prediction for 2015 (or sooner)

[medicboy]

I have come to the belief in the last few years that there will be a complete and total failure of the emergency health care system sometime in the next 10 years.  Unless there is a major change in the way the medicare system is run.  There are all ready some ambulance companies going out of buisness and even some hospitals looking for a loophole that will allow them to dump the ER side of buisness and just stay in Med-surg, and ICU.

Just an observation.

[GtoRA2]

Medicboy
 What are the problems that are causing this. Why are emergancy rooms such a problem?

[Lizking]

We are losing mergency rooms at a rapid rate.  I think it will be closer to 3-4 years.

The problems include:

People with no money or insurance who use the ER as a clinic.

Liability Insurance premiums.

Refusal of medical students to work in ERs for various reasons.



On our local news today, they cited a statistic for uninsured residents of Travis county: 25%.  I have nothing to back this up with but my personal experience, but of those 25%, I would guess that 15-20% are illegal aliens.

[Steve]

People with no money or insurance who use the ER as a clinic

This is a huge problem in Arizona.  The many illegals here do not have health insurance so every time one of them  gets a runny nose or a hangnail, they go to the ER since our ER's cannot turn people away as regular doctors can.

[medicboy]

Back in 1993 or 94 the panel that determines the financial layout of medicare (called HCFA "hic-fa") decided that emergency medicine and paramedics specificaly cost medicare too much money and came up with a plan to systematicaly eliminate medics from moderen health care.  This plan was put into operation in 1999 and has been impliminted in stages.  Each year medicare has "adjusted" the payment schedule for ambulance support and emergency payment.  Of course this adjustment has gone down every year so that now we only get about 20% of what is billed, where it used to be close to 40%.  Medicare makes up about 60-70% of most ambulances total income, so that 70% was just cut to 35%.  Now most major insurances are following suit and cutting payments.  During this metting of the HCFA in the early 90's the director (some lady and I dont remember her name) actualy said something to ther affect of:  Paramedics are too expensive, people that 20 years ago would have never made it to the hospital alive (thus costing them almost nothing) are now arriving in ER's alive and spending weeks in ICU, running up hundreds of thousands of dollars worth of bills.  We have to find a way to get rid of paramedics.    
         As far as air ambulances go you use to see the hospital based helicopter programs flying all the latest aircraft.  Not any more, due to changes in the part a, part b medicare almost 80% of reimbersiment for hospital based aircraft was cut out.  Now they are either flying aircraft like the EC-120 or the AS 350-b2/b3.  Cheaper single engine aircraft.    Most privet air ambulances (like the one I worked for in Cali) already flew these single engine birds.  

Cost of insurance, maint, payroll have done nothing but go up, gross income has been cut by about 1/4-1/3 in recent years, just dont think most of these privet companies can do this much longer.   (Most hospitals and ambulances are privetly owned.)

[moot]

What Steve said.
I had a pretty thorough food poisoning the morning after a party, and while trying to stay conscious and not throw up too much waiting in line at the Tempe St Luke's ER, all I remember is mexicans telling jokes and a few of them looking a little tired taking their time passing ahead of me.

[Goth]

Medicboy, don't take this the wrong way.

I think a lot of problems extend from hospitals charging waaaaaay too much money to the people that have insurance and can pay their way. Look at doctors wages, nurse wages and even the wages of ambulance/emergency responders.

Doctors in all truth could cut their pay in half and still live nicely. However, one reason they charge so much is because of malpractice suits.

Nurses, skilled and educated as they are, are paid a heck of a lot of money. Why, because there is a shortage?

First responders, paid too much. You probably think I have no business talking about that, but in all actuality, I could have taken the EMT test after leaving the military and become one, but there is no way in hell I want to do that work. Is there a shortage of EMT's? I don't think so, but there is a lotta BS to put up as one.

Hospital equipment-outrageous costs and equally outrageous billings. This year alone I went through 4 MRI's, and if I had not had insurance I would have been a huge burden on someone else because those little 20 min tests are expensive....too expensive.

The whole health care system is fubar, and it starts with CEO's making too much. It might very well becoe federalised, and God help us if it does, but until prices come down I don't see it getting better. The industry needs to start self regulating itself.

[Steve]

skilled and educated as they are,

Umm doesn't one acquire skills/education in order to get paid more?

Your typical RN makes something in the 40's.  Do you really think that is being overpaid?

[rpm]

Originally posted by Lizking
We are losing mergency rooms at a rapid rate.  I think it will be closer to 3-4 years.

The problems include:

People with no money or insurance who use the ER as a clinic.

Liability Insurance premiums.

Refusal of medical students to work in ERs for various reasons.



On our local news today, they cited a statistic for uninsured residents of Travis county: 25%.  I have nothing to back this up with but my personal experience, but of those 25%, I would guess that 15-20% are illegal aliens.

So that would leave 80-85% of that 25% that are not illegals. There are LOTS of uninsured workers. Most working for small buisnesses that don't offer benefits. Most of those that are insured are underinsured.

For your 3 points you offered a national healthcare system would eliminate these issues.

[Goth]

Originally posted by Steve
Umm doesn't one acquire skills/education in order to get paid more?

Your typical RN makes something in the 40's.  Do you really think that is being overpaid?

In a way I do and in a way I don't....now let me explain.

Nurses have a great deal of knowledge and probably handle about 90% of the doctors load, which makes you wonder why the doctors earn the amount they do. Are nurses trained too much and should doctors handle more of the load? That is the true question. For the load that nurses handle, they are paid appropriately.

Why stop there tho...why not go a slightly different route and get a doctorate instead of RN? A nurses anatmoy and physiology course is very intensive, yet what's to stop them from going pre-med?

I have a good amount of respect for health care practicioners from Doctor on down to EMT. Home health care and RN's are important in todays society. Are they as important to the degree we hold them to?

Look at your typical hospital staffing of just care providers from orderlies to nurses to doctors to candy strippers (if they still have them). For a nurses knowledge and capabilites, do you think they are being used to their fullest on normal wards? Could lower paid orderlies with proper supervision carry out many of the duties?

I'm certainly no hospital administrator, so I sure as hell don't know all the ins and outs of everything. But a revamp is surely needed and instead of going to the strictest of defenses, ask yourself is the system working as it is now.

[Lizking]

No RPM, I knew when I type it that it wasn't the best form, but what I meant was that 15-20% of the uninsured in Travis County are illegals.

[rpm]

Originally posted by Lizking
No RPM, I knew when I type it that it wasn't the best form, but what I meant was that 15-20% of the uninsured in Travis County are illegals.

And that leaves 80-85% of the uninsured that are citizens. Just using your numbers.

[Lizking]

15-20% of the of the residents of Travis county are both illegal and uninsured.  Is that clear?

The only stat I could find to back it up is that 28% of the residents of Travis County speak a language other than English at home.

http://quickfacts.census.gov/qfd/states/48/48453.html

[rpm]

Wow, I speak 2 languages. Am I illegal?

[Lizking]

Do you speak your second language at home?  That means as your primary language, my disengenous friend.