See more health care news from around the web on the Satellite Edition of this week’s update over at ER Stories.net.
A new study in the Annals of Emergency Medicine shows how much time emergency physicians spend performing direct patient care versus indirect patient care. Also see a news article on the study here. In two hours, the average emergency physician spends only 40 minutes in direct patient care – while managing 6 to 7 patients at at time. More than half a physician’s time is spent in “indirect” care with such important tasks as filling out paperwork, making phone calls, filling out paperwork, avoiding being beaten by upset patients, filling out paperwork, making sure that patients don’t drink hemoccult developer, and filling out paperwork.
In addition, emergency physicians were interrupted up to 32 times over a 2 hour period for academic hospitals and up to 19 times in 2 hours at community hospitals.
Can you say “EMTALA violation”? 61 year old Birgilio Marin-Fuentes drove himself to an Oregon emergency department for evaluation of coughing. He crashed his car in the parking garage just 125 feet from the emergency department entrance. When bystanders told the security guards what was happening, the security guards went out and started CPR. One went back inside to get help and was told to “call 911.” By the time the ambulance arrived, the patient was dead from a heart attack.
As Medicaid rolls increase by 12% per year and are expected to increase by another 2 million due to health care reform, Texas is planning to slash Medicaid payments by up to 33%. Hospitals are now planning to cut services. Several hospitals will likely discontinue maternity services. Another hospital plans to close its outpatient clinic for low income patients. Only 42% of Texas physicians accept new Medicaid patients and the Texas Medical Association states that the number of physicians likely to accept new Medicaid patients will drop to single digits if there are further cuts.
In other news, a survey of trial lawyers on this topic shows that they believe the system is working perfectly and that they propose higher penalties for hospitals that cannot operate at a loss.
Florida also plans to cut Medicaid spending by $4 billion over two years.
California plans to cut $1.7 billion in care for its 7.7 million Medicaid recipients. Among its proposals include cutting provider payments by 10%, limiting Medicaid patients to 10 doctor visits a year, limiting prescriptions to six per month – except lifesaving medications, eliminating adult day care, imposing $5 copayments on doctor visits, $50 copayments on emergency room visits, and $100 copayments on hospital stays.
Another Texan dies while waiting in an emergency department waiting room. This news report states that the patient was waiting 16 hours in a wheelchair.
Meet your new triage nurse. “Rosie” the kiosk. C’mon – you have to remember the Jetsons …
Man becomes violent in hospital emergency department and threatens staff, mentioning his .45 caliber pistol. Arrested and charged with disorderly conduct and criminal mischief. Hospital officials say this was an extremely rare occurrence. Apparently they haven’t been reading the news.
Florida jury awards $2.4 million to family of child who died after taking aunt’s methadone pill.
The “choking game” is still around. And it’s still killing our kids.
Vindication for some men who say that lesion on their genitals really was because it got caught in the zipper: Study shows that nearly 1 in 5 syphilis tests are falsely positive.
“Only 42% of Texas physicians accept new Medicaid patients and the Texas Medical Association states that the number of physicians likely to accept new Medicaid patients will drop to single digits if there are further cuts.”
After all your touting of the Texas “miracle” of tort reform, and all alleged increased access in Texas thanks to it, I wonder if you even get the irony of this post and your criticism of lawyers. I think not.
And then below it, another happy recipient of the benefits of the increased access:
“Another Texan dies while waiting in an emergency department waiting room. This news report states that the patient was waiting 16 hours in a wheelchair.”
All of the WC “we need tort reform for access” bullshit is being laid open for all to see when the money gets tight. Cash talks, all the rest is just insurer lobbying. Single payer, here we come!
Matt:
How open is your door for free services?
Sadly, more often than I’d like. Why? I’m not saying you should. I’m just pointing the fallacy of the whole “liability protection=access” claim. It’s nonsense. Money=access to physicians.
The question to be answered isn’t for me, though. The question is to you – Is your door open for free services? Are you prepared to leave the third party payment model? If the government makes it unprofitable to take Medicaid patients, and soon Medicare, doesn’t that squeeze the available patient population pretty well? What do you do then?
I believe that the problem is that most, if not all, ED’s are required to treat anyone who comes in the door regardless of their ability to pay.
So, yes. Their doors are open to free services. Forget about third party, one payer, or anything else, they are on no payer.
Actually Matt, I would love to get away from the third party payor and have patients responsible for their own bills and negotiating their own prices. Additionally, I would like to have a contract with the patient that details how any disputes would be handled. In many ways, it would be just as we pay our attorneys. Right now over 33% of what we do in our practice is not just for free, it is actually at our cost. I wondered, what if we were paid like attorneys where we could bill by the hour, bill for the expenses and then get a percentage of the result. How much would it be if you saved the life of someone? Do you get a percentage of their future earnings?
On a more serious note. It is a fallacy to think that the whole answer to access is just tort reform. It is many things but reform does help. I can tell you that it is hard to get someone to take call and to care for someone out of their own time and pocket and then to carry all the liability for it. It is a “thank you sir, may I have another!” It is all simple economics, people want to get paid. If patients pay and are accountable, they get seen. The problem, is we have patients who want to be seen, but who don’t want to pay and who also want to sue.
“I wondered, what if we were paid like attorneys where we could bill by the hour, bill for the expenses and then get a percentage of the result. How much would it be if you saved the life of someone? Do you get a percentage of their future earnings?”
We don’t usually bill by the hour AND take a percentage. But stop wondering – I’m sure there are people out there who would sign that contract. Nothing is stopping you. There is nothing unserious about you query. As long as it’s an enforceable contract, go for it.
“It is many things but reform does help.”
No it doesn’t. In 40 years it’s never done a single thing you guys keep claiming it will do. Doesn’t reduce “defensive medicine”, reduce the overall cost of healthcare, or increase access.
Now Matt.
First, we’re going to use a definition of “strawman” that we both agree upon so there isn’t any more of this “you don’t know what the word means” in an attempt to divert attention from the specious arguments you make. The definition you used was from Dictionary.com: “a weak or sham argument set up to be easily refute”
What did tort reform in Texas accomplish? It brought more doctors to the state. So tort reform (and other reforms) set the stage for an increase in access to care. So you’ve created a sham argument by stating that I advocate a position that “tort reform = access” when it is not true.
“Perfect care or available care?” Isn’t that one of my mottos? You plaintiffs attorneys want to sue your way to better health care, the doctors are going to leave or they’ll stop taking call. Sound vaguely familiar?
So by reigning in malpractice lawsuits, Texas set the stage for increased access, and I’m sure that there is increased access in some areas as a result of Texas’ efforts.
But Texas and many other states are dropping the ball when it comes to another prong of access: Fair payment.
Wouldn’t it be great if you could move to a town that has great schools and affordable housing, and lots of jobs available? Then, after you sell your old house and put a down payment on a new one, you learn that the only jobs available in the area pay you $2.50/hour.
A little bit of a sham argument to suggest that the *only* issue in increasing access is tort reform, isn’t it?
Of course, we’ve gone back and forth over all the different facets that affect access and the willingness of physicians to practice in a given area, but you just ignore them. Keep beating up that strawman, though (your definition, not mine).
You’re right. Cash does talk. Cash is king. Use whatever idiom you want. But again money is only one facet of many that comes into play.
For example, I recently got a letter from a placement firm offering me almost double what I’m earning right now. The only problem is that I’d have to move to a state that has poor reputation for medical malpractice, would have to work in an understaffed emergency department, and would have to live in an area of that state that is not very well populated.
By your logic, I should take the job, because, after all, “cash talks.” Then we could set up every human interaction to take place over eBay because “cash talks” and “all the rest is just insurer lobbying.”
We already have a pretty good look at single payer. Most healthcare in the US is already government run (70%?). Look at what the single payer system gets those who participate in it: Limited access which continually gets whittled away by the “payer” trying to save money. Limited medications – you only get what’s on the state formulary. Limited providers.
Like things the way they are? What do you think will happen when all the new patients with Medicaid hit the system?
Tort reform brought more doctors to the state? As opposed to, say, Texas’ population increase (per capita number of physicians has stayed the same) or more job openings due to new hospitals coming online? How can you be so certain it was tort reform? Short answer: you can’t. You have no idea. Considering that many of them moved from states that already had “reform” the evidence doesn’t bear your claim out.
So that’s your first conclusion based on wishes rather than data.
Second, you claim tort reform increases access. Or, in your revised parlance, “sets the stage for increase in access”. Yet here’s the problem-the facts show, and always have, that access to physicians is a function of the wealth of te community. Far and away above any other factors. You have literally no evidence to the contrary. Zip. Zero. If your claims were true, wouldn’t there be some widespread examination of rural areas with similar demographics with both capped and noncapped states? You have literally nothing like that. You just have some raw numbers from one state over less than five years. After literally four decades of your reform. That’s telling.
A state that has “a poor reputation for malpractice”? Really? How does one tell a “poor reputation”? Some tobacco lobbyists told you? This is how you reach conclusions?
You use a phrase like “fair payment”. That tells me you are getting well versed in lobbyist speak. How does one define “fair pay” and how is Texas the state supposed to take care of it? You illustrate exactly why single payer is the only option. “Fair pay” is what the market will bear. You have little concept of the market because you don’t sell your service to the public.
What will happen? Single payer. You’ll unionize and terms like “fair pay” will be in vogue a lot. Really you asking me if I like the way things are doesn’t matter in terms of physician-patient relationship doesn’t matter. The only people who can stop that train are physicians. But they have to be willing to step away from their ever declining payment model.
So really, the question is to you-will you leave your payment model? Because that’s the heart of the healthcare issue.
All the rest is just window dressing for marginal players-like tort reform. All about liability carriers, doctors are just the face. Tobacco and the pharm industry is trying to ride those coattails. Don’t believe me? Follow the money and you’ll see where all these grassroots tort reform organizations started. Tobacco money run through Covington & Burling, the industry’s law firm. Think they really care about healthcare or physicians?
““Perfect care or available care?” Isn’t that one of my mottos?”
Why would you make that one of your mottos? You offer neither. It’s one of your silliest statements. In fact, it directly contradicts your previous statement about not equating tort reform directly with access, something you used to do all the time, until the facts became too obvious to ignore. So what does that statement mean?
No one asks for perfect care. Just care up to the standard set by your own industry. And most of the incidents of malpractice don’t result in a claim – so who is getting perfect care?
And you’re not promising “available care” if you do get your liability caps on those injured the worst. In fact, you’re not promising anything.
Pretty poor motto if it doesn’t make logical sense, and even if it did you wouldn’t mean it.
“So by reigning in malpractice lawsuits…”
I’m sorry, I must not understand here, but how do you “REIGN IN” something?
Perhaps you meant “REIN in”.
How many chest xrays have I looked at that were normal, shocking the patient who had been told by an attorney that he had ” asbestosis”?
Is it just me, or does it seem like democrats are beating medicaid to death with a shovel just by trying to make it better? Who would have thought the best way to win was to let the other team defeat themselves.
You’re looking at it the wrong way. Reduced Medicaid increases the pressure for the government to pick up the whole tab. Everyone in healthcare, including physicians, speaks of the healthcare “system”, the giant bureaucracy. They don’t look at it any other way.
When the system isn’t working, do you think the solution most see is to get rid of it? No, too many stakeholders making too much money. The solution is to make it bigger! Bureaucracy doesn’t retreat.
And, when you have the baby boomers, who want to live forever but haven’t saved the money to do so, as your largest, most politically active group, do you think THEY want to reduce the amount someone else is paying for their care? Of course not.
It’s actually pretty brilliant, if unintentionally. By creating a crisis so big, the public, and indeed the practitioners of medicine, see only solutions so big that only government can provide them.
Bernie Madoff is serving time for less.
i’m assuming that oregon case happen on hospital property? if not, i think there’s actually a distance within the hospital that emtala covers.
either way, how hard would it have been to send out some people and a stretcher to have him wheeled in? the outcome probably would have been the same but it wouldn’t look quite as bad PR-wise.
NY’s Gov. Andrew Cuomo convened a committee to come up with proposals of how to cut NY’s Medicaid budget by $2 Billion.
“In other news, a survey of trial lawyers on this topic shows that they believe the system is working perfectly and that they propose higher penalties for hospitals that cannot operate at a loss.”
WC, you asked for the definition of a strawman – see above. No one, lawyer or otherwise, has ever argued any “system” is working perfectly. Perfection does not exist among us humans. Nor has anyone proposed higher penalties for hospitals that cannot operate at a loss – in fact, that sentence doesn’t even make sense. Except as the definition of a strawman.
Carry on.
You could do a whole post on this one or add it to the next update….PHOENIX — Arizona lawmakers are trying to widen the state’s illegal immigration crackdown with a proposal to require hospitals to confirm whether patients are in the country legally.
This could be accomplished in your down time of course.
If you’re a patient or provider, here’s a far more meaningful article on the subject of healthcare and things that affect access and your income than the insurer lobbying WC usually provides:
http://www.theatlantic.com/business/archive/2011/02/the-ever-more-desperate-health-care-budget-gimmicks/71327/
“And that’s kind of a problem, because in 2014, the looming cuts to doctor reimbursements will be even bigger, and even less politically feasible, than they are now. We’re going to have to find even bigger cuts to pay for them. But since the Obama administration has used 10 years’ worth of revenue out of the (say it with me now) easiest and most obvious pay-fors, we’re going to have to find the money in some even less obvious, and more politically difficult, place.”
Matt- please go annoy some “accident victims” somewhere else. Did your mother not pay enough attention to you as a child ?
I love getting comments from the readers. Thanks for keeping up with us!
WOW….no WONDER The People’s Republic of California is totally insolvent! Many of these programs come right out of a socialist’s wet dream!
Regarding the $5 co-pay? When the military started charging a TWO-dollar co-pay for after-hours dispensary visits for non-emergent problems in dependents (ie, not the service member) , the number of visits at that post dropped over 60%.
Nothing like spending your own hard-earned money to make you think that the rash really CAN wait for an appointment in the morning!
[...] Alabama: “A Jefferson County jury has awarded $2.4 million from an emergency physicians group to the mother of a 2-year-old who died after ingesting methadone.” Lawyers said the emergency department failed to take proper steps to rule out drug overdose as a reason for the child’s condition. [AP/WHNT via White Coat] [...]