The solution causes a problem

[thyme4change]

If you provide emergency services, you can't turn anyone down, for anything. Good law - it means people do actually get treated. But, of course, they don't pay.

My son banged his head tonight and we couldn't find an Urgent care facility that was still in business. I called one that is 15 miles away and they have a wait time that might be 3 hours.

We live in a mixed area, and surrounded by hospitals and doctors offices - but are also on many lines of public transportation and near areas that might be affordable to low income people of all types.

Why can't we have a 2-tiered healthcare system where if you can pay, you can actually find the service? I have decided we would be better off driving over an hour and waiting 30 minutes than going to anywhere around here.

[mnsharon]

I got food poisoning in Tampa and didn't want to go to an Emergency Room with a 4-6 hour wait. There was a doctor service that actually came to the hotel and treated me - $450.00, and damn well worth it. I had puked for 2 days, and would have paid anything to stop.

[❤ mollymouser ❤]

My insurance coverage doesn't allow for Urgent Care centers ~ just my regular doc or an E.R. with a $100 copay unless I'm hospitalized. This seems like a waste of money and time, but some injuries and illnesses occur after doctor's hours. And, of course, the ERs always have waits of hours and hours.

[Clever Username]

I don't think many hospitals have pushed the envelope much on it.
But I've seen a handfull of articles about some ERs that will stabilize patients and wish unpaying ones "good luck" while following through with actually treating paying customers only.

[jkscott]

Concierge doctors are the future for the upper middle class and above.

[mtshastawriter]

We live in a rural area and have MediCal. There are literally two doctors in our entire county who will take MediCal. If you are not able to see one of them because they are booked, or it is after hours or a weekend, they will tell you to go to the ER.

I think the first step in fixing the ER mess is to require all doctors to accept both Medicare and Medicaid. This would allow people more options in taking care of issues before they require a trip to the ER.

One of my relatives is always talking about us "welfare people" clogging the ERs. What they, and many others, fail to understand is that the ER is sometimes the only option people have...

[Savoir Faire-Demogague in NJ]

I think the first step in fixing the ER mess is to require all doctors to accept both Medicare and Medicaid.

Both of those govt run programs drastically under pay the physicians providing the care. This causes fee increases for patients who pay with cash or who have insurance.

Requiring healthcare providers to take patients borders is akin to slavery, which was thankfully abolished 145 years ago.

[cronewitch]

We could solve hunger by demanding stores give food to people if they can pay or not too. Apartment owners could be required to house the homeless regardless of ability or willingness to pay.

Medical care, lack of food and shelter can all kill so the merchants and doctors should take care of the problem free or at a under market price.

[thyme4change]

I'm not trying to solve the problem of giving care to people who can't afford it. I want to solve the problem of giving care to people who CAN afford it. I want to pay for a service that doesn't appear to be available because they are required to give away that service - so people have opted to just not offer it at all.

The problem isn't that uninsured people aren't getting care. The problem is no one can get care.

[The Walk of the Penguin Mich]

I think the first step in fixing the ER mess is to require all doctors to accept both Medicare and Medicaid.

When doctors treat Medicaid patients, they do not even receive a fraction of what it costs the facility.

We have a dentist who provided dental treatment to children on Medicaid. The dental van was almost wholly supported by university funds, the support staff was on the university payroll and the dentist was providing his services for free.

So by forcing all doctors to accept Medicaid, you're asking them to provide their services for a loss.

[Urban Chicago]

Visions of "Royal Pains" dancing in my head.

[michelyn8]

Feb 1, 2011 11:14:08 GMT -5 @mtshastawriter said:

We live in a rural area and have MediCal. There are literally two doctors in our entire county who will take MediCal. If you are not able to see one of them because they are booked, or it is after hours or a weekend, they will tell you to go to the ER.

I think the first step in fixing the ER mess is to require all doctors to accept both Medicare and Medicaid. This would allow people more options in taking care of issues before they require a trip to the ER.

One of my relatives is always talking about us "welfare people" clogging the ERs. What they, and many others, fail to understand is that the ER is sometimes the only option people have...

I have to agree with the others. You can't require ALL doctors/dentist to accepts gov't insurance. If we did, we'd have fewer good doctors and be left with those that will provide substandard care so they can get the patient back in their office for another visit (read another billing to the gov't) just so they can break even.

I gather by the name "MediCal" you're in CA. I don't know how big and rural your county is but is it possible to find a Dr. in another locality? In VA, as long as the doctor or facility will accept Medicaid, you can go. You can even find a list of docs by locality and specialty who will accept state provided insurance. My BF and his kids are on it (he can't work due to injuries from a car accident) and he also lives in a low-income rural area. I've taken him to doctors and facilities over an hour from his home simply because that is how far he has to drive to get good care. What's closer to his home provides only as much as they have to because of low median income in that area. Shoot, I won't even go to the hospitals close to my home for pretty much the same reason (plus the fact that they made us wait almost two hours to tell us my father had passed away when he was taken in for his heart attack).

However, my ex took my daughter to an ER 45 minutes away last year when she abdominable pains and she was in back already being "interviewed" by a nurse before I got there 10 minutes after they did. A few days later, BF and I took his daughter ther and she was taken back before we could get comfortable in the waiting room. This is a fairly new hospital and in a more upscale area and I was very impressed with how BF and his daughter were treated (despite being on the dole). I've taken to transferring my business to Dr.'s affiliated with that hospital and have been very pleased with the service I've received.

[bobbysgirl]

The last I heard the re imbursement to the doctor for a cast put on from medicaid is 7.00.

Urgent cares serve a hugh purpose. I wonder why yours are all down?

[thyme4change]

Urgent cares serve a hugh purpose. I wonder why yours are all down?

I think they all went broke. Either that, or they couldn't find doctors to staff them. Who will pay for them if they only get $7 from each patient? Even if they can get 10 patients through an hour, how are they going to survive on $70/hour. You need at least one PA and one desk staff, and a facility. You need insurance and rent and electricity. You need to clean and have equipment. And, if any of those 10 patients that come in for care are not on Medicaid or Medicare (possibly undocumented worker?) your reimbursement just went from $7 down to zero.

[soon2bmomof3]

We use Urgent Care or Emergency Care (stand alone, not inside the hospital) when it's the weekend and our doctors are not available. All the times we've used it, it's for the kids, high fevers over 102, outbreak of hives one time, etc. Our insurance has $35 copay for urgent care and $100 copay for emergency room. We've never had to wait more than 30 mins and if it was really early morning, no wait at all other than signing the paperwork. The visit usually takes about the same as if it was at the pedi's office, sometimes faster because they're not booked up.

[thyme4change]

That is awesome soon2b - I'm guessing you are in a "nice" area - more middle/upper-middle class? In that area most people probably have private insurance instead of being on a government sponsored program, or no insurance at all.

[Wisconsin Beth]

My HMO is a clinic setting. The lab area also hosts Urgent Care with limited hours (I think noon-8pm on nights and 9am-4pm on weekends.) My copay is $10, same as it would be for seeing our doctors upstairs. I think we've been there about 8 times in the last year (gotta love toddlers) and I've heard them refer people to other care places nearby while waiting.

[pepper112765]

I used urgent care versus ER all the time. I only have to pay the co-pay of $20.00 when using Urgent Care, but have to pay $50.00 for the ER, in addition to the all other bills from the physician billing, etc., until I meet my $1000 deductible and it is considered in network. And thank God for the Urgent Care ... the wait isn't long, the care is excellent and they have the lab on site. Son went there last Monday night around 8:15 for stomach pains, vomiting, etc., thought it was a virus ... blood work helped determine probable appendicitis. They called the hospital, sent me there with the lab results, son was admitted to hospital immediately, surgical team assembled and surgery at 3:00 a.m. Tuesday morning. Couldn't have asked for a better outcome.

[Sharon]

If the Obamacare legislation is allowed to stand there will probably fewer doctors accepting Medicare and Medicaid. Doctors who accept these clients will be required to convert to Electronic Health Records(EHR) and those that don't their reimbursement rates will be cut even further. The EHR systems have to be certified and can cost 10's of thousands of dollars to the doctor to get up and running. The cut in the reimbursement rate is supposed to be the incentive for them to convert to EHR.

[daisylu]

Feb 1, 2011 10:59:07 GMT -5 Clever Username said:

I don't think many hospitals have pushed the envelope much on it.
But I've seen a handfull of articles about some ERs that will stabilize patients and wish unpaying ones "good luck" while following through with actually treating paying customers only.

I have used the same hospital for the last 15 years. While I was not an "unpaying" patient, there was a very brief time years ago that I was without medical insurance. In 1 month's time, I was in the ER 3xs for severe abdomenal pain. Each time I was given antibiotics and pain medication and sent on my way. 2 weeks after my last visit, I was once again in pain. The difference was that this time I had insurance. My appendix was taken out the very next day. The doctor who did the surgery commented that it had looked so bad that he could not understand how I had dealt with the pain, and was surprised that it had not burst by then.

Those who have never been without medical insurance are a lucky lot.

[BeenThere...DoneThat...]

...your son doing okay today?

[thyme4change]

Who isn't getting care?

I couldn't find a facility within a 15 mile radius of my house. The ones 15+ miles away all had 3 hour wait times. Technically, I could have gotten care. But, the reality is pretty bleak.