Veroniche
Western Region, US
Female, 54
I’ve been an ER nurse manager since 2009. Previously, I spent 24 yrs as an ER nurse. My hospital, a Level III trauma center, sees 70,000+ ER patients/yr. My responsibilities include billing, federal/state regulation oversight, metrics reporting, software education of e-records, and hiring/termination/disciplinary actions. The ER is one of the key impacted areas of healthcare reform. It’s a scary and exciting time for us, not just in the care of patients, but what the future holds for healthcare.
Generally speaking, there are not dentists in the Emergency Department. Some ED's may have dentists on call that they can refer a patient to for a dental emergency, but dentists do not come to the ED, at least in our area. Our ED does have limited on call oral surgeons for dental trauma, but they are not on call every day 24/7. Most of the oral surgeons do not come in to the ED but ask us to send the patient to their office. The ED doc can treat for dental pain with dental blocks (like Novacaine), or infection with antibiotics, but they cannot reimplant teeth. In our ED we have a list of nearby dental clinics that will take uninsured patients on a sliding scale fee schedule that we refer to for general dental problems. In 2012, our ED treated over 800 patients with dental problems, about 1% of our total volume.
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I would like for our hospital and ER to not have to worry about where the money to care for the public is going to come from. There is not enough money to sustain the health care system as it is. The only way the government will get more money is to either tax the citizens more, or cut down on the healthcare that they pay for. And the insurance companies will have to charge more for their premiums. There is a lot of negative press given to corporations and pharmaceutical companies. But they are the ones that develop the state of the art treatments for cancer, heart disease, etc. Who pays for the development of technology? It is truly between a rock and a hard place. Will the US become like so many other nations who have to ration health care in order to afford it?
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ER's are prohibited by Federal law to turn anyone away that has an "emergency medical condition." So every person has to be screened by a physician or a PA to determine that, which requires taking a medical history and performing a physical exam. By then, the docs in our ER just treat them. There is a hospital in our metro area that has a clinics attached to the ER, and they will screen non emergencies and send them to their clinic. But in our case since we have no on- site clinics, it is to risky to do that and potentially face Federal fines, or risk a patient's safety.
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It depends on the severity of the fracture--you may not need anything, you may only need a hard soled shoe, you may need a walking boot, or you may need a cast, or even surgery. Every fracture is different and needs to be evaluated by a physician after an x ray. The physician will be able to determine the best treatment.
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That is a simple question that has a very complicated answer. If you get a chance to read Time Magazine's cover story from March 4, 2013, titled "A Bitter Pill," please do. It is a great article about a lot of things in healthcare, however, a great deal of the article is devoted to a hospital's "chargemaster", which is the spreadsheet document that shows what the patient/insurance company is charged for every thing from soup to nuts. What a person is charged for a certain service or procedure is not what you or the insurance company eventually pays. There is a tremendous mark-up for everything in the hospital because generally, the only income a hospital gets is from payment from the patient/insurer for the services it provides. Of course, a hospital can have investments and investment income, but that is not the main source of income for the hospital system I work for, which is non profit. So the money the hospital receives from the patient/insurance companies is what pays all of the bills, salaries for 1500 employees, utilities, work comp insurance, etc, whatever it takes to run the hospital. When our hospital is doing ok (making budget), we generally do so with a 2-3% operating margin at the most. However, in the first two months of 2013, our hospital lost over 1 million dollars. Most of that had to do with what is called the "payor mix." In January and February, a greater percentage of patients had no or minimal insurance, so there was no way to pay for the cost of providing care to patients. So to finally answer your question, you can probably get a ballpark answer of what the charges might be, but that is not what you or your insurance company will end up paying--it is usually a 40-60% discount on the actual charges. Plus there are a lot of charges that make up the bill--the facility charge (the ER room charge, basically), any doctor's charges, which are billed separately, lab charges, x ray charges, pharmacy charges for any medication you may receive, etc. So it is hard to estimate. I can tell you easily what the facility charge would be, but I can't speak to the other charges.
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I would love to know the answer to that question! I could write a book and never have to work again! Really, the truth is that we don't know. This is driving hospital CEOs and CFOs crazy because how can you plan for a future when you don't know what is coming. Personally I think that the workings of the ER won't change day to day. I do believe that we will be a lot busier. Our patient visits for 2013 are already up about 10% from last year. I think hospitals will have to do more with less, which means being extremely efficient with money, nurses, equipment and supplies. I already see the nurses working a lot harder for the same amount of money, the raises get smaller and smaller, and the patients are sicker and sicker. I don't know where the money is going to come from. It has to come from somewhere. The patients don't have it, the government doesn't have it, and insurance premiums don't nearly cover the cost of healthcare, so the insurance companies are going to run out of money. It is a crisis that has come to our country and I sure don't see what the answer is.
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Sorry it has taken such a long time to answer your question Kendall. Our hospital has an active volunteer program for all areas of the hospital. If a volunteer wants to work in the ER, there is a couple of days of training to familiarize them with the procedures and flow of the ER, and to make sure the volunteers (usually younger people) are not violating any Federal privacy laws, etc. They stop in and talk with the patients, bring them water or food if allowed, warm blankets, and some times just keep people company. The hospital has an active pet therapy program, and the volunteers will bring in the dogs to visit with the patients. Since the ER can be a somewhat uncontrolled environment, we are careful with the pets--they only come in if there is relative peace and quiet.
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