As Pogo said years ago, " we have seen the enemy, and it is us!" I would favor promoting the institution of Medical Screening to divert non emergent patients away from EDs and into either offices or urgent care settings. EDs would be better staffed to handle the emergencies that still have to see us. EDPs would be better satisfied ( more acuity = more professional satisfaction) , less strain on nursing and more importantly patients would be seen in the best settings for their particular needs. That effective MSE is almost unheard of us our own "undoing", just as Pogo said. We need to get tougher and smarter about who we treat and where we treat people.. Reimbursement for patients, MC and Medicaid has been barely adequate to sustain EDs, and though the marginal costs for a low acuity patient in an ED is not significant, the volume of patients results in the need fo rmore staff, more facility expenses for materials and supplies, and wear and tear on the facility itself. A patient who pays either privately or through commercial insurance, still pays more to be seen in an ED than they would if seen in an office or UCC. The prfessional fee isn't much different but the facility fee is. SO overall it costs more to be seen for a low acuity complaint in an ED than in an outpatient setting. Todd is right, I think we will see patietns being diverted away from the ED. It is really the right thing to do for our patients. SOciety needs us to be more mindful of the costs of care, and they too should be mindful of the costs of their convenience choices to seek care at inappropriate locations, just because we are always available, almost 24 -7 everywhere. Most patients would not be harmed by waiting to be seen by an office practitioner or UCC provider but they come to us whenever they feel the need, because they have learned we wont turn them out. THat needs to end. Our open door policy of treating all and every kid who presents just isn't financially responsible and isn't sustainable. Maybe with better availability in the outpatient settings our volume will go down. that might mean we will need less PEMS, which is a good thing for the specialty as less providers= increases demand, which should convert to better compensation preservation over time. Not too mention that facilities that employ us need revenues to support the costs of our salaries and benefits, which currently are feeling the strain of having to support larger staffs to handle the volume of patients who present for care but whoose associated compensation is inadequate to cover the costs. Hence the tightening of financial belts, which affects all of us.. Perhaps some of us would do well to consider opening outpatient care centers for rapid care of low to moderate acuity patietns who can't be seen in ED ( don't need EDs) and do not have private providers willing to see them either. Frankly I think that is a good place for the government to play a role. Using programs like the National health Service, we could put providers in a lot of communities, who could see these patients. with 16,000 medical students a year graduating, that's alot of folks who could see patients ( non emergent) for the government. In return government could pay for medical school and also pay the providers a generous salary and it would still a lot less than the trillion or more the Affordable Care Act is slated to cost. THis type of governemnt service could leave the private pay, commercial paying patients for practitoners in private practice. It also makes a cash only urgent care service a very reasonable business model for the more adventurous
It should be interesting to see how all this plays out.. I for one am fearful of universal health care, but see us moving to a 2 party system of care. Universal care for those who can't afford their own health care and a private fee for service model for those who prefer to be selective as to their providers and the type and place of their care. Marty
> Date: Thu, 4 Apr 2013 10:47:07 -0500
> From: [log in to unmask]
> Subject: Our Future
> To: [log in to unmask]
> How are we positioning ourselves looking toward the very near future with ACO development and Obamacare?
> More insureds could mean more encounters. BUT, the future is pushing healthcare away from the hospitals into outpatient settings, ie urgent care, immediate care outpt. surgery centers etc...
> This could be a real issue for er medicine.
> Either inundation or drying up of patient encounters, depending on which actually takes precedence.
> Either way...we are in for it...
> The smart ones will capitalize on this.
> Todd Zimmerman
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