Friday, July 25, 2014

The Corrupt Idiocy of Blaming the Victim for Emergency Department Use

This note explains once again that poor people go to Emergency Departments for sick care:

CQ Healthbeat:  More Medicaid Families Sought Emergency Room Care, Statistics Show
Three-fourths of children treated in emergency rooms in 2012 were taken at night or on weekends, according to federal statistics released Thursday. The figures also showed that families on Medicaid were more likely than those with private insurance or without any coverage to use the emergency department. The frequency with which people use pricey emergency department care is getting attention as policymakers struggle to find ways to lower federal health spending. Lawmakers want to persuade people to use less expensive outpatient care whenever possible. The Centers for Disease Control and Prevention statistics released Thursday suggests that families still use the emergency room in part because of convenience, and that Medicaid families may need help in finding a primary care physician or understanding when an emergency visit is necessary (Adams, 7/25).

What would you do if you wanted to really change this situation? It's not so hard. Would you try to change the behavior of poor patients whose kids get sick? They can't change their behaviors for everything in their lives, or they wouldn't be on Medicaid, I guess you could say. What are they supposed to do when their kids get sick and they're worried? They can't regulate when they do things, and where else are they going to go, especially since they have been doing this for years and years?

No, you wouldn't try to change their behavior. What you would do is have services available when and where they are needed, and you wouldn't have them in the emergency department, you would have a clinic very near the ED where they were taken care of by primary care physicians and advanced practice nurses under supervision. It wouldn't be in the most expensive facility imaginable, it would just be a clinic. Unless you wanted it to be the most expensive facility imaginable, because you want to get paid for it at the highest prices available.

Could you afford to run a clinic and get paid Medicaid rates? Probably, yes. If not, you could cut a deal with Medicaid – not that it would be easy dealing with that government bureaucracy, not at all, but it could most frequently be done.

But if you are a hospital, of course, that is not in your interest. In fact, Children's Hospital Oakland years ago had an urgent clinic set up just like that. But they shut it down in order to send the patients to the ED, because they would make more money that way.

Is it the case that hospitals need the Medicaid patients to come to the ED to subsidize maintenance of high intensity services that are not extensively used? Well, the truth is probably that nobody knows. The famous Harvard Business School professor Michael Porter has pointed out that hospitals have such poor accounting that they don't know what anything costs, actually.

No, this whole trope is utter BS. It is a problem that produces nothing but money for the hospitals. Hospitals do what the hell they want and they blame high costs on everyone else, even the poor. It doesn't stop. It is such crap.

Budd Shenkin

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