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On 11/7/11, james reingold <[log in to unmask]> wrote:
> I really agree with everything you said.  The counterargument is the
> possible revenue generated by competing with urgent and primary care
> centers.  Since we already see many of the these patients, I could see how
> scheduling them could actually allow smoother functioning of the actual ED,
> which can get clogged when lots of non-urgent pts present all at once.
> Spreading them out and directing them to the non-urgent side makes some
> practical sense.  But I can't get over that gut feeling that says this
> further erodes what the ED is all about and further confuses that in the
> public's mind. James
>  > Date: Mon, 7 Nov 2011 10:42:15 -0500
>> From: [log in to unmask]
>> Subject: Re: Appointments in the ED
>> To: [log in to unmask]
>>
>> Whether or not patients are "scheduled" to arrive at your acute care
>> facility (Clinic, Office, Surgicenter, etc.), I believe EMTALA would still
>> apply. Prudent administrations would operate under the assumption this is
>> the case.
>> My personal concern is one much broader in scope. That is, with society's
>> trend towards "doing more with less", I have sincere reservations about
>> "ED Appointments" because they represent a further erosion of the practice
>> of Emergency Medicine. The focus of the Emergentologist is the treatment
>> and stabilization of urgent and Emergent conditions. Currently, that role
>> has been redefined by society to be one of a glorified 24 hour clinic but
>> with the benefit of Critical/Trauma Care capabilities attached. The next
>> step in the evolutionary process must span the obvious gap created by
>> patients expecting to be seen at a specific time, juxtapositioned against
>> nonurgent, urgent and Emergent patient presentations - who gets seen
>> first? How will acuity affect that decision process? Each appointment then
>> becomes a liability and an impediment to the flow of delivered care in the
>> ED. An untenable situation at best without significant numbers of
>> additional staff at hand.
>> DGLooney, MD, FACEP, FAAEM
>>
>> *****************************************************
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>>
>> > Date: Mon, 7 Nov 2011 03:10:29 -0600
>> > From: [log in to unmask]
>> > Subject: Re: Appointments in the ED
>> > To: [log in to unmask]
>> >
>> > Out hospital system has just announced that this service will be
>> > offered.
>> >
>> > In addition to the concerns expressed by Ernie, I have these additional
>> > concerns:
>> >
>> > 1) Approximately 55% of our patients are ESI Level 4 and 5. This means
>> > that
>> > if we could figure out a way to implement this, we would have to make
>> > available "appointments" to more than 25,000 patient visits/year.
>> >
>> > 2) Our population is approximately 70% Medicaid/Medicaid HMO. I am
>> > concerned that "scheduling appointments" will give the states just the
>> > excuse they need to decrease reimbursements to Hospitals for ED visits.
>> > In
>> > other words, why should insurance companies pay ED fees for non-emergent
>> > patients who have "scheduled" appointments?
>> >
>> > I would appreciate hearing your thoughts regarding the scheduling
>> > "appointments" for pediatric patients in Emergency Departments.
>> >
>> > Thanks,
>> >
>> > Bob Flood
>> > Division Director, Cardinal Glennon Children's Medical Center
>> > St. Louis, MO
>> >
>> > On Tue, Sep 20, 2011 at 7:46 AM, Ernest Bertha
>> > <[log in to unmask]>wrote:
>> >
>> > > Just a thought as I am reviewing some CME.... If patients make an
>> > > appointment in the ED, is the hospital and the ED doc still
>> > > responsible
>> > > under EMTALA?  Obviously, if it is an appointment, no emergency
>> > > medical
>> > > condition exists and therefore a MSE isn't required.  Just wondering
>> > > how
>> > > this might/will affect this type of care in the ED?
>> > >
>> > > Ernie
>> > >
>> > > Ernest G. Bertha, MD, MBA, CPE, FAAP
>> > > Chief Medical Officer, Pediatric Services
>> > > Sheridan Healthcare Services, Inc.
>> > > 1613 North Harrison Parkway
>> > > Suite 200, SH-10
>> > > Sunrise, Florida 33323
>> > > 954-838-2746 (Direct & Voice Mail)
>> > > 954-858-0100 (FAX)
>> > > [log in to unmask]<mailto:[log in to unmask]>
>> > >
>> > >
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