2019. Right now it's optional. They can get access if they want but most let us shoulder the burden.

[Neonmoon 38130]

 

[Bullneck 19230]

12 hours ago, SuingToGetAMessageBoard? said:

We’re not saving the world.  We are trying to fix an overtaxed system. Those 80 people in Dallas are using the ER resources of, what, about 25,000 average people?  I’d be interested at seeing what level you’d have to get to before to thought it might be worth looking at. 

There are always be people who use ER who shouldn't.  

People should never have to use ER because they can't afford scheduled treatment.

[Brothahorn 10087]

One of the elements of white or class or educated privilege that has become vivid to me over the years is encapsulated by this passage:

Michael Johnson is 57. He’s from Dallas. He’s diabetic. He has a job in fast food. He rents a home. He gets by.
Until recently, no one ever explained to him how hospitals, doctors and emergency rooms work. 
“My momma always told me when something’s wrong with you, go see the doctor,” Johnson said. 

There are some people, probably a startling number, that even Obamacare and Medicaid aren't going to help.


Because they are dumbasses.

[Biff Tannen 45751]

16 minutes ago, Brothahorn said:

There are some people, probably a startling number, that even Obamacare and Medicaid aren't going to help.


Because they are dumbasses.

/thread

[Okie State 3848]

Here’s part of the problem- there’s no accountability for people like Johnson. Going to the ER doesn’t cost him anything so why the hell not go?
 
I, on the other hand, have a co-pay and a deductible that could run into the thousands if I go to the ER before the insurance even kicks in. Therefore, I don’t go to the ER if I’ve got a cough, or I think I’ve got the flu, a stomach bug or cut myself on glass. These are all ailments that don’t require an ER visit but people visit the ER all day, everyday for them.
i don’t know what the answer is for people like Johnson but there needs to be some accountability for him. Mine is a financial penalty that I don’t want to incur. He needs something similar to curb his visits.

My first real experience with this was a few years back when my two year old nearly cut her finger clean off at daycare when some little shit slammed the door on her. We ended up at the TCH in the Houston Med Center for surgery. It was a Tuesday and the very large ER was bursting at the seams. A few of the people waiting looked to be sick, but I don't recall a single person with what I would consider an ER type ailment. Of course that's based on physical appearance only, but it was still surprising to me how many people seemingly use the ER for a cough or a runny nose.

The few times we've been forced to visit an ER with actual emergencies, it has cost us thousands out of pocket and that doesn't even take into account the hours and hours of wait time. I can't imagine why anyone would visit voluntarily unless they are receiving care for free.

[Gene Parmesan 4016]

Obviously I know they aren't paying any bills, but in these situations are hospitals even sending bills or have they already written it off before even sending the patient home.

[Onboard 2.0 9083]

Just now, thestud said:

Billing department for most hospitals isn’t on site, and in many cases isn’t even in the same state. Everyone gets a bill.

All gods children get a bill.....

[Okie State 3848]

They get bills and they go in the trash. I personally know people who have done this and they see no issue with doing so.

 

 

[TwiceHorn 31600]

On 5/29/2019 at 11:17 PM, Brothahorn said:

There are some people, probably a startling number, that even Obamacare and Medicaid aren't going to help.


Because they are dumbasses.

I mean, no doubt, but how much is sheer ignorance versus being low IQ?  As noted above, with poverty and related things outside the mainstream culture (it has come to my attention that a fair number of immigrants, legal ones, with jobs and some money, just don't know how to do things and don't have anyone to show/tell them how).

Edited May 31, 2019 by TwiceHorn

[Onboard 2.0 9083]

12 minutes ago, TwiceHorn said:

I mean, no doubt, but how much is sheer ignorance versus being low IQ?  As noted above, with poverty and related things outside the mainstream culture (it has come to my attention that a fair number of immigrants, legal ones, with jobs and some money, just don't know how to do things and don't have anyone to show/tell them how).

I think it's just general ignorance (not low IQ) coupled with laziness. 

[Firemans4Horn 18132]

I’ve volunteered at the Bridge (homeless shelter) in downtown Dallas a few times and I’m surprised the city doesn’t build a clinic right on site. Seems like 3 or 4 ambulances are down there in the hour and a half I volunteer; and taking them to Parkland (15-20 minute drive) seems extremely inefficient. 

[Vic Mackey 47182]

On 5/28/2019 at 4:23 PM, Deej said:

We had two people in our office, who had perfectly good health insurance provided by our employer, who went to the ER for every little thing. Cold, allergies, scrapes and cuts...you name it. I guess it was just too difficult to pay the $30 co-pay for an office visit, or for White Glove to come by the house or office to give them some meds. 

When I was on my parent's health insurance, I'd go to the doctor often. For any little thing. I haven't been to the doctor for an illness since I came down with pneumonia in February 2015. All I get is colds (various degrees of severity) and I can get over that on my own. I didn't know going to the ER for minor shit was a thing. I have never stepped foot into an ER as an adult for any reason.

[Nice Guy Eddie 13529]

4 hours ago, thestud said:

Billing department for most hospitals isn’t on site, and in many cases isn’t even in the same state. Everyone gets a bill.

I was under the impression the hospital attempts to collect as much as possible during the ER visit for people without insurance.  Im not saying that a bill doesn't get produced for the balance later but I thought both occurred.

It must suck for the ER doctors, who rarely work for the hospital, in that they discover later that many of the patients they saw that day will never pay them. It would seem like the hospital would have an easier time spreading those losses across many patients and services. An individual doctor doesn't have that luxury.

[Pig Bellmont 8742]

On 5/28/2019 at 5:48 PM, Buffsoldier said:

Drug. Seeking. Behavior

Ding ding ding ding

[Gene Parmesan 4016]

4 hours ago, TwiceHorn said:

I mean, no doubt, but how much is sheer ignorance versus being low IQ?  As noted above, with poverty and related things outside the mainstream culture (it has come to my attention that a fair number of immigrants, legal ones, with jobs and some money, just don't know how to do things and don't have anyone to show/tell them how).

It seems kind of hard to claim ignorance if you are just tossing the ER bills in the trash.  Poor people know what bills are.  Assuming they are getting bills and not in some loophole.

[Onboard 2.0 9083]

2 minutes ago, Gene Parmesan said:

It seems kind of hard to claim ignorance if you are just tossing the ER bills in the trash.  Poor people know what bills are.  Assuming they are getting bills and not in some loophole.

They know they can get away with not paying.  It's the status quo.

[Gene Parmesan 4016]

1 minute ago, Onboard 2.0 said:

They know they can get away with not paying.  It's the status quo.

Agree but knowingly abusing the system isn't ignorance or stupidity it's just being a POS.

[JimmyHoffa 1188]

I am guessing the people that go to the ER with an ACTUAL emergency are somewhere in the 30% range if not lower. 

[Onboard 2.0 9083]

11 minutes ago, Gene Parmesan said:

Agree but knowingly abusing the system isn't ignorance or stupidity it's just being a POS.

Pretty much.

[Guest]

36 minutes ago, Gene Parmesan said:

Agree but knowingly abusing the system isn't ignorance or stupidity it's just being a POS.

This.

 

They fucking know.   Hell, they DESERVE it...

[elfenix 34343]

On 5/28/2019 at 8:54 PM, Trey3216 said:

That’s damn near 5/7 days every week.  Good God 

perfect.

[Trey3216 15379]

6 hours ago, elfenix said:

perfect.

Like I said, damn near 

[immortal13 4059]

No wonder they have to charge outrageous prices

[Bevo 13604]

15 hours ago, Gene Parmesan said:

Agree but knowingly abusing the system isn't ignorance or stupidity it's just being a POS.

That is status quo.

[Bevo 13604]

7 hours ago, immortal13 said:

No wonder they have to charge outrageous prices

I don't know why people are surprised by this.

[TwiceHorn 31600]

15 hours ago, Gene Parmesan said:

Agree but knowingly abusing the system isn't ignorance or stupidity it's just being a POS.

To a certain extent, I think this is where the "health care is a right" thinking comes from.