And that's one of the first places to look for savings. If the government is going to regulate anything, that's a great place to start. There needs to be a sign on the ER door directing patients to the nearest urgent-care clinic, preferably one next door.
This could be done very easily and would make a real difference in the quality of care and the cost to the indigent patient.
But the realty is that without that patient flow into ERs, you're going to have ERs closing down all over the place. They (hospitals) say they hate it. But the truth is that money has to come from somewhere. While hospitals claim they lose money on ER operations, there is some reason they don't staff a minor emergency clinic next door. I suspect when you figure the ER P&L "all-in" they end up being a contributor, not a detractor, from the hospital's bottom line. A study a few years ago showed that 20% of California's hospital admissions come from their emergency departments, yet California hospitals were claiming they "lose money" on ER operations.
When you go to the local ER here it is $500 to get in the door. Drugs are marked up not merely 10 or 20 times their cost, but 50. Supplies, same thing. I just do not buy that they're not making money. In one of our hospitals it is a small operation owned by a large hospital corporation. If they weren't making money off it there is no reason for not just shutting it down and they would do so. The other, bigger, Sisters of Mercy hospital has a fine ER facility a couple miles down the road.
Could money REALLY be saved? Or would it just be moved around? Does it actually save money when you cut out the expenditure for those ER visits (moving them instead to the cheaper clinic next door)? Or does it just result in lousier overall care, since that ER will eventually be scaled back or done away with altogether?
These are complicated issues that have to be addressed before you do something legislatively that might affect it. You and I can agree that it makes perfect sense to put in one of these low-cost clinics. But might it threaten the existence of one of the two 24/7 ERs in our small city? And would that be a good or bad thing (do we REALLY NEED two?)
I'm not sure government is able to be rational in making these decisions. If our health care system receives the treatment the stimulus bill did, I know damned well it is a disaster.
Minor changes to complex systems can have unexpected consequences. My concern is that I believe this administration sees an opportunity to make "major changes" to the health care system and I think the potential is there for them to wreck what is basically a good thing.
This is essentially what happened in Canada. They took a system that worked and turned it into one that doesn't. I don't want to see that happen. |
