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.
I would not go to the ED for a rapid HIV test, although you could. This type of testing should be done through your PCP or clinic to ensure adequate followup. If a person has concerns they have been exposed, one negative test only tells you that you are negative right then. The conversion to a positive result may take months, so you may need further testing. An ED is not the place to create an ongoing doctor-patient relationship. As far as treating with the medication, the physician would talk to you about the risks of immediate treatment with these medications. The meds are not without risks or significant side effects, so that would have to be balanced with the chance of developing a positive HIV test. If you know for certain that the other party was HIV positive, that could sway the decision. It also depends on how much exposure you had--long term continuous exposure vs. a one time thing. There are a lot of factors.
Share Answer: 
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.
Share Answer: 
Our ED has 60 beds, we are located in a suburban community non-profit, non-teaching hospital. In 2012 we had over 73,000 ED visits, which makes us the second busiest in our state. We are a designated Level III trauma center. We care for all ages of patients, from newborn to geriatric. We are a certified chest pain center, certified stroke center, and have a large psychiatric population. We also have started a Senior ER, an area within the main ER that focuses on the medical and social needs of patients over the age of 65.
Share Answer: 
Honestly, I don't know of any ER doc who left that profession to become a nurse, so I can't really answer that. Or any type of doctor, for that matter. Other than the instance I mentioned in a previous post, I have also never seen an ER doc do the tasks that traditionally fall to the nurses or the techs. I wouldn't get annoyed, but I wonder what was up. We have great professional relationships with the ER docs, but usually they come and get us if a patient needs something, instead of getting it themselves. For example, if a patient asked for a blanket, the doc will go find the nurse, and then he or she will go get the blanket. The patient just wants a blanket for heaven's sake, just go get one.
Share Answer: 
Dry Cleaner
Why don't more dry cleaners stay open late?
Nail Technician
How sanitary are the pedicure basins really?
Call Center Employee (Retail)
What's the craziest unprofessional-phone-rep story you've ever heard?
You want to get on the phone with billing start talking to them right away. Generally if you are uninsured, the bill can be lowered to approximately the same contract rate insurer's pay, you can get from 40-60% off. Ask for the patient rep, ask to talk with financial services and don't wait. You can also ask for a payment plan for the negotiated balance. Don't forget to go over your bill for any errors, just that could save you some $. Don't ignore the bill though, start talking to them right away. It's when you ignore it that it starts down that collection road. good luck, and start looking for the insurance exchanges to get coverage for yourself.
Share Answer: 
I realized after I wrote the stuff about the blanket that I was kind of contradicting myself... Hopefully being nice doesn't slow them down! I believe that it takes no more time to be nice than to be hurried and abrupt, plus the patient will have a better experience, which is what it is all about anyway--the patient. The federal government is beginning to tie reimbursement (the payments the hospital receives) to the patient satisfaction scores that the hospital has on patient surveys. So everyone is going to have to be nice, and take care of the patient from their point of view. I'm glad that your son got good care in the ER.
Share Answer: 
The Emergency physician is a board certified specialist who enters a 3-4 year program after medical school. They are specifically trained in Emergency Medicine--they need to know how to treat any kind of health issue, including trauma, and medical emergencies for adults and children. They are unlike primary care or family physicians, who treat and have established relationships with their patients. ER physicians generally do not have private practices, they only work in ERs or Urgent care centers. In 2011, about 7% of graduating medical school seniors entered an Emergency Medicine residency program in the US--there are about 100 programs in the US. It is a fairly new specialty, just over 20 years, so it is very popular and can be difficult to enter. A physician who is not board certified in Emergency Medicine can still work in an ER, however, I would want a board certified physician treating me if I had an emergency. In the hospital where I work, all of the physicians are board certified, and you will see that in most ERs. ER physicians are not generally on call--they work their shift and go home, so it can be an attractive area for that reason. The malpractice insurance is higher than some other specialties, but not the highest. You can't really compare ER docs to other specialists, whether one is "better" than the other, it is like comparing apples to oranges. I would want an ER doc to treat me if I had an emergency, and I would want an OB/Gyn doc to take care of me if I was having a baby.
Share Answer: 
-OR-
Login with Facebook (max 20 characters - letters, numbers, and underscores only. Note that your username is private, and you have the option to choose an alias when asking questions or hosting a Q&A.)
(A valid e-mail address is required. Your e-mail will not be shared with anyone.)
(min 5 characters)
By checking this box, you acknowledge that you have read and agree to Jobstr.com’s Terms and Privacy Policy.
-OR-
Register with Facebook(Don't worry: you'll be able to choose an alias when asking questions or hosting a Q&A.)
Browse Jobs
Host a Q&A
Search
Submit Your Question
Host a Q&A
Last 7
