Tuesday, April 26, 2011

Why health care has become so expensive that only the indigent can afford it.

Yet another horror story from the bowels of the health care industry:
Apparently he woke up on a Sunday evening feeling constipated. Rather than doing the obvious and just buying a laxative somewhere, he had his girlfriend drive him to the Emergency Room...
It's a fairly innocuous start to a blog post that was pressure-testing my cerebral arteries by the time I was finished.


Lazy Bike Commuter said...

Sounds just like what I remember from working in a doctor's office. The comment I left there has more detail.

North said...

The story has a happy result, though: Everything came out OK.

Flighterdoc said...

LOL, better stay away from any emergency room.

How about women coming into the ED in the wee hours of the morning for a pregnancy test? You know, the one they could buy at the drug store for $10?

Or, come into the ED, waste their apparently valueless time, make some weak claim about abdominal pain (because they know they'll get an expensive workup), just to get the pregnancy test results?

Or the drug seekers who come in complaining of back pain. When they have a better understanding of 4th tier NSAID analgesics than the pharmacist, and they're 'allergic' to everything except vicodin (hydrocodone and acetominophen) which just happens to be worth $10-15 per pill on the street, and of course ALL of their diagnostics (Xray, MRI, physical exam, history....all of which takes time away from really sick people, and costs lots of money) comes back without significant findings...

Thanks to a federal law called EMTALA, and the tort system in the US, you can bet they get exactly what they want. Lets hope real patients don't need attention while we're wasting time on these people.

Tam said...

See, that pisses me off.

The last time I used an ER was over ten years ago, and it was only because the EMTs took me there after scraping me off the street, although I guess having bones hanging out does qualify as an emergency.

Of course, the first thing I said to the EMTs, between screams, was "Call my boss and tell him I'm going to be late," so I probably have a slightly different worldview from the people to whom you refer.

North said...

Tam: You scare me. I think I need to go to the ER.

Bubblehead Les. said...

Now if you're a Military Vet, and you arrive at the VA Medical Center for your Scheduled Appointment (that took you 6 weeks for an opening to come about), chances are your Assigned Doctor is not there, they lost the paper work on your condition, and you'll have to reschedule with the 3 "People" sitting in the little room down the corridor that has had the "Out to Lunch" sign posted on the door since you arrived 4 hours ago, even though you hear them Chit-Chatting on their Cell Phones. I was there, helping my Army Buddy out, because he wouldn't be able to drive home if the Medical Procedure he was scheduled to do had actually taken place.

Scott said...

I hope that the EMT's used a clean scraper to pry you off of the pavement. By the way did your Boss get the message?

Tam said...

Yes. I gave them his phone number and somebody called. :)

(When I told the EMT to tell my boss I was going to be late, I hadn't moved since the accident. I knew it was bad, but not how bad it really was. He glanced down at my legs, back up at me, and said "I think we'll tell him that it doesn't look like you'll be in today.")

Mike W. said...

Yep. Last time I went to the ER it was because I was wheeled out of my office on a stretcher and brought there via ambulance.

You don't go there because you're full of shit.

North said...

Last for me: I had a kidney stone that the Army Corps of Engineers took to carve a presidents face upon.

Ed Rasimus said...

It was about fifteen years ago, and I was in San Francisco for the national convention of the American Library Assoc. (I know, strange venue for a fighter pilot, but that's another story.) The newspaper announced that the city of San Francisco had determined that all hospitals would no longer accept private healthcare insurance. If you had benefits they didn't want to deal with you. Only the uninsured would be cared for because the accounting was simpler. That was fifteen years ago, I would be naive to expect it to get more sensible since then.

Mikael said...

Last time I went to the ER(around 3 years ago), for some stitches, it was quiet, and I payed the $23(in today's exchange rates) co-pay for it.

"Socialist" sweden has co-pay, even for ER. However it's less than for scheduled appointments.

Oh and I went there by taxi, as I didn't feel a small knife wound(1/3rd inch wide and deep, 3 stitches) was worth calling an ambulance for.

Bram said...

I've stopped dreading the coming collapse and now welcome it. It will be a much needed eugenics event.

After the collapse, the patient in question will be presented with a bill before service at every step in his little adventure.

perlhaqr said...

Mikael: An ER (and ambulance, while I'm dreaming) co-pay would be a fucking godsend.


Joining everyone else, the last time I went to the ER for medical care, oooooh, let's see. I think that would have been back in November '06, when I smashed my right ring finger in a jack stand.

Anonymous said...

At least he had his girlfriend drive him to the ER.

In the OB-ER where I work, most of these frivolous-use stories begin with a $1000 ambulance ride.

Carmel IN

Anonymous said...

Oops, just read the link.

I see he did get the ambulance ride in, after all.


Anonymous said...

There really are some useless people walking around consuming valuable oxygen.


Divemedic said...

I work EMS. Here is a recounting of my favorite calls:

- The woman who called because her 13 year old daughter was having stomach cramps. Apparently, she had them a month ago, too.

- The woman who called at 2 am because it was hot in her house, and she didn't know how to adjust her electronic thermostat.

- The man with the key ring stuck on his penis.

- One woman called 911 because her child had the flu. When the ambulance arrived, she asked them to take all 6 of her children, because "If one of them gets sick, they all will."

There are also the "frequent fliers," mostly homeless men, who call a hundred times or more a year.

I have hundreds of stories of EMS and ED abuse. I would say that upwards of 75% of my EMS runs are not medical emergencies.

Anonymous said...

Geez, it's been so long that I don't even remember the last time I went to the Emergency Room, if at all!

Hell, my mom pretty much has to tell me to go to the doctor at times.

Justthisguy said...

Heh. I passed _my_ kidney stone all by myself. (I had a little vicodin left over from a tooth extraction) I did finally bear up and go to the ER a few years back, though, after a week with a collapsed lung. Just the thought of having to talk to doctors creeps me out.

Fuzzy Curmudgeon said...

The only time I've been to the ER was several years ago when I got -- hmm. Constipated. LOL

Except that as it turned out, I'd been constipated for a week due to diverticulitis (first experience of that lovely condition) and had no idea what was wrong with me except that I had shooting pains in my abdomen and a 102° fever. And it was a Sunday and my doctor was, of course, unavailable.

So they checked me out, determined it wasn't appendicitis (could have told them that, it was on the left side), gave me laxatives and sent me home. It wasn't till I got to the doctor the next morning that he finally made the correct diagnosis.

And told me "No more pepperoni."

Robin said...

Part of the problem is that excessive federal regulations has led to the demise of the county free clinic.

Jake (formerly Riposte3) said...

Hm. The last time I went to the ER (as a patient) was when I got so sick while on duty that I was passing out while lying down - and I had been fine just 2-3 hours before. I got a little morphine and phenergan and over 2 liters of fluid by IV before they let me go, so there must have been something to it.

But then, I actually had health insurance through my employer, too. Covering that kind of ER visit is what I was paying for.

Joanna said...

Since we're sharing: The only time I've been to the ER as a patient was when I came home after major surgery and a vital piece of post-operative kit became dislodged. That was in 2007.

I did see the doc-in-a-box a couple months ago (turned out I had the flu).

Moriarty said...

I can't resist a war story...

In the grim, dark days of residency, there was a certain patient whom I'll call "Greg."

He was a masterful abuser of EMTALA.

The son of a successful lawyer, over $75,000 of Daddy's money had been utterly wasted on him in an effort to curb his alcoholism. His typical presentation was to down a bottle of the nearest thing containing alcohol and head to the ER for an admit, "three hots and a cot" for a day or two, then home for a couple of days.

You knew it was going to be another long night when you were called to the ER and spotted a bottle of "Suave Maximum Hold" hairspray at the registry desk. Greg told me it mixed well with orange juice.

(If Greg didn't feel that he was being properly treated on hitting the floor, he'd steal a can of Lysol off the housekeeping cart, spray it in his water cup and down that. It would always buy him another day in house.)

After at least two admissions a week for the better part of a year and hundreds of thousands of dollars down the drain, the hospital finally arrived at a "Greg Protocol." This kept him in the ER under observation for a few hours until he sobered up, at which point they'd boot him back out.

That only worked because it was a small hospital in a small town where everyone knew "Greg." You can't make this stuff up and as Divemedic points out, it's far more common than generally supposed.

Fuzzy Curmudgeon said...

Yeah, I guess I should note that insurance paid for my ER visit, too.

Spud said...

Blame the greedy asshole insurance/lawyers and those that use both. Not those that can't afford anything else. The system sucks.
It's easy to look down on those that aren't favored by the system.
And yes it is class warfare, like it or not, it is.

Anonymous said...

Spud, you seem to have swallowed a left-media meme that goes something like this: "the only reason people abuse emergency services is because they don't have access to nonemergent care. If they had outpatient access, they wouldn't do that."

It's simply untrue.

I work in an OB ER. We have an excellent network of nonprofit clinics in our city, located in all the lower income neighborhoods, that have all kinds of mechanisms for indigent care, including providing services free of charge for those with no resources at all.

Over 90% of the patients I see in OB-ER are registered in these clinics, so they have access. It doesn't stop them from taking ambulance rides downtown and presenting for nonemergent emergency care in the middle of the night - frequently, when they have a clinic appointment the VERY NEXT DAY.

In my family's health plan, our copay is $20 for outpatient nonemergent, and $120 for ER. Plus, if we use the ER for nonemergent/noncovered indications, we're stuck with 100% of the bill. Guess how much frivolous ER use we engage in.

The problem isn't access, it's lack of consquences. When you have no financial stake in using the most economical resource, you're a lot more likely to use an unnecessarily expensive resource.

EMTALA needs to be reformed. People who rack up ER bills in the 10s of thousands for drug seeking and frivilous complaints need to experience some kind of personal consequence for this behavior.

Carmel IN

BobG said...

When I had my heart attack I was able to have my wife drive me to the nearby hospital in the emergency room.

The last time I rode an ambulance I had a 104 fever, and my blood pressure was 89/58. I would have had my wife drive me to the hospital, but every time I tried to get up, I would faint and fall down.

Spud said...

No doubt there are abuses, we can blame the liberal left for allowing such.
My point is that medical should not be as expensive as it is.
We can blame frivolous law suits for much of it, and a bit of greed.
I am glad for you that in your area there are places for the poor to go.
Such is not the case everywhere in America, especially in small towns.

staghounds said...

One doesn't go to hospitals. One is told they are full of sick people.

( Only fooling, Karma! Actually I was made to go once I think, heatstroke when I was like 13 or so.)

Tam said...


Amazingly, all these health care workers are telling you what happens, and you're telling them it ain't so.

Britt said...

What the hell do they know about healthcare? Only people with proper breadth of perspective and far reaching insight can make proper judgements on issues. The notion that mere rudimentary training in a given field qualifies one to comment on the operations of said field is terribly.

Besides, math is hard, and my political science degree makes me an expert on everything!

captcha is storbeer: to prepare for the coming collapse, one should storbeer.

Guffaw in AZ said...

@North - which President?

I worked overnight security in an 'Urgent Care' facility.
In addition to legitimate medical calls, a teen patient with an applicator of Absorbine, Jr. 'you know where' needed it removed.
Thankfully, the cap was still on.
His father believed him that he fell on it.

North said...

GFA: President Calcium

Billy Beck said...

"Scraped off the street..."

Jimmy Carter Blvd, 1990. By the time I'd crawled out to the street to switch off the ignition on my 650 Savage and then crawled back off the street, I was able to very confidently announce to the crowd which had gathered to hold me down: "It's cool. My right hip is broken. I'll behave myself now."

Only ambulance ride in me whole life, and one too many.

(wv -- "clownism")

karrde said...

Strange piece of news I heard about two weeks ago.

Seems the City of Detroit and their EMS dispatch service were no longer going to dispatch EMS to every emergency call.

It was touted as an effort to save money. Purportedly, they were training the operators to ask questions to determine whether the call was about a life-threatening emergency.

Dunno about everyone else here, but hearing that story made my ears twitch.

Have similar ideas been floated in other areas?

Matt G said...

He's considered a fiscal moderate, because he didn't call an ambulance to take him.

Jake (formerly Riposte3) said...

Karrde: It's called Emergency Medical Dispatch (EMD) and it's been around for at least 10-15 years. I was certified as and EMD dispatcher about 10 years ago (not anymore, though). It actually works pretty well, especially in systems that are overburdened.

The protocols used are pretty accurate, and are also designed to err on the side of caution - and they're certainly better than simple blind dispatching. Every time an ambulance runs lights and sirens, there's potential for an accident (people are amazingly stupid when an emergency vehicle gets behind them). It also lets you sort out the proper response order when you have simultaneous calls, especially if one is obviously BS.

Without EMD, every call gets an emergency response, and must be responded to in the order it arrives, because the dispatchers "aren't medically trained" to distinguish true emergencies from non-emergencies from BS. (I know, I know, but liability concerns can really suck sometimes.)

Jenny said...

"and it went earth, sky, earth, sky..."

Best sticker ever. :)

Anonymous said...

Blame the hospitals. And the doctors, the lawyers, the insurance companies, and certainly the mooks. And you'd be right; they all share the shame.

But...this shit, this ridiculous charade of a "system" of guaranteeing "equal" access ($1200 bucks a month medical ins. for wife and self and *my* access should be so equal) regardless of cost and regardless of need and regardless of any shred of ability or willingness to pay one's own way?

It's government. It's us. We did this to ourselves. And this and all manner of other insanely unsustainable behavior, is in the process of imploding before our eyes. Catastrophic collapse is coming sooner or later, and I think sooner than even those who watch in disassociated disbelief, might expect.

And God forgive me for thinking it let alone saying it...but that is good. Let the welfare state collapse. And let the real healing begin.


re: street-scraping...1976, got off work, trying to catch up to a friend and going way too fast down the main small-town drag on an amateur-chopped Honda 360 with no front stoppers. Car pulls out of parking lot from behind car, AT can't even slow let alone stop...well, you know the rest. Even back then a boy coulda died waiting for the doc to show up and find that the chrome trim strip from the Olds 88 had neatly entered the knee like a sword, going way deep and causing way pain, but with just a slit of an entrance wound. Couldn't walk right for a month or so, but no broken bones and just some heavy bruising of other body parts. Coulda been worse, but once is enough.

Ambulance Driver said...

Welcome to my world.

We have people who regularly use the ambulance as a taxi, when there is absolutely nothing wrong with them.

They'll call and fake an illness, and request transport to the ER across town, which just happens to be a block away from the liquor store/food stamp office/their homey Mookie's crib.

As soon as we get to the ER, they'll leave without being seen and walk to their intended destination.

Ambulance Driver said...

"The protocols used are pretty accurate, and are also designed to err on the side of caution - and they're certainly better than simple blind dispatching."

Jake, most of the research touting the accuracy of MPDS was done by Jeff Clawson or his cronies, and is about as accurate as Paul Helmke and the VPC's "research."

The only independent research I've seen on MPDS showed that, of the 32 dispatch cards, 16 had a positive predictive value of only 50%, and the other 16 had a positive predictive value of less than 50%.

In other words, half the dispatch cards were only as accurate as flipping a coin, and the other half weren't even that accurate.

Jake (formerly Riposte3) said...

"We have people who regularly use the ambulance as a taxi, when there is absolutely nothing wrong with them."

Ditto here. The nursing homes are bad about it, too. "He's doesn't have Medicare, and there's no non-medicare transport available on weekends." I don't care, that doesn't make [insert condition here] a 911 emergency.

"Jake, most of the research touting the accuracy of MPDS was done by Jeff Clawson or his cronies, and is about as accurate as Paul Helmke and the VPC's "research."

I'd never heard that before. Interesting. How recent is that information, and is it only for one company's cards? IIRC, when I went through it, there was more than one brand and the cards weren't always consistent from one to the other (and could be customized for local protocols, too). They were also heavily biased toward an emergent response. The company I worked for at the time also recognized that the cards couldn't cover everything and required all dispatchers to be EMT-I or higher so we would have the knowledge to use our own judgment (actually, it was VA EMT-C at the time, which was higher than NREMT-I and no longer exists / is now called VA EMT-I).

Still, 50/50 chances or less by the cards might be worth it if it allows the experienced former paramedic who's dispatching to tell the guy with the ingrown toenail that he'll have to wait for us to get a 4th or 5th truck out while our first units deal with the 3 car pileup with an ejection, even if he did call first. Right now, they're not even allowed to do that much - it's strictly first in, first out, and frankly, it's STUPID.

Big Brother said...

I worked in an ER for about 8 years. That's not the worst story of it's type I've seen.

How about calling an ambulance for a *sunburn* on a 14 year old kid?

It was just a 1st degree burn and the treatment was quanities of Calamin lotion and a couple Tyleonol. No IV needed even.

Rob (Trebor)

John B said...

only ER I ever did was cellulitus, and Diabetic Neuropathy that made my leg feel as if it were on fire.

Oh, and a male yeast infection.

Both were on holiday weekends where any other care was impossible.
I have driven people to the ER for legit complaints and they've been treated like drug seekers.

Admin actually came in, and told a reception worker she was fired, and legally enjoined from entering the hospital again, or from seeking employment, anywhere, as a health care worker.

My charge had a hot appendix.
She figured it for drug seeking behavior, and kept putting the file on the bottom, hoping we'd leave.

The deal we worked out had all care paid for, no lawyers involved, and I wouldn't burn down the hospital.
And the little bitch got fired.
She got off easy!

Flighterdoc said...

And don't forget the 'indigent' who have the latest smartphone/dataplan, who have the latest 'kicks' (what I grew up calling tennis shoes), who can't be bothered to GET OFF THE DAMNED PHONE when I come in to see them (finally, because I've been dealing with their colleagues all night), who demand food - something between a light snack and a full-course meal, while they're waiting.

I have seen 'indigent' (i.e., state-pay or no pay medical treatment) get wheeled out to the parking lot (because they're too ill to actually walk), to get to their vehicle (with the $3500 'spinners' on the wheels), to get another pack of cigarettes?

When I worked in California, fully 1/3 of my patients didn't pay - AT ALL. No insurance, no medicaid, no medicare, no cash, no real name or phone number. Now it's not quite as bad (maybe 1/6th don't pay).

So, the folks that show up with insurance, or cash, wind up paying for them.

And you know what really sucks? Most of them could get some sort of state aid (Medicaid) if they'd just register. But they'd rather put one over on society, get their entitlements...

Oh, and those patients that never pay, never have any intent to pay? I'm still liable if I screw up their treatment - or if they THINK I screwed up their treatment. We can be backed up 14 hours in the ED, and they complain to the state medical board about my treatment...because they had to wait for their free pregnancy test, or their work excuse, or because their kid has a cold.

I should have known...I was a paramedic before med school.

Christina RN LMT said...

Silver, you've never been to an Emergency Room. Obviously, I didn't make you play outside enough. ;)

Anonymous said...

Ambulance Driver,

I know that in most diagnostics, a PPV of 50% is considered very poor performance. But it's not bad performance for a screening test. If you can identify half of the bogus calls, that's a 50% reduction in unnecessary calls.

Now, if the NPV is only 50%, that's a real problem - if we're moving half of the real heart attacks to the bottom of the queue, then the protcol is a nonstarter.

Carmel IN

Matt G said...

Hey, Spud? When the paying customers are paying for the other half of the customers, prices are going to be high.

When the abusers who don't actually go for the intended purpose use the resource, and then don't even pay? The price goes up for those of us that do.

If you go to a Gap in the mall where half their stock is shoplifted every day, don't complain that the cost of a pair jeans is high there.