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Overtreatment in the ED? You better believe it.
Given that in a typical shift of eight hours you see an average of two patients per hour (16 patients/shift), could you have eliminated any of the following tests and/or treatments without compromising the quality of care? If so, how many of each? 

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How much could we save? Try billions.
If you chose to eliminate the actions above, what would you estimate the value of the changes to be?

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EPs Express Broad Pessimism
Given that some type of health care reform is likely to be passed, what is your general feeling about its impact on the nation as a whole? 

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How would you vote?
Assume that you are a legislator voting on health care reform. Your goal is to reduce the cost of health care while maintaining quality. How would you vote on the following proposed amendments? 

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What have you done to impact health care reform?

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EPs split 60/40 against the ‘public option’, but those who oppose it feel their opposition is ‘non-negotiable’ by a 3:1 margin.

Over 90% of EPs favor the creation of physician boards to determine standards of care the provide immunity from litigation

Almost 15% of EPs would like to see top paid specialist make less

Over half of EPs think they could eliminate one or more tests/X-rays/scans, orders without lowering quality of care

84% of EPs say that caps on non-economic malpractice damages are a non-negotiable part of health reform

75% of EPs oppose or strongly oppose the creation of a powerful central board that can control medicine payments, rationing, etc...

EPs Respond
Readers suggest their own health care reform ideas
  • Have a nominal copayment for all services regardless of income level (i.e. $5/visit). 
  • Specialized malpractice courts without juries but with trained physicians.
  • Standardized payments for malpractice that our disease based.
  • Determine the direct impact of EMTALA an each physician and give a tax rebate proportional to the amount of “indentured servitude.”
  • Free market. Public posting of prices.
  • Tort immunity if physician complied with government standards of care.
  • Pay the lowest price for proven effective modalities. Let folks purchase with private $ above that.
  • No dialysis after age 80-85.
  • Make nursing homes pay for patients care that are transferred to ED for treatments that are not covered by Medicare.
  • There must be an allowable ‘miss rate’ to halt the temptation for excessive test ordering.
  • No public funds to pay for elective abortion.
  • Promote medical savings accounts.
  • A single payer system is the only way to control the outrageous steady increase in utilization and cost. Cap salaries of CEO’s and top management of all health insurance companies.
 

Comments   

# MD JD FACEPDavid D 2009-09-16 17:47
Oh my, who would have thought your sample would be so conservative, and want to maintain the status quo.
Yeah, tweak a little, but keep the insurance stockholders in charge.
Reply
# M.D.John M. 2009-10-08 16:18
Let there be a co-pay for every service, adjusted to income, with those on public assistance having it taken from the welfare check. The adjustment bureaucracy would be a walk in the park compared to, e.g. a public option. This way rationing would be an individual decision and supply and demand would rule.
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# MD, FACEP, FAAEMPaul 2009-10-10 21:50
Need tort reform like New Zealand. No more millionaires from malpractice. National Health Care is a must. If you think that we already don't have it, you are not working in today's ED. Tough decisions on "rationing" health care. Not everybody needs "everything that medicine has to offer". If there is not some decision on spending, we will bankrupt the nation. EMTALA needs to be changed. If you can not prove that you are a US citizen, then you pay cash (up front).
Reply
# Mark Baird 2009-12-08 03:14
"Reduction of payments to top paid medical specialists"
so that deserving low income patients are not able to be compensated for those doctors that other doctors are not willing to through in jail.

How about if we put a cap on doctors salaries as well as caps on CEO of hospitals or insurance companies. How about a cap on what is paid out to shareholders.

Yes, let's put a cap on awards to the poor will suffer, after all they do not vote and are not heard because of money.
Reply

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