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(CBS News)   One reason for the high cost of emergency hospitalization in the America? "Superusers" that are clogging the nation's emergency rooms by treating them like party rooms for any little thing that ails them   (cbsnews.com) divider line 259
    More: Interesting, Villareal, emergency rooms, San Francisco General Hospital, emergency physician, primary care physicians, MedStar Washington Hospital Center, rubber bands, American College of Emergency Physicians  
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9775 clicks; posted to Main » on 15 Oct 2013 at 10:22 PM (38 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-10-16 12:31:07 AM

Ablejack: YouFarkingIdiot: fusillade762: But I've been assured by very serious people that our health care system is perfect as it is?

Few people think our health care system is great, let alone perfect.  Many people believe that Obamacare will make things much worse.  That's not the same thing as saying the system is perfect, great, or anything else including "in dire need of major changes".

Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.


Obamacare is the ONLY hope, are you just trolling?
 
2013-10-16 12:32:40 AM
The average lay person is so ill informed regarding healthcare.

Most 'superusers' usually have some form of insurance...the most common offender is medicaid patients. They often pay nothing for their ER visits and thus have not a single disincentive to wait to see their primary doctor. If you ask them why they are in the ER for a minor ailment, they are usually very up front that their doctor cant see them for a few day and they didnt feel like waiting. Its a matter of convenience and there is no cost to them.

Other forms of 'Superusers' come in the form of privately insured or medicare patients with some variety of personality disorder which drives their need for repeated er visits. Typical examples are the chronic pain patient who is never given enough pain medication or the borderline personality patients that fabricate a variety or nonsepific symptos in order to get attention and create a disturbance.

The fear of legal consequences permits the continuation of this behavior at the detriment of care to others. Even without all of these people abusing the system, emergency services are already struggling to meet demand.

And if I can give one piece of advice, it is for lay people to please stay out of healthcare decision-making. The reality is that most people are ignorant of the actual problems and their good intentions often only make things worse.
 
2013-10-16 12:33:39 AM

Adolf Oliver Nipples: Ablejack: Actually Adolf, it's people like you that get hosed. The doctors and hospitals get paid; by you, others with insurance, and the government (you again). The US government pays more for healthcare per capita than the French government does.
/if only our healthcare were as good.

Infernalist: Also, I don't give a single fark. The lives of American citizens are more important that a rich fark getting richer.

Yep, rich. That's it.

For every doctor you see driving a Beemer and jet-setting there are 10 struggling the same as you. The arrogance of the position you guys are taking is astounding. A doctor owes you nothing. NOTHING. As much as any other person in the workforce, he earns his living. Yet you demand his charity, or, more to the point, his blood, out of some absurd sort of social justice which doesn't exist and isn't anything of the sort under any circumstances.


Now you are just rambling on about things you've made up. I have healthcare insurance. It's just that I understand the system is failing.
 
2013-10-16 12:34:48 AM
When a super user comes in, stick their ass in the bathroom and forget about them..... they'll leave sooner or later.  Or, die - either way, problem solved and cheaper healthcare for everyone.
 
2013-10-16 12:37:22 AM

mikeray: Ablejack: Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?


Well, the healthcare industry was toppling the economy. Something had to give. Obamacare makes the system more efficient rather than scrapping it and going public.
 
2013-10-16 12:39:28 AM
It's the Pareto principle in another dimension. 99% of the population uses 1% of ER resources. The other 1% of hypochondriacs, homeless drunks and addicts, and maybe a smidgeon of new mothers prone to panic burden the system.

The hypochondriacs need to be treated elsewhere (or given a course on how they'll get MRSA in the ER), programs have experimented with giving the most expensive homeless subsidized apartments, and new mothers need access to educational programs.
 
2013-10-16 12:40:11 AM

Ablejack: mikeray: Ablejack: Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?

Well, the healthcare industry was toppling the economy. Something had to give. Obamacare makes the system more efficient rather than scrapping it and going public.


Now that's just crazy talk. Good day sir, good day.
 
2013-10-16 12:41:39 AM

mikeray: Ablejack: mikeray: Ablejack: Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?

Well, the healthcare industry was toppling the economy. Something had to give. Obamacare makes the system more efficient rather than scrapping it and going public.

Now that's just crazy talk. Good day sir, good day.


How so?
 
2013-10-16 12:42:37 AM

mikeray: Ablejack: YouFarkingIdiot: fusillade762: But I've been assured by very serious people that our health care system is perfect as it is?

Few people think our health care system is great, let alone perfect.  Many people believe that Obamacare will make things much worse.  That's not the same thing as saying the system is perfect, great, or anything else including "in dire need of major changes".

Obamacare is the only hope for the insurance based system. Without ACA, the US would socialize medicine much more quickly; out of necessity.

Obamacare is the ONLY hope, are you just trolling?


Did you stop reading before the "insurance based system" part?
 
2013-10-16 12:45:46 AM

Ablejack: Now you are just rambling on about things you've made up. I have healthcare insurance. It's just that I understand the system is failing.


I also understand the system is failing, and for years I fought against the idea that we should socialize medicine because I didn't want MY money to go to the freeloaders. I had this great big highfallutin' idea that I was earning it and I owed nobody anything. I don't believe that anymore. More to the point, I don't see how I ever did believe that. Now I am completely 180 degrees from where I was before, so much so that I don't think Obamacare goes far enough. In that you and I are in complete agreement.

That does not mitigate the fact that doctors, even the ones that do drive Beemers and live in mansions, do a job that I am both incapable and unwilling to do. It is not right to assert a claim on their labor because they are "rich". You want to be "rich"? Go to school and earn it. I think you'll find that it doesn't pay off quite as well for everybody as you've been led to believe.

This isn't so much about you or your comment as much as it is the idea that we have some sort of right to lay claim on someone's work. The other guy I quoted said exactly that. Your comment about high cos per capita merely implied it. While you're right about the high costs, how much of that trickles down? Healthcare is like any other industry, the people at the bottom always suck hind tit.
 
2013-10-16 12:46:03 AM

Rev.K: Well, if there's one thing we know it's that the United States put a man on the moon, but healthcare can just never be fixed.

Never ever ever.


Well sure, that would be soshulizm and we can't be having that.
 
2013-10-16 12:53:52 AM

Fano: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

Not one statement in your post is correct, regarding anyone other than you.


No?

"Despite the widespread belief that these patients can be directed elsewhere, these patients for the most part need to be treated when they come in,"
 
2013-10-16 12:54:32 AM

nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?


Your rationalism has no place in America.
 
2013-10-16 12:54:53 AM

OscarTamerz: [www.screeninsults.com image 500x368]
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!


So original...
2/10
 
2013-10-16 12:55:39 AM

Infernalist: phunkey_monkey: OscarTamerz: [www.screeninsults.com image 500x368]
Thanks for the free healthcare estupido gringos. Send the bill to general delivery TJ and a check will be in the mail sooooon. I'm sure glad I voted for Hobama!

Hit the nail right on the head.

Most if not all illegal aliens are taught to use the emergency room for all their medical care.

There's just something about the Main page that drags out the retards.


He's not that wrong. When I got bitten by a raccoon in D.C., I was in the process of traveling, and headed to Florida to get my exam in the ER. When I asked how much it would cost (I didn't have insurance at the time) the doctor asked me if I could pay. I said "of course, I'm not a deadbeat." He laughed and then said, "then you'll be paying a lot." He explained to me that they had tons of illegals who didn't pay squat, therefore, everyone else had to pay MUCH more.
 
2013-10-16 12:58:16 AM

HotWingAgenda: nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?

Your rationalism has no place in America.


I'm sorry but you are in the wrong thread to be talking about personal responsibility . What is that and who is going to pay for it for me?
 
2013-10-16 12:58:28 AM

TheMega: When a super user comes in, stick their ass in the bathroom and forget about them..... they'll leave sooner or later.  Or, die - either way, problem solved and cheaper healthcare for everyone.


Asshole.
 
2013-10-16 01:02:26 AM

ginandbacon: Fano: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

Not one statement in your post is correct, regarding anyone other than you.

No?

"Despite the widespread belief that these patients can be directed elsewhere, these patients for the most part need to be treated when they come in,"


The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?
 
2013-10-16 01:05:37 AM

HotWingAgenda: nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?

Your rationalism has no place in America.


Cool!  Poor people dying in the streets!
 
2013-10-16 01:07:56 AM

Reverend Monkeypants: HotWingAgenda: nickdaisy: Here's an idea: how about everyone take care of their own bills?  Get the state out of it completely. If you want to pool resources with some like minded folks and spend money for insurance, go for it. Or if you want to just pay as you go, or save up and pay, or save nothing and then bleed out when something happens-- go for it.  Similarily, if you want to start a charity to fix clef lips or teach retarded kids to skateboard-- go for it.

That's the American way. You succeed or fail based on your own ability.  Should be no different for health care than it is for education, quarterbacking, or meeting chicks. Unfortunately, under today's quasi-socialist system, everybody gets an A, everyone gets a chance to play quarterback, and if you can't find a date to the prom it's because you "suffer" from Asperger's and are a "victim" of bullying.

More person responsibility, less collectivism.

However, IF you insist on turning us into the USSA, at least go full throttle. The current system is NOT free market and Obamacare is NOT true socialism. Health care (including Obamacare) is driven by corporations that are so in bed with the federal government that they have corrupted any sense of altruism, yet at the same time they are not true market actors.  We're getting the worst of both worlds.

Who's with me?

Your rationalism has no place in America.

Cool!  Poor people dying in the streets!


As opposed to what?
'
 
2013-10-16 01:09:26 AM
So taking full advantage of the Bush national health care plan?
 
2013-10-16 01:27:45 AM
it would also help if ER doctors would grow a farking spine and kick out the patients who are well known to use the ER for food and shelter. Most of my on call conversations go something like this:

ER Attending:  Hey, this guy say's he suicidal
Psych Consultant: Yeah, he's a well-known malingerer who uses psych wards as shelter.  He's full of shiat.  You can send him on his way.
ER: But he says he's SUICIDAL!?
Psych:  yeah, he says that every time he comes into an ER.  He gets himself admitted, gets a few days of sandwiches, gets bored, and moves on to a new hospital
ER:  So can we admit him to your psych floor?
Psych:  Umm, no.  we're not a homeless shelter.
ER:  So what happens if he kills himself?
Psych:  He won't. Our whole department knows this guy.  He's been coming in with the same feigned psych complaints for the last 10 years. He says in psych wards because they're more cozy than the city's homeless shelters. Not once has he had anything close to a suicide attempt
ER:  But he says he has "Schizoaffective Bipolar Disorder"
Psych:  (gives look of "are you a farking moron?)
ER:  Look, I'm really concerned about my liability, can you just admit him?
Psych: Look, it's Friday night, and we only have two beds on our unit.  We're not wasting one on a guy who is well known in the entire city of ____ to be faking his symptoms as a means to get sandwiches. If we run out of beds and one of our established patients shows up between now and Monday morning, we're putting that patient's life at risk if we transfer them to another hospital.  We've had enough problems with community hospitals abruptly stopping clozapine on our patients this year, and I'm not about to let that happen because you're too much of a pants-pisser to make a god damn necessary clinical decision.
ER:  Fine, I'll admit him to telemetry.


...and that's how your healthcare dollars are spent.
 
2013-10-16 01:53:02 AM
uhh, obvious tag missing?  Hospitals are already legally required to treat everyone who comes to the ER.  Sharing the cost for a privilege everyone has is not that crazy.
 
2013-10-16 02:03:18 AM

GreenAdder: Can't we just disable root access at the admin level?


Surprised it took so long for a su comment
 
2013-10-16 02:23:20 AM

Fano: The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?


The Tea Party caucus?
 
2013-10-16 02:29:50 AM

ShawnDoc: Fano: The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?

The Tea Party caucus?


Yes California, they will just be normal folks there.
 
2013-10-16 02:52:10 AM

ransack.: GreenAdder: Can't we just disable root access at the admin level?

Surprised it took so long for a su comment


This incident will be reported.
 
2013-10-16 03:08:35 AM

fickenchucker: And where do some of you live--six hours in the ER? The longest I've ever waited, start to finish, is maybe 90 minutes, and I'm out the door or watching my kid go into appendectomy surgery.


5 hours, last week, University of Michigan, medium sized city, 8 PM, weekday, damn good hospital and thankfully my insurance doesn't discriminate and covers all ERs (pathetic I had to call and check).  Went to urgent care first and they gave me a do not pass Go go directly to the ER directive.


I did get periodic progress throughout though (triage nurse at 30 minutes, in a room an hour after, registration person, nurse, etc., treatment proper between hours 3 1/2 and 5.  The periodic progress + Walking Dead marathon + in a room = I was cool.

Longest I've waited just to get a room and an exam beyond "pain 1-10" and temperature (while in the waiting room) was in a different hospital, 6 hours, and that was with urgent care (again, my first choice is not the ER if I can help it) ready to call an ambulance if my SO didn't drive me there.

Congrats.
 
2013-10-16 03:10:44 AM

Longtime Lurker: Look, I'm really concerned about my liability,


Yup, there it is.

/facepalm
 
2013-10-16 03:24:35 AM
Last year, drove into town to pick up my after after some cancer tests,pulled into the ER, and it looked like it was standing room only when I walked in. What a mess! I asked the attendant, and she said it always gets like that after normal business hours. I'm of the impression "there's nothing on TV tonight, let's hang out at the ER".
/Scum.
//Uninsured.
 
2013-10-16 03:32:12 AM

Fano: ginandbacon: Fano: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

Not one statement in your post is correct, regarding anyone other than you.

No?

"Despite the widespread belief that these patients can be directed elsewhere, these patients for the most part need to be treated when they come in,"

The article stated for the most part they were drunks and mental patients. Can we do it cheaper by having a place for drug abusers and nuts to go to, that ISN'T the ER?


Wow, it did? Where? Because I read it again, and I nowhere saw the words "drunks and mental patients" and the only thing even close to what you said was in reference to ONE program in ONE hospital which said, quote:

According to Villar, many patients are using the ER to access other services, such as substance abuse treatment.

Now, also according to the article, quote: He says although his program had success, it came to a stop once the research finished. Villar said the problem was an issue of resources, including money and personnel.

So a) for the most part, the chronic ER users are not, according to the article "drunks and mental patients," they are chronically ill with a variety of illnesses, including mental illness and substance abuse, and b) yes, we could in fact make services available cheaper and free up ER space; unfortunately kindly people like yourself don't seem to want to fund people like Dr. Villar; instead they would rather criminalize drug use and stigmatize the mentally ill so they have nowhere to go BUT the County ER.

Do you begin to see the problem here, or do I need to use smaller words for you?
 
2013-10-16 04:00:23 AM
If only there were some program ... maybe funded and run by the government ... that assured that Americans got affordable access to basic healthcare, regardless of their employment status.
 
2013-10-16 04:12:34 AM

Mitch Taylor's Bro: I'm willing to be that most of those "superusers" should be going to urgent care, not ER


This reminded me of something - if you don't have insurance but DO have a reasonable amount of assets 'urgent care' at the proper clinic* can be far cheaper than an ER visit.

I have to make the disclaimer because there's still not enough 'competition' between health care providers, nor enough disclosure of billing practices and reasoning.  It's quite possible to have a urgent care visit that's under the cost of most copays/deductibles as is.

runwiz: I actually read something that had contrary conclusions.  It said that while superusers clogged the system their problems were often easy and cheap to treat and were profit makers that subsidized the high cost of expensive equipment.  If emergency rooms only treated true emergencies there would be too few to offset the cost of operating the emergency room and would result in either higher costs or the closure of ERs.  The problem comes from the fact that many superusers are uninsured and thus the hospitals cannot charge as much as they would like.


Well, a 'superuser' in the form of somebody with a chronic condition will indeed likely be fairly cheap to treat in the sense that you won't need a huge amount of diagnostics/doctor time, as they'll likely already know what's wrong with them and the necessary course of treatment.

However, on the equipment - there's a reason that all ER's I know about are attachments to a hospital.  The equipment within an ER for the most part is necessary for the hospital anyways, and I think that the marginal cost for setting up another exam room or even operating theator is quite reasonable if you look at it from a business angle vs a personal one($100k is often nothing to the large businesses that most hospitals are, $100k is a lot to most individuals).

Of course, my personal preference is that we don't involve healthcare plans masquerading as 'insurance' from dollar 1 anyways.  If most people paid for most of their own healthcare I think costs would drop substantially - the insurance companies impose an extreme amount of overhead, and not just in their policies.  As a result of them healthcare providers have to both set up extremely expensive billing departments to get money out of them, but are also insulated from standard competitive pressures that result in better services at lower costs.

Shop around a bit in medical realms where people still normally pay themselves, such as for plastic surgery, laser vision correction, and such and you find that costs tend to be quite reasonable.  Whether that's because they wouldn't exist if they weren't reasonable could be argued, but I remember the price drops these procedures have undergone as they went 'commercial'.
 
2013-10-16 06:06:10 AM

OtherBrotherDarryl: Use urgent care centers!


Serious question--do urgent care centers have to take people irregardless of ability to pay the way emergency rooms do?
 
2013-10-16 06:25:45 AM

Firethorn: Of course, my personal preference is that we don't involve healthcare plans masquerading as 'insurance' from dollar 1 anyways.  If most people paid for most of their own healthcare I think costs would drop substantially - the insurance companies impose an extreme amount of overhead, and not just in their policies.  As a result of them healthcare providers have to both set up extremely expensive billing departments to get money out of them, but are also insulated from standard competitive pressures that result in better services at lower costs.

Shop around a bit in medical realms where people still normally pay themselves, such as for plastic surgery, laser vision correction, and such and you find that costs tend to be quite reasonable.  Whether that's because they wouldn't exist if they weren't reasonable could be argued, but I remember the price drops these procedures have undergone as they went 'commercial'.


One thing health care plans provide is discounting. If you have insurance and even if you are paying out-of-pocket with a high deductible, hospitals will bill you at a much lower rate for care (saw a hospital stay of $30k get billed to Blue Cross for $9k). With no insurance you pay full retail. Also you can set up an HSA with high-deductible insurance so your health care is tax-free. Without an HSA you pay after-tax dollars and you can't even start to write it off until it's around 7% of your income.
 
2013-10-16 06:50:26 AM

ginandbacon: Mitch Taylor's Bro: ginandbacon: Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.)

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.

It is the point of access for those of us who have major crises. That's sort of the point of them.

You lack reading comprehension. Got it.

How is that?

You start off with "most superusers are like you..." then talk about how your chronic conditions force you to go to ER a lot. Then you move into talking about how some people go to ER when they should be going to a primary care physician, but it's not that common, then say that no one goes to ER for minor stuff.

Is that accurate so far?

So I highlight the least ranty part of that paragraph, "No one spends six hours in an ER for something minor," and copypasta-ed that sentence FTFA that describes you to a "T" to point out that the article agrees with your original statement that "most superusers are like you." Maybe I should've copypasta-ed the three paragraphs that preceded it? Maybe you could go back and re-read TFA and let me know if that would've helped. Or m ...

I get the feeling you and I probably have very similar goals for health care for our fellow citizens. 

I think this article sheds a slightly better light on the issue as evidenced by this quote "While they represented just .2 percent of all patients, they accounted for 4.5 percent of all emergency department visits in the region.
The new studies found that frequent users typically have serious medical issues."

http://www.healthpolicysolutions.org/2012/10/10/er-frequent-flyers-n ee d-more-care-not-less/

"Superusers" aren't really a big burden on ERs and most of them are there for a very good reason.

As I mentioned, I am really lucky. I have conditions that I have learned how to manage for the most part to keep me out of the ER and fantastic health insurance, BUT there are times when I need that critical care. I don't think anyone should think twice about seeking out that care when they need it just because the media has coined a nasty term to describe them. (Or me.) The next time I wake up on a sidewalk from low blood pressure or end up in acute renal failure after vomiting for 5 days, I will end up in the ER. And that's exactly where I should be. I could get even more graphic but it seems unnecessary. 

And I need to stress again that I am one of the lucky ones. Except for the renal failure and the pulmonary embolisms last spring, I really don't have anything to worry about. And I, unlike millions of very ill Americans, I don't have to worry about how to pay for my many trips to the ER.

And just to wind this up, I really do think you and I are probably on the same side on this issue if we just had a chance to sit down over a drink and hash it out.


If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.
 
2013-10-16 06:52:02 AM

hardinparamedic: Marcus Aurelius: hardinparamedic: Free treatment in the ER?

That's the joke, right?

/EMTALA is not free.

Don't even get me started on the ambulance ride.

Which in an ideal world of taxpayer funded third service EMS agencies would be free too.

Thanks Obama.


It still wouldn't matter. 30million illegal aliens would still be using emergency rooms as first line medical because they work for cash and don't pay into the standard taxing systems.

You'd have to try to push a VAT tax to cover it, which wouldn't be a bad idea if you could get some cost controls in place.
 
2013-10-16 07:12:46 AM

Ablejack: Adolf Oliver Nipples: Well, we can now dismiss your opinion. Someone go to school for 8+ years, learns a highly demanding discipline where failure means somebody dies or is crippled for life, incurs a six-figure debt, and then puts themselves out there so that people can use them because "they can afford it"? No wonder we have a doctor shortage, who would put themselves through that just so people like you can hose them. There's absolutely no justice in that.

Actually Adolf, it's people like you that get hosed. The doctors and hospitals get paid; by you, others with insurance, and the government (you again). The US government pays more for healthcare per capita than the French government does.
/if only our healthcare were as good.


Look up when the French got air condictioning in their hospitals.
 
2013-10-16 07:26:29 AM

Gyrfalcon: Do you begin to see the problem here, or do I need to use smaller words for you?


Heh. I've had you favorited for a very long while and posts like this are exactly why.

Firethorn: Well, a 'superuser' in the form of somebody with a chronic condition will indeed likely be fairly cheap to treat in the sense that you won't need a huge amount of diagnostics/doctor time, as they'll likely already know what's wrong with them and the necessary course of treatment.


This is actually really true--unless something funky is going on like the time I got the blood clots in both lungs (I knew something was very wrong, I just didn't know what) I can pretty much show up and tell the attending what they need to do to treat and release me. My first few visits were ridiculously costly because no one in the room knew what was going on so they would order every test on the books and admit me.

These days I pretty much show up with a treatment plan and most of the time, depending on which ER I end up in, I can get in and out fairly quickly. And most EMTs will take me to the hospital I prefer which is in the same network as my PCP so they have my records which also helps speed things up a lot. I'm also incredibly compliant and basically pretty pleasant to deal with so I tend to get seen right away. Most of the staff in ERs are usually really happy to treat me since I'm not hard to work with. I've even become close friends with a nurse I had during one of my admissions.

Again, I should point out that most of what I'm dealing with is not life-threatening unless I manage it badly and I am learning how to not do that so I am a patient who is fairly easy to deal with. Most of us frequent flyers come in knowing exactly what needs doing and we do it with good cheer which makes us kind of the darlings of the ERs.

And I infinitely prefer not to be there but it's a whole heck of a lot better than being admitted and having to deal with hospital food for a few days. I'd rather go to the ER sooner and avoid that. Which is also cheaper in the long run.
 
2013-10-16 07:39:47 AM

AlwaysRightBoy: If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.


Ah no! I have tutored kids in reading but it is a volunteer gig. It's insanely gratifying and something I would recommend to anyone. I have had insurance through the private sector and the public though. Both were wonderful. My private sector insurance was top notch. I think it was $10 to see my PCP, $40 for ambulance or ER visits, and $5 for meds. Admissions and diagnostic tests were free. I pay less with my gubmint one but it is a little more restrictive and I can't just do whatever my PCP wants whenever we want to. I have no real complaints though. Everything I have needed on it has been covered. The private insurance I had when all of this first started really needing insurance was through a very well known university and was one of the things that made up for the thin-as-air paycheck. That and the time off were hard to beat.
 
2013-10-16 07:45:55 AM

Mitch Taylor's Bro: ginandbacon: "Superusers are a small but expensive group: One large study conducted from 2009-2012 at a Los Angeles hospital noted that 99 percent of ER visitors come in fewer than 10 times a year, with nearly 67 percent coming in just once. But, the remaining 1 percent of visitors accounted for thousands of visits in one year."

This paragraph is completely devoid of meaning.

Most "superusers" are like me, people with chronic conditions that put them in crisis at least a couple of times a year. I have excellent insurance (thank goodness) but I have 4 neurological conditions that have me dialing 911 not infrequently. Some people are certainly using ERs when they could use a PCP but that's not really that common. Ers suck. Hospitals suck. I've discharged myself against advice from both because I knew they were only keeping me because they didn't know what to do or because I would be an interesting case for the students the next morning. No one spends six hours in an ER for something minor. (Six if you're lucky. I've spent that long just waiting to be seen and then another six for tests before being admitted.) 

I don't understand why we keep vilifying patients and championing the assholes who profit off the ones they can and try to bankrupt the ones they can't exploit.

You must've missed this key sentence:

"There are patients who have serious medical conditions who see the ER as the point of access," Dorner said.


In the state where I live, people on Medicaid are limited to those doctors who choose to accept the small, normally late payments from the State. This can make it very difficult to get an appointment, so very often they're waiting until that little ailment gets bad enough that they can't put off a visit any longer, then heading to the ER.

Sure, ER visits are much higher than regular office visits, but hey, the state's paying the bill so who cares?
 
2013-10-16 07:54:35 AM

flondrix: OtherBrotherDarryl: Use urgent care centers!

Serious question--do urgent care centers have to take people irregardless of ability to pay the way emergency rooms do?


Urgent care centers still cost more than a family doctor will typically charge up front per visit for the uninsured, and unless they are within 100 yards of an ER, or meet certain requirements outlined under EMTALA, they are under no obligation to see you or treat you if you cannot meet the up-front fee. (Typically 75 to 200 dollars)

jaybeezey: It still wouldn't matter. 30million illegal aliens would still be using emergency rooms as first line medical because they work for cash and don't pay into the standard taxing systems.


Uh, you might want to re-think that position statement.
 
2013-10-16 07:56:36 AM

ricochet4: TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.

citationneeded.jpg


No citation needed.  This has been going  on for a LONG time.  Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency.  Let them go to the local welfare clinic the next day.
 
2013-10-16 08:08:23 AM

jestme: In the state where I live, people on Medicaid are limited to those doctors who choose to accept the small, normally late payments from the State. This can make it very difficult to get an appointment, so very often they're waiting until that little ailment gets bad enough that they can't put off a visit any longer, then heading to the ER.

Sure, ER visits are much higher than regular office visits, but hey, the state's paying the bill so who cares?


That's interesting. My BF has worked in social services here in MD for almost a decade and Medicaid is one of the favorite insurances of healthcare providers here. It pays for pretty much everything and pays fairly quickly. There is another program run by the state (PAC--I forget what it stands for, something adult care?) that is notoriously bad to work with, but most of those patients will be upgraded to better plans with ACA. In fact, he's applying for a grant position to do outreach in the homeless community to get them enrolled in Obamacare. They are very hard to get through to because of how much personal information they have to give out to take advantage of any kind of public assistance. I gather most of them are really reluctant to participate in any way even if it benefits them to do so. Not to mention the fact that many of them don't even have possession of their birth certificate and social security cards which they need in order to get into a benefit program. I'm not sure how many even have ID cards.

But he is very excited by the expansion this program offers to a very underserved client base.
 
2013-10-16 08:08:53 AM

sno man: And yea, not free.  But not bloated full of for profit middle men that only add cost to the system.  We can do it for "free" for a tickle over half the US cost per capita, with a tenth of the per capita that should by volume, reduce cost...


Nothing is ever free, especially when the government does it. If there was a single-payer system (government bureaucracy), as soon as the $$$ started rolling in they would spend it on something else - just like how they are bankrupting SS, Medicare, etc.
 
2013-10-16 08:09:59 AM
Don't biatch about them. These are the people you're trying so hard to help
 
2013-10-16 08:10:54 AM
Patient: Get me some primary care

ER: What? Get it yourself.

Patient: sudo get me some emergency care

ER: Okay.
 
2013-10-16 08:12:28 AM
Fark professional health care, I keep my own emergency kit handy:

www.colourbox.com

www.thedrunkgnome.com
 
2013-10-16 08:12:53 AM

thegreatmurgatroid: The average lay person is so ill informed regarding healthcare.

Most 'superusers' usually have some form of insurance...the most common offender is medicaid patients. They often pay nothing for their ER visits and thus have not a single disincentive to wait to see their primary doctor. If you ask them why they are in the ER for a minor ailment, they are usually very up front that their doctor cant see them for a few day and they didnt feel like waiting. Its a matter of convenience and there is no cost to them.

Other forms of 'Superusers' come in the form of privately insured or medicare patients with some variety of personality disorder which drives their need for repeated er visits. Typical examples are the chronic pain patient who is never given enough pain medication or the borderline personality patients that fabricate a variety or nonsepific symptos in order to get attention and create a disturbance.

The fear of legal consequences permits the continuation of this behavior at the detriment of care to others. Even without all of these people abusing the system, emergency services are already struggling to meet demand.

And if I can give one piece of advice, it is for lay people to please stay out of healthcare decision-making. The reality is that most people are ignorant of the actual problems and their good intentions often only make things worse.


You're mostly right except...
1) Medicaid is not insurance. It's an indigent healthcare program.
2) Your point about chronic pain patients wrongly puts the blame on anyone other than the patient for running out of meds.
3) It sounds like wherever you are doesn't have a large population of illegal immigrants. Here, they're the majority of ER patients.
 
2013-10-16 08:18:19 AM
What a Superuser may look like.
 
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