Friday, February 26, 2010

Healthcare: So Easy a Caveman Can Do It! (So why can't Congress?)

Are you as frustrated as I am? All this back and forth about health care reform, health insurance reform, "socialized" medicine, insurance company greed, cost containment, etc. and no one-- literally no one in government or the media has begun to address a few of the key issues that contribute to the current crisis. All the Democrats do is take the current system, include more people in it, and increase the cost for it. The Republicans have offered a sham alternative that also fails to address core issues that could be resolved in the private sector at great savings, if they had even the slightest amount of imagination.

There will be NO real health care reform or health insurance reform unless or until the key issues at the root of our crisis are resolved. Today we'll tackle the first and biggest issue: the over-utilization of the emergency room.

This is the single most broken and most costly aspect of the U.S. health care system and no one is addressing it. Experts say that somewhere between 30% and 50% of patients seen in the emergency room do not require emergency services. Instead they could and should be seen by a primary care physician or a routine (minor) care clinic (staffed by nurse practitioners or physician assistants).

People go to the emergency room for minor care for several reasons.
1. They haven't taken time to establish a primary care relationship, and suddenly are sick, and have nowhere else to go.
2. Related to #1 above, they have good insurance, their insurance pays for most or all of ER care, and it seems easier just to go to the ER.
3. They have no insurance and the ER cannot turn them away (by law).
4.They aren't sure how serious their symptoms are and don't want to wait to be seen.

There is no excuse for 1-3. Those who aren't sure can certainly go to the ER for triage, or they can go to a minor care clinic for triage. Either way, if they aren't appropriate for care at the level of the program doing triage, they would have to move to a more appropriate level of care.

But wait, under current statutes, the emergency room can't turn anyone away. They can ask them to wait hours while more critical patients are served first, but they are not allowed to turn anyone away. Hmmm! Might this be the crux of the problem?

It just might be. And because of the fact that hospitals are not permitted by law to screen patients out of the emergency room, 30-50% of the patients treated there, don't need to be there.

Experts say that the absolute minimum bill for ER treatment in this country is $700, all inclusive. On the other hand, minor care can be provided by paraprofessionals under MD supervision for $25 per encounter. If every inappropriate patient seen in the ER was charged only the minimum, that means that 30-50% of the total number of emergency room patients are costing the system approximately 3000% more than the appropriate level of care should cost.

Somebody do the math. I don't have the numbers yet, but it is obvious that if 30-50% of patients in the most utilized department of the typical hospital is costing three thousand percent too much, that has to be a major factor in the cost of health care and health insurance. Why isn't anyone talking about this?

The solution: First of all, simple legislation requiring emergency rooms to screen patients for medical necessity and turn away patients that do not meet criteria would solve the problem. The legislation should include immunity from malpractice liability for any actions taken in good faith. Gross negligence could and should still be actionable, but unless someone can prove that a hospital missed obvious indications of a critical condition, they could not be sued for turning someone away. There should be ample latitude for giving the benefit of the doubt if someone more examination is need to rule out a serious condition. But most of the inappropriate cases are easily identified. The patient complains of cold or flu symptoms, other minor distress, or comes in with a minor injury. All of which could and should be treated by a paraprofessional such as a paramedic, physician assistant or nurse practitioner. Instead of costing a minimum of $700, such care would cost $25.

But what if minor care clinics are not available? Trust the market. If emergency rooms were required to turn away non emergent patients today, there would be minor care clinics on every corner by tomorrow.

But it's not good enough to read this article and agree with it and leave it at that. If you agree with it, you need to contact every elected official on the ballot in your precinct and demand that they do as much as possible given their sphere of influence and responsibility, to get this issue into the national health care dialogue and on the legislative agenda.

The other thing you can do is share this article with others, and spread the word by any means you can. ***

A comprehensive plan proposal:


  1. Well stated John...Even for a politically no nothing like me. Explained so well, even this caveman could understand it.

  2. Great food for thought and sound solutions.