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Mayor addresses Itron, emergency room closure during state of the city address – Owenton News-Herald

Editors note: The following is a transcription of Owenton Mayor David Milkweed Wotiers annual state of the city address given at the Owen County Chamber of Commerce breakfast meeting June 27. Wotier opened the address by recognizing city council members Bob Osborne, Larry Dale Perry, Jimmy Marston, Milford Sipple, Adam Gaines and Joan Kincaid, as well as Owenton Fire Chief J.O. Powers, city clerk Laura Aldridge, treasurer Anita Sipple and the citys new grounds keeper and maintenance man, Jacob Harris. This portion of the address is omitted from the transcription due to space.

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It was last Oct. 11 that I stood here giving the state of the city address for last year. You might remember that I could not do it at the regularly scheduled time because of federal grand jury duty. But since that short time from Oct. 11 to the present time, theres been many challenges, there have been many struggles that have come down the pike, of which I will be speaking to and addressing in a few minutes.

First, let me say, as you enter the city limits you see the welcome sign with the caption that reads, Taking pride in our city. This has been our motto for several years, probably around 2000-2001 when we came up with that. But how do we take pride in our community? It looks nice, its a nice caption, its a nice motto but how do we really take pride in our community? I could probably spend the next hour or two talking and addressing that question because there are many ways to do that, but I believe one of the best, one of the most effective, one of the most vital qualities has to be a sense of community, a spirit of togetherness. We are a strong unity together, but alone we cant do very much. Alone we are in essence powerless. Together, we can make great things happen if we join forces with like-minded individuals, forming an alliance and sticking together we have a much greater chance of being heard. Together, Im convinced we can make great things happen. Together, we can make great things come together.

Lets spend a few minutes looking at two of the most challenging situations to hit our community, at least in the 29 years that I have been a part of this community.

Everywhere I go theres somebody asking, What are we gonna do without our largest employer? Whats the answer? Losing 450-plus employees by the end of the year will affect us as a city, as a county and as a community in many adverse ways. Itron has been a very vital part of the economic growth of this county for the past 30-plus years. But understandably, technology since that time has changed enormously.

I understand the changes that had to be made. And I want to take the time and the opportunity to thank Itron for being such a vital, powerful influencer part of our community. Their presence in our town where they operated under the name of Itron or Schlumberger or whatever the name might have been, their presence in our community has played a very vital part. They will be missed, however, as true and as sad as it is about them leaving, this does not mean that Owenton cannot or Owenton will not be able to draw in another industry.

Let me assure you this, your elected officials, including our (Owen County Judge-Executive Casey Ellis), his magistrates, my council members and other elected officials, along with many other community leaders, are actively and aggressively moving to make things happen. Can I stand here this morning and guarantee you that well have something in there by Jan. 1 of next year when Itron moves out? I cannot exactly tell you that. I do think that well be able to get something in there, and the stronger we work together, and together is the key word, Im convinced we can make things happen. It will be a tedious and tenacious job, but Im convinced working together our dreams will come true.

Now the second greatest challenge facing our community is the closing of our local emergency department. I spent 11 years on staff at our local hospital. It is a place that is very near and dear to me, and Im convinced that the emergency department has saved many, many lives. Ive been there, Ive been right there with the patients as they were brought in. Ive been there with the families in life threatening situations when it appeared death was imminent. But because of trained medical professionals that knew what they were doing and were on the top of their game, they were able to walk away with a sense of joy, and the tears turned to tears of joy. Ive been there many times, Ive witnessed that. Did we save every life that came through the ER? No, but theres been a lot.

Weve been fortunate to have the emergency department as long as we have. The faade of medical care all across our country is changing. Its changing dramatically. Many communities of our size and similar demographics have not been able to withstand the test of time as long as we have. So I am grateful for that.

Having said all of that, the closing of the emergency department did not come as a surprise to me. Sixteen months ago there was a lot of talk about that, and after many talks, meetings and conversations with John Mitchell and many other St. Elizabeth team members I began to see the handwriting on the wall and seeing whats coming down the pike with healthcare all across our country. I truly believe that they tried every way they could to make this work. Im grateful to St. Elizabeth for giving us a chance.

You might have heard me say this before, but way back during that transition, when we were switching over from New Horizons Medical Center to St. Elizabeth Owen, I begged them not to close our emergency room, because I have seen what has happened. Other people that live in this community jumped on that bandwagon too and begged them, Dont close this emergency room. They gave it a 16-month trial, and it just did not work, so I can understand as you can, a business that is not profitable cannot progress forward, and thats exactly what was happening here. All attempts thus far, and Ill underscore the words thus far, to bring in another emergency department or urgent care has proven to be futile. However, we pledge to do everything we can to bring the best healthcare possible to our community.

Triad is now a big part of our community. (Melody Stafford), you are a big plus for Triad. I think Triad has done good and Ive worked with them sort of on a secondary level in the past, but you being here I think is the best thing that could happen for Triad. Youre well known, youre well leveled, youre well respected, and thats in your favor and its in our favor. Then when I think of people like Kevin Callihan with Air Methods, making their service available to us, and weve got some others that could be here, were gonna be leaning on them a little bit more. Weve been in conversations together, we have the extended hours at the clinic, plus we have Triad here. Then Jim Ziege with physical therapy, having his presence here in our community helps aid and support and the strengthening of healthcare here in our community.

Theres a lot of things I could say about the police department and all the issues were dealing with. I do think we have a very, very good police department. Their lives are at risk every day, and one of my biggest fears, one of my strongest prayers is support, Gods blessings upon them, as well as all of our emergency responders. We live in a crazy world out there. One part of me says Im glad to tell you that our drug arrests in the city are down from last year, but on the flip side of that, the overdose rates on drugs are up. As a city, we cannot afford to continue to buy Narcan at the current price. We just cannot continue paying what were paying for it for the Narcan. Right now were down to one dose for each cruiser. Its very expensive, and all of that could be used in one day or night. There are a lot of things that Im not at liberty to talk about, but just know that it is a major factor.

I spoke with a prosecuting attorney here a few weeks ago that congratulated me. I said, OK, whats that about? He said of the three counties that he serves, Owen County has the least number of people on their dockets. The other two have surpassed us even with drug arrests. I dont know what that says. Im glad that were down, but its still an issue that were trying to tackle and it will not be resolved any time quickly.

On a brighter side and in closing, let me add that were gradually picking up speed with our Lower Thomas Lake project and the family fun part that we hope to put in there.

Nathan Clark, its been great knowing you over the years and working with you. Now we got the opportunity to work with you a lot closer. I cannot say enough good about Kentucky American Water. We would not be where we are today as a city, as a county with the quantity and quality of water that they have provided and its hard for me not to ring their bell when Im around them. If youve been down to the Lower Thomas Lake, they have spent thousands of dollars down there restoring that, and were getting ready to get it back here. We sold it to them, and they spent thousands of dollars on it, and now theyre giving it back to us. Im excited about the possibilities; theres a lot of potential down there. Some of you have seen the pictures, those pictures have been around for a year. We first had Strand Engineering to develop those for us and do this assessment, its been over a year ago, but weve had other issues to deal with, particularly with industry and healthcare. Were still finalizing some things with Kentucky American, but it looks like now well be able to do that real soon.

In talking with and meeting with Mike Stafford two months ago on council breakfast meeting, we went and met down at the lake. He, in turn, is working with other people at Owen Electric and they are investigating a possibility of making an investment into the community as a community project there. More information is forthcoming on that, but I did talk with Mike.

Let me say this — I have a great love for Owenton and Owen County. I have invested a lot of my life a lot of time, a lot of resources into this county, and I want to help it. I want to see it move forward. Weve got some negative things going on, but lets accentuate the positive and eliminate the negative. We can do that only by working together. There is strength in unity. When more than one person comes together to unite for a common good we are able to complete the task at hand. We know what our task is, lets come together, move together, I believe now is the right time to move forward together for the cause of the good.

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Mayor addresses Itron, emergency room closure during state of the city address – Owenton News-Herald

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Just 21 Wild Emergency Room Stories – BuzzFeed News

Spoiler: there is no limit to what people will stick up their butts.

Posted on June 24, 2017, 18:46 GMT

“The man who tried to start his chainsaw with the tip resting on the ground. It kicked to life and then kicked back into his face. Missed his eye by a centimeter and he was able to go home (with a bunch of stitches).”

“A kid had shoved a popcorn kernel up his nose and didn’t tell his parents until it got too hot and steamy in his sinus cavity that it popped.”

“One time we had a kid who ate about 60 Legos.”

“A patient swallowed a fitness tracker and it was still recording the patient’s steps from their stomach.”

“A guy drove himself to the ER and handed me a bowl of ice with three of his fingers in it.”

“A 72-year-old patient was admitted due to kidney stones and eventually ended up with a catheter. Everyone noticed that he had tons of visitors, all of whom were blonde females under the age of 35. One of the nurses made a comment about how nice it was that his granddaughters were visiting him, at which point he laughed and said, ‘Granddaughters? Those babes are from OkCupid!’ Not sure why he thought that a date in the hospital watching him pee in a bag was particularly romantic, but I do hope that he landed a second date in the end.”

“A guy called the ER nurse hotline to see how he could prove that a local McDonald’s got blood on his burger rather than ketchup. He wanted an ER doc to run a DNA test so that he could sue McDonald’s.”

“This prisoner who got out of his handcuffs, took his clothes off, tried to escape, and then ran into a door, knocked himself out, and gave himself a head bleed.”

“A man caught himself and his bed on fire while smoking. He was wearing oxygen.”

“People come in with some pretty weird stuff stuck in their, uh, butts…one time someone came in with five UNCRACKED eggs up there.”

“One time a patient came in for rectal bleeding. They had stuck a glass candle up there and couldn’t get it out.”

“Someone walked into the ER with a cucumber stuck in their asshole.”

(Now is a good time to remind everyone of this helpful quiz from BuzzFeed Health: Should You Stick This Up Your Butt?)

“Chief complaint of, ‘I went to kill a spider and ended up with a broken hip.'”

“A girl called the ED at 3 a.m. because she lost her tampon after having sex with it still in.”

“One night when I was working my fourth grave in a row, one of the nurses had just gotten a call from local law enforcement that they were bringing in a patient for medical clearance before he went to jail. When they arrived, we placed him in a trauma room…turns out, the guy caught his wife with another man and he drove his car through the guy’s house. I’m talking about going in one side and driving through every single room. By some miracle he didn’t even have a scratch!”

“Catching a tonsil stone in my mouth….gross, horrible, life shattering, and I should probably go to therapy.”

“Delivering a baby to someone who didn’t know they were pregnant!”

“A patient took off their purple gown and bolted down the hallway out the door to the exit. Security brought him back after he grabbed a random lady on the street in a bear hug (he was still naked). Imagine being the lady.”

“I had a lady who had been shot multiple times. She had at least 15 individual gunshot wounds. All she could do was gripe about her hair clip digging into her scalp. Not a single complaint about the 20-30 holes in her body. (None of them hit anything very important.)”

“Obviously there is a thrill in knowing that you have just saved someone’s life and that’s always amazing, but the most memorable moments come from genuinely connecting with the people you care for. I once had a patient who was the only member of her family to survive the concentration camps. She gave me advice on how to overcome hardships and grief that I will never forget. Connecting with patients with life experience has given me some of the best life lessons.”

“While triaging a patient I asked the standard question about drug use. He told me that he stopped using five years ago, and that it was the staff in my ER who had motivated him to get clean. He had come in for a drug-related problem, and our staff was kind and compassionate, but also honest. We told him in no uncertain terms what his future would look like if he stayed on the path he was on. He got into rehab the very next day. Encounters like that are few and far between, but it’s one of the reasons most of us got into this line of work.”

Note: Submissions have been edited for length and/or clarity.

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Just 21 Wild Emergency Room Stories – BuzzFeed News

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Capital Regional Medical Center to open two freestanding emergency rooms – WCTV

By: Lanetra Bennett June 21, 2017

TALLAHASSEE, Fla. (WCTV) — Capital Regional Medical Center is set to open two full-service emergency departments in Leon County.

Ambrose Kirkland has lived on Tallahassee’s south side for 41 years. He’s glad that one of the two new emergency rooms opening will be on his side of town.

“I think that it’s fabulous.” Kirkland said.

Administrators at Capital Regional Medical Center say they chose Capital Circle at Orange Avenue, and North Monroe near I-10 to give access to care to parts of town that are well established and continuing to grow.

“Most of the people that are over there have to depend on either family or the bus to get them around. With this place being over there, maybe now they can get the help they need.” Kirkland said.

Capital Regional has the E.R. at the main hospital in Northeast Tallahassee and a freestanding E.R. in Quincy.

Administrators say the two saw 101,000 visits in 2016. The C.E.O., Mark Robinson, says E.R. growth is on pace with Tallahassee’s three-percent population growth over the next five years.

“We want to make sure that we’re prepared for that growth and that we provide great quality health care.” Robinson said.

Both one-story facilities will have the same footprint. They will be about 10,800 square feet with 12 rooms and 24 emergency room beds.

Both will provide the same services as any E.R.: offering a full-range of capabilities from pediatric to adult care, full-service lab, C.T., trauma, ultrasound and X-ray.

Robinson said, “It gives folks a chance to do something they might not normally do, and that’s seek care. So, as opposed to debating whether or not they’re going to make the long drive somewhere, they’ve got a place right around that corner that can support them and hopefully treat that injury or illness that they have.”

Construction is scheduled to begin in about three months. The facilities should be open in 2018.

By: Aubrey Brown | WCTV Eyewitness News June 21, 2017

TALLAHASSEE, Fla. (WCTV) — Capital Regional Medical Center is set to open two full-service emergency departments in Leon County in 2018.

One of the emergency rooms will be located on North Monroe Street, just north of I-10. The other will stand at the intersection of Capital Circe SE and Orange Avenue, near Southwood.

There is a need for additional ER services in south and northwest Leon County,” said Mark Robinson, CEO of Capital Regional Medical Center. “Our goal is to provide quality care for our patients with little to no wait time. The new freestanding ERs will allow us to provide critical healthcare services in convenient locations for our patients.

CRMC says both emergency departments will offer 24/7 ER care and are expected to serve more than 25,000 patients per year.

The new ER facilities represent our latest step to expand health care into the community, said Robinson. “The hospitals main campus emergency room and the ER in Gadsden County saw more than 100,000 visits in 2016.

Both facilities will feature 24 emergency room beds and will employ about 62 people full-time.

The project will cost nearly 25-million dollars.

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Capital Regional Medical Center to open two freestanding emergency rooms – WCTV

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Overdoses flood area emergency rooms – The Columbus Dispatch

Encarnacion Pyle The Columbus Dispatch @EncarnitaPyle

Charlie Stewart knew just what to do and say after paramedics brought the woman to the Mount Carmel West hospital emergency department after she nearly died of a heroin overdose.

She was crying, scared and didn’t want to walk out of the hospital only to use again. But she was new to Columbus and didn’t know the resources or whether she had the strength to attempt recovery again.

“She was in a bad place,” Stewart said.

After getting to know her and her situation, he helped get her signed up for Medicaid and into a detox bed within a matter of days.

“I want people to know that there’s hope,” he said. “And I want them to see the potential I see in them.”

Stewart is not a doctor, nurse or social worker. He’s a recovering addict who, through training and experience, knows a thing or two about what to do to upright a life. It’s what makes him so effective, his hospital colleagues say.

The hiring of peer-support coaches, who have been addicts themselves,is just one of many ways that local hospitals are trying to better support patients struggling with addiction and ending up in their emergency departments.

Between 2009 and 2014, Ohio saw the greatest jump in opioid-related emergency department visits of 44 states,with a 106 percent increase, according to a report by a division of the U.S. Department of Health and Human Services.South Dakota came in second with a 95 percent increase; Georgia, third, with an 85 percent jump.

In addition to treating overdoses, emergency department staffers also see people with skin and soft-tissue infections caused by their drug use or, in more serious cases, heart and spinal infections, said Dr. Alan Gora, chairman of Mount Carmel West’s emergency department.

The rate of hospital inpatient stays in Ohio because of opioid use also increased 52 percent from 2009 to 2014, according to the latest available data fromtheAgency for Healthcare Research and Quality. It’s justanother piece of grim proof that the abuse of heroin and narcotic painkillers has hit alarming levels, officials say.

“I’d like to tell you that the percentages have fallen or flattened since 2014, but they haven’t,” said Amy Andres, a senior vice president with the Ohio Hospital Association.

From 2014 to 2015, there was a 39 percent increase in the number of Ohio emergency room visits due to opioids. Last year, there was a 41 percent jump, according to an analysis by the hospital association.

People alsocan sit on a waiting list for weeks before a detox bed opens up, and some recovery programstake only private insurance or pay, leaving those with fewer financial resources fewer options, experts say.

A few hospitals across the country have had early success with administering buprenorphine,a medication that blocks opioids from affecting the brain, to stabilize patients in the emergency department before referring them to medication-assisted drug treatment. But the practice is relatively rare and most local hospitals said they’ve only started talking about the possibility.

Central Ohio’s emergency responders are increasingly being overwhelmed by overdoses caused by heroin laced with potent synthetic drugs such as fentanyl and carfentanil, an animal tranquilizer so strong that a few grains can be lethal. There were a record 3,050 overdose deathsstatewide in 2015.

That figure is expected to be shattered when final 2016 numbers are released this year. According to figures compiled by The Dispatch from county coroners, there were at least 4,149 people who died of overdoses last year. That doesn’t include tallies from six small counties that didn’t respond to the newspaper’s requests.

“It’s devastating, and I don’t see it getting any better unless we can stem the flow of drugs getting into people’s hands,” said Dr. Terrill Burnworth, director of the emergency department at Licking Memorial Hospital in Newark.

The one piece of good news: More overdoses are being reversed than ever before.

The percentage of emergency department patients who died from opioid-related overdoses at hospitals statewide dropped from 21 percent in 2009 to 14 percent in 2014, largely due to getting naloxone in the hands of more people, Andres said. The medicationabruptlyand effectively counteracts deadly overdoses and is now being administered by paramedics,hospital staff and even family members who have received some basic training.

Since starting a pilot program in July, University Hospital East has dispensed 220 naloxone kits to patients who have been treated in the emergency department or their families, said Ken Groves, a nurse manager at the Near East Side facility.

“The best thing we can offer them is an element of hope and a feeling of being supported until they’re ready to seek treatment,” Groves said.

The hospital also has an addiction counselor who helps with emergency room and inpatient consultations, he said.

Since the end of March,OhioHealth has sent 36 patients treated at one of its four emergency departments in Columbus, Marion, Pickerington and Westerville home with naloxone, said Dr. Krisanna Deppen, a family physician who specializes in addiction medicine.

“I think there’s a lot of stigma associated with naloxone, and some people believe we’re enabling bad behavior,” she said.

But like other chronic diseases, such as diabetes, addicts can’t change their behavior overnight, Deppen said. And naloxone is just a tool to keep them alive until they can start to work on recovery, she said.

Similar toMount Carmel West, its Marion hospital is working with a local drug and alcohol addiction group to hirepeer-recovery coaches, whom they hope patients will trust because of the common experiences they share.

Stewart, 25, of Hilliard, said he started “drinking and partying a little too much” as a teenager. He also started taking painkillers after breaking his collarbone in a snowboarding accident.

A misdemeanor theft arrest in 2013 led him to the courtroom of Franklin County Municipal Court Judge Scott VanDerKarr, who at the time presided over a “drug court.”

Stewart said he has been clean and sober since and helping others seek treatment. He joined Mount Carmel in November and has been working with people struggling with addiction since January. He also has a personal-training business as part of his quest to get a “healthier body, mind and spirit.”

After discharge,Stewart helps patients with food stamp applications, housing, job searches or whatever they need to start down the path toward sobriety.

The one out-of-state woman he helped get into detox is in a day-treatment program now. He also helped get her brother into detox recently.

“Last week she sent me a text that said I had saved her life,” he said. “It’s just so humbling and amazing to touch people’s lives this way.”

epyle@dispatch.com

@EncarnitaPyle

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Overdoses flood area emergency rooms – The Columbus Dispatch

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Would You Take Uber to the Emergency Room? – Healthline

In a segment on Jimmy Kimmel Live earlier this month, people on the street voiced their opinions about the new healthcare bills various provisions.

However, the segment, called Lie Witness News, was really a sketch made up by shows producers.

Those interviewed approved of proposals like deploying veterinarians to perform surgeries on patients who lacked insurance, and paying people to stitch up their own wounds using YouTube tutorials.

But one suggestion, which elicited peals of laughter from the studio audience, was not actually so far-fetched.

Lets talk about the bills provision replacing ambulances with Uber EMT, the interviewer said. A lot more drivers on the road obviously and time is of the essence. It doesnt really matter who drives.

Yeah, as long as you get to the hospital quick, reliable. I think that could be provided by regular people, said the young man on camera.

You support Uber EMT? asked the interviewer.

Id be in for that, he said.

Read more: The challenge of taking someone with dementia to the emergency room

While the government is not actually proposing that Uber replace ambulances, more and more people do seem to agree that regular people are capable of bringing someone to the hospital in the event of an emergency.

According to Stat News, and other outlets, hard data isnt available to quantify the trend, but Uber and Lyft drivers are encountering riders who need more than a ride home from the bar.

When I got there, to my dismay, I see him literally dragging himself toward my car, hand on his chest, stating he was having chest pains and was getting dizzy, wrote a driver on an online message board.

I offered to call 911, as the hospital he wanted to go to was over 15 minutes away, but he insisted for me to take him, the driver continued. Fortunately, I was able to get him to the hospital and he was admitted, but it made me wonder why someone in that situation would prefer an Uber over an ambulance the only rationale I can come up with is money.

Uber, Lyft, and medical experts would all agree that the mans situation was one that required an ambulance, not a rideshare.

In an ambulance, EMTs can administer treatment en route. Plus, their knowledge of the areas emergency rooms enables them to bring the patient to the hospital best equipped to handle the situation.

But there are occasions when ridesharing services are appropriate, and may even serve to fill a void in access to healthcare.

Last year, Uber partnered with Circulation, a company that arranges rides for people getting medical care.

And Lyft is entering the healthcare market in multiple ways, forging direct partnerships with providers like Blue Cross Blue Shield, and with traditional medical transportation companies like American Medical Response.

For us as an organization, healthcare aligns very, very well with our mission, with our values, Dan Trigub, head of healthcare and elder mobility solutions at Lyft, told Healthline.

People who get insurance through a company that has partnered with Lyft dont request a ride themselves. Their providers schedule a pickup through the companys stand-alone website, Concierge.

So whether they know it or not, a patient covered by one of these services may be taking an Uber or a Lyft to their next doctors appointment.

Read more: Hospitals open emergency rooms specifically for senior citizens

A 2005 report from the National Academies of Sciences estimated that 3.6 million Americans miss or delay healthcare due to lack of transportation.

Minorities, people with low incomes, and those with chronic illnesses are affected disproportionately.

The same report found that paying for transportation to make sure people get to their appointments would cut down on healthcare costs in the long run.

That reasoning fuels the federal requirement that Medicaid pay for its beneficiaries to take a cab, van, public transportation, or other mode of transport to the doctors office if the patient has no other way of getting there.

The Centers for Medicare and Medicaid Services (CMS) spent $2.7 billion on nonemergency medical transportation (NEMT) in 2013, according to the U.S. Government Accountability Office (GAO).

Most companies providing Medicaid services partner with transportation brokers, who in turn contract with cabs or other livery services to arrange rides. They then bill CMS for reimbursements.

But this system has come under scrutiny for being opaque, expensive, and ineffective. GAO officials identified NEMT as an area of high risk for fraud and abuse. Last year, New Jerseys Medicaid program failed an audit of its NEMT services for improper oversight and reporting.

There was clearly a need for something better, Robin Heffernan, chief executive officer of Circulation, told Healthline.

With the traditional service, you had to call several days in advance of the ride and then the broker would go take several hours to figure out whether they could accept your ride, and come back and give you a four-hour window for your patient to be ready, she said.

Its huge to be able to have one platform which can, in a more structured manner, deliver these rides, track them, and account for them, she said.

According to CareMore, a company that serves Medicare beneficiaries, its partnership with Lyft has cut both wait times and per-ride costs by about a third.

People no longer have to wait an hour or more to be picked up after their appointment ends, Dr. Sachin Jain, CareMores president and chief executive officer, told Healthline.

With Lyft, youre working with a driver who is proximate, theyre relatively close to where you are, so that wait time on the pickup ride is shorter, Jain said.

Jain said that CareMore provided senior sensitivity training to Lyft drivers to prepare for picking up a customer base that is not widely associated with using ridesharing services.

Read more: Rural hospitals closing at an alarming rate

But these services are not, however, replacing ambulances. At least not yet.

Unnecessary ambulance rides rose from about 13 percent to 17 percent between 1997 and 2007, according to a study from the University of Pittsburgh.

James Langabeer, a professor of health informatics at the University of Texas, said that people call an ambulance when they dont really need one for all sorts of reasons.

I think the emergency department is a place where you can go and you know youre going to get care, whereas if you call a provider and they say tell me about your insurance, its a barrier, he told Healthline.

Even people with insurance may not have a primary care doctor or medical home they feel comfortable visiting, he added.

Langabeer studied a pilot program run by the Houston Fire Department, called Emergency Telehealth and Navigation (ETHAN).

ETHAN allows EMTs to offer alternatives to patients who call 911 but do not require emergency services.

One solution is to offer cab vouchers for office visits, which the EMT can help schedule. Langabeer said he can imagine ridesharing filling a similar role.

But despite his interest in easing the burden on ambulances, Langabeer stressed that 911 is still the best option for anyone in medical distress.

Were not always as patients the best people to diagnose, or the right people to diagnose our own conditions, he said. On the other hand, we do know our body, and we know whats abnormal. And if you do know this isnt normal, and youre completely convinced, now how do you get there?

In those cases I say, Yeah, call any type of special transportation that can get you to those places and get you in.

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Would You Take Uber to the Emergency Room? – Healthline

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Tip No. 1 For Taking Charge Of Mass. Health Care Costs: Avoid The ER – WBUR

wbur (Open Grid Scheduler / Grid Engine/Flickr)

If you’re wondering why health care costs so much in the U.S., here’s one little piece of the answer: emergency room visits.

Forty-two percent of emergency room visits in Massachusetts in 2015 were for problems that could have been treated by a primary care doctor, according to the state’s Health Policy Commission. This state agency, which is charged with driving down costs, says a 5 percent cut in avoidable emergency room trips would save $12 million a year; 10 percent fewer such visits would save $24 million.

That extra spending is passed on to all of us in the form of higher health insurance premiums. Andgoing to an emergency room for non-urgent care is often not the best move.

“If its not a true emergency, youre going to wait for hours in the emergency room, its not the best practice for coordinated care, and you run the risk of having a lot of tests that might not have been necessary if you saw your regular provider,” saidSarah Sadownik, deputy director of the research and cost trends team at the Health Policy Commission.

The commission is breaking down some of the ways we in Massachusetts could save money without doing ourselves any harm. We’ll be posting many of these tips as they are released.

What’s your guess about the most common reason your neighbors go to an emergency department (ED)? Here’s the answer, by zip code:

Statewide, the top five reasons are: sinus problems (sinusitis), stomach pain (that’s my work zip code), rashes and skin conditions, acid reflux and bronchitis.

I go to the ED on weekends or after 5 p.m. when the office of my wonderful doctor is closed. But it looks like most people go during office hours.

Sometimes we go to the emergency room because we can’t tell if our symptoms signal a common problem or something more serious.

We used to assume that most of the people who visit an emergency room were uninsured. But that doesn’t seem to have been the case before the state expanded health coverage and is likely even less true now. Here’s the most recentcomparison we could find.

I’m surprised cost is not a factor for more people. An emergency room visit is more expensive than going to see your doctoror visiting urgent care facilities, which are often open on evenings and weekends. So what’s missing from this analysis? What are your reasons for going to the Emergency Department?

If you want more juicy details about avoidable ED visits, try this. And if you’re up for a deep dive into the reasons Massachusetts has some of the highest health care costs in the country, and maybe the world here’s the HPC’s most recent cost trends report.

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Tip No. 1 For Taking Charge Of Mass. Health Care Costs: Avoid The ER – WBUR

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GOP Rep. Kevin Cramer claims emergency rooms are universal health care – Shareblue Media

Rep. Kevin Cramer (R-ND) has repeatedly and falsely claimed that a law mandating hospital emergency rooms provide care to anyone who needs it is the same thing as universal health care a cruel interpretation of the law that has become an article of faith for Republicans.

Cramer, who may run against Democratic Senator Heidi Heitkamp in 2018, made his statement in at least four appearances over the last two weeks.

At a town hall meeting, he told constituents, We have universal health care access because we require by law and by tradition and by compassion that any person that walks into an emergency room receives care.

In another appearance, Cramer said, In the early 80s or mid-80s wepassed a law requiring health care for everybody in the United States of America. That was 30 plus years ago. So that means no one can be turned down for care.

He also made the claimin tworadio interviews, and at another town hall meeting, as repeated justification for his vote in favor of the Republicans health care repeal plan, which would strip health insurance from at least 24 million Americans.

CRAMER: Back in the 1980s, actually, when Ronald Reagan was President we the country passed universal healthcare by, you know, guaranteeing that no one would be denied health care. So, weve had it since the 1980s, this mandate. Its just that how you pay for it has always been the sticking point. So, most people, for a long time it was through the emergency room, and thats very expensive care. And that burden is then passed on to other people who have insurance and drives up costs.

Cramer is citing a 1986 law which mandates emergency room treatment for anyone who needs it, but the law does not cover care before or after an emergency room visit.

And no matter how many times Republicans say it, emergency room care is not health care.

Laws like the Affordable Care Act understand this, and provide for health care access so doctors and other health care professionals can catch illnesses before they become so severe that an emergency room visit is needed.

The goal of preventative medicine is to save money in the long run, but more importantly to prevent pain and long-term suffering. Catching someone before they have a heart attack is obviously preferable to an emergency room visit for cardiac arrest, for instance.

Furthermore, the emergency room is useless for diseases that need ongoing treatment, like cancer, diabetes, and end-stage renal disease. The emergency room cannot provide chemotherapy or ongoing dialysis that hundreds of thousands of Americans need to survive.

Universal health care is a system that provides health care to all citizens, regardless of income. That means in all phases of care, not just when things are so critical or life-threatening that emergency services are needed.

An actual universal system of care does not yet exist in the United States, and Cramer is lying to his constituents when he says otherwise.

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GOP Rep. Kevin Cramer claims emergency rooms are universal health care – Shareblue Media

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Why visiting the ER costs so much money | KAGSTV.com – KAGS News

9Wants To Know looks at how something as simple as giving a patient a cheap splint or over-the-counter medication in an Emergency Room can lead to bills in the thousands of dollars. KUSA

Suspected strep throats, miserable bladder infections, and potentially torn ligaments dont necessarily scream EMERGENCY, but a 9Wants to Know investigation has discovered theyre leading to massive charges nonetheless.

And in a country where hospitals are recommended, but not required, to follow a series of industry guidelines, ER visitors remain subject to a complicated system that pays hospitals more for doing more.

Thats even when more involves something as simple as giving the patient a cheap splint or handing them an over-the-counter medication readily available at any nearby grocery store.

Paige Thoele felt awful.

So last July she did what around 1.8 million Coloradans do every year.

Paige Thoele was charged for a level 4 ER visit for treatment for a bladder infection (Photo: KUSA)

She went to an emergency room. In her case, she went to St. Anthony Hospitals ER.

I had a bladder infection. I was miserable, she told us.

In the grand scheme of things, Paige now knows the visit might have been a mistake. ERs tend to be expensive, but at the time, she felt sick enough to go.

According to hospital paperwork, the July 13 visit was fairly standard for patients with bladder infections.

Staff tested her urine, looking for an infection.

Yep, I peed in a cup, she explained.

A doctor gave her two tablets of phenazopyrdine, a relatively inexpensive, over-the counter medication. At Walgreens, she could buy a box of 36 tablets for around $8.

The doctor also wrote her a prescription for a painkiller.

It takes two to three points for an ER visit to be classified “level 3.” (Photo: KUSA)

About 52 minutes from start to finish, she said. The doctor saw me for about five minutes.

Weeks later, a letter from the hospitals owner informed her she had a balance in her account of $3,733.12.

I was shocked, she said.

By far, the largest charge on the invoice was for this: HD ED Level IV.

They billed me at a level 4 admittance, she said.

Do you know why? I asked.

No, no idea, she replied.

What she also didnt know at the time was the fact that she had been caught up in a numbers game where the difference between a 3 and a 4, for example, could be as much as a thousand or more dollars when it comes to the bill.

Dr. Dave Friedenson knows hes likely the exception as opposed to the rule when it comes to emergency medicine.

Not only is he the immediate-past president of the Colorado chapter of the American College of Emergency Physicians, hes also the chief medical officer of a medical coding company.

So he, unlike many ER doctors, knows just how much more can be tacked onto a bill with one simple, seemingly innocuous decision within an emergency room.

An over-the-counter medication?

Yes.

A urine screen.

Yes.

Dr. Dave Friedenson is the past president of the Colorado chapter of the American College of Emergency Physicians and the chief medical officer of a medical coding company. (Photo: KUSA)

So if the doctor decides to order a splint, even if its a cheap splint, for somebody, then that can up the code? I asked.

Absolutely, he replied.

That appears to be what happened to Laura Prinzi when she visited Swedish Hospitals SW ER late last year for a pain in her knee.

Every few steps I would have a shooting pain, she said.

Prinzi figures it took the doctor less than five minutes to diagnose the problem.

Her ACL appeared intact.

No X-Ray, no MRI, and no CT Scan.

The doctor did, however, offer her one thing.

They gave me a soft splint, and I was on my way, she said.

Weeks later, an itemized statement from Swedish showed up in the mail. There was only one charge.

SHOW US YOUR BILLS: Tell us about your high ER costs

RELATED: How peeing in a cup can cost you $6,250

Next to the line, EMER DEPT LEVEL 3 was this: $2,783.00.

Its a lot of money, Prinzi said.

On that same line, Swedish assigned the code 99283 to the visit.

Laura Prinzi visited an emergency room for pain in her knee (Photo: KUSA)

In order to understand the meaning of that code, you have to understand a little more about hospital codes in general.

In 1983, the Centers for Medicare and Medicaid (CMS) established whats known as the Healthcare Common Procedure Coding System (HCPCS). Using the American Medical Associations Current Procedural Terminology (CPT) codes, CMS established a uniform way to process claims.

Yes, we know, there are a lot of acronyms here. For that, were sorry, but this is important to understand.

Private insurance companies quickly adopted the CPT codes as a way to simplify their own processes.

Today, there are generally five CPT codes attached to ER visits.

99281, 99282, 99283, 99284, and 99285.

You only need to pay attention to the last number of each.

So, for example, a 99283 is a level 3 visit.

And a 99285 is a level 5.

INTERACTIVE: Emergency department severity level trends

Hospitals bill the bulk of their charges for ER visits this way. Each one represents whats commonly referred to as a facility charge.

ERs are expensive. No one denies that. They are open and staffed 24 hours a day. Staff has access to all sorts of high-tech equipment that can be used at a moments notice.

And, by law, they have to treat everyone who comes in the building, no matter any persons ability to pay.

Many times, people dont pay. Thats part of the reason why there are facility fees for the rest of us.

So, yes, ER bills can easily stretch into the thousands.

After getting rejected by multiple hospitals, UCHealth finally agreed to talk to Chris Vanderveen.

But what many people dont realize is the code attached to your visit has a ton to do with the amount youll be asked to pay.

Weve reviewed more than a 100 bills as part of our showusyourbills@9news.com campaign.

Level 3 visits routinely result in charges in excess of $2,000.

Level 5 visits can lead to charges that near $10,000.

Insurance will frequently negotiate lower rates for people. People with copays might only be responsible for a few hundred bucks per visit.

People with deductibles about half of those who receive health insurance through their work have a deductible of at least a $1,000, according to the Kaiser Family Foundation frequently are asked to pay at least a sizeable percentage of the charge.

So how a hospital codes you next visit, can make a massive difference in terms of what youre expected to pay.

And, as Dr. Friedenson told us, The more the hospital does, the higher the code.

Last November, Keith Westfall brought his daughter to the ER at Castle Rock Adventist when a large rash developed on her back.

It was very alarming, yes, Westfall said.

Keith Westfall took his daughter to an emergency room for a rash and was charged at a level 5 visit the first day, a level 3 visit the second day. (Photo: KUSA)

I didnt know what it was. Measles? I just didnt know, he said.

At the hospital, doctors ran a number of tests on her. She received an IV as well in order to medicate and hydrate her.

A few hours later, they sent her home with not much of a diagnosis, according to Westfall.

The next day, the rash looked even worse, and so he went back to the same ER.

Same deal, same deal, Westfall insisted.

Hospital paperwork shows staff did much of the same work they had done the day before. The coding wouldnt necessarily indicate that, however.

The first visit resulted in a level 5 (99285) code and a $9,817.07 facility charge.

The second visit resulted in a level 3 (99283) code. Westfalls records dont show how much the facility charge was for the visit, but the entire amount charged including all tests and other services came out to $4,346.52.

A February letter sent by a patient representative at Castle Rock Adventist to Westfall doesnt provide any explanation for the two different codes other than to say, Your bill reflects the level of care your daughter received each day she was here Since the bill is in alignment with the care your daughter received, your bill will not be adjusted and you re expected to pay the full amount.

Keith Westfall got a $,9817.07 facility charge for taking his daughter to the ER when a large rash developed on her back. (Photo: KUSA)

Centura, the owner of the hospital, told us in a statement that it follows American College of Emergency Physicians (ACEP) guidelines in determining how to code ER visits.

Dr. Friedenson, Colorados past president of ACEP, told 9NEWS the guidelines, for the most part, have no teeth.

He said ACEP has asked for its guidelines to become, in essence, national standards but the cause hasnt gone over too well with many hospitals.

So as of now theres no national standard for how hospitals code? I asked him.

Thats correct, he replied.

It all means, hospitals can say theyre following ACEP guidelines, but theres really not much a patient can do if he or she feels like their coding was done improperly.

Dr. Friedenson was quick to point out he believes most hospitals follow ACEP guidelines very closely, but he also acknowledged there are exceptions.

Which got us thinking about Paige Thoele and her level 4 ER code for her bladder infection.

Its hard to look at the list of charges for Paige Thoeles 2016 visit for a bladder infection and not stare at the figure next to the line ED LEVEL IV.

$3,460.15

That was the amount the hospital charged her for her 52 minute visit to Centura-owner St. Anthony Hospital.

Paige Thoele was charged for a level 4 ER visit for treatment for a bladder infection (Photo: KUSA)

It was also, by far, the largest charge on the list. As of now, half of it remains her responsibility.

Thoele wasnt exactly knowledgeable of ER coding when she complained to the hospitals billing department, but she was certain there had to be a mistake.

In January, the Centura Dispute and Resolution Department sent her a letter explaining to her why the hospital charged her the way it did.

Read more from the original source:
Why visiting the ER costs so much money | KAGSTV.com – KAGS News

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Free-standing emergency rooms offer costly convenience – Stillwater News Press

HOUSTON – Not far from neighborhood streets lined with million-dollar homes here lies an open-air mall where people go to eat, shop and – when needed – get emergency medical treatment. People pull up to the front door, park next to a gleaming antique ambulance and enter a waiting room that feels more like a graceful hotel lobby than a holding area for sick people.

It isn’t a clinic or an urgent care – it’s an emergency room, without the hospital.

When lawyer Richard Yount opened the facility, called Elite Care Emergency Center, in 2009, the idea was simple: Emergency rooms were crowded, with miserable waits and rushed doctors. He could fix that – and make a lot of money – by carving the department out of the hospital, putting it in a neighborhood where people without insurance were unlikely to show up and charging hospital-level prices.

There was just one problem: People assumed it would be cheap, especially at first. “No matter how many times you tell people you’re an emergency room, they have a tendency to think: If you’re in that kind of an environment, you’re an urgent care,” said Yount, who now operates four free-standing ERs.

Free-standing emergency rooms, standalone facilities where people can receive acute care any time of day, have increased in Texas in recent years as a result of a 2009 law that permitted the establishment of emergency rooms independent of hospitals. They join a host of other on-demand facilities – including hospital ERs, hospital-owned satellite ERs, “microhospitals” and urgent-care facilities – where people can receive care, especially if they have robust health insurance.

Texas’s wild west of competition, with lit-up signs advertising “SHORT WAIT TIME FOR LACERATIONS” and highways punctuated by warring billboards, is a leading example of how an emerging wave of convenient medical-care options for Americans can also create confusion and lead people to seek expensive treatment for conditions that might not merit it, pushing up costs across the health-care system.

Across 32 states, more than 400 free-standing ERs provide quick and easy access to care. But they also are prompting complaints from a growing number of people who feel burned by hospital-size bills, like $6,856 for a cut that didn’t require a stitch or $4,025 for an antibiotic for a sinus infection.

Emergency care requires costly imaging and laboratory equipment and facilities that are open 24 hours a day and staffed round the clock by a physician – and the costs reflect that. Prices for an average free-standing ER visit have grown and are now similar to hospital ERs, but patients with the same diagnosis rack up bills 10 times higher than at an urgent care, according to an analysis of one insurer’s Texas data by Rice University economist Vivian Ho. She found use of the facilities in Texas more than tripled between 2012 and 2015.

The high cost raises the question of whether people are seeking out more expensive care only because it’s convenient, not because it’s necessary.

“If there had not been a close, convenient emergency department, would that person have gone to an emergency department, or sought care somewhere else?” said Jeremiah Schuur, an emergency medicine physician at Boston’s Brigham and Women’s Hospital who studies the industry.

Texas’s flowering of freestanding ERs leads a debate about whether convenience makes people healthier or needlessly drives costs up – a central dilemma in health=care innovation. Health-care specialists want people to seek care that’s necessary. But with U.S. health-care spending surpassing $3 trillion this year, new attention is focused on how making health care a better consumer product might simply increase its use. Research shows, for example, that walk-in retail health clinics and telephone medicine, which might seem to replace more expensive options, actually tend to slightly drive up health-care spending.

“The vast majority of people who get sick on a monthly basis don’t go get care, don’t even think about getting care – and among those who do think, ‘I should go get care,’ only two-thirds of them end up getting a visit of some type,” said Ateev Mehrotra, a physician and researcher at Harvard Medical School who did that research. “There is an enormous market of people out there who . . . choose to get care when it’s convenient.”

Texas’s crowded landscape of ERs and clinics may seem like a consumer paradise, in which people are able to shop around. But it lays bare a simple truth: It’s hard to shop when no one knows what anything costs.

Bryan Piccola of Frisco, Texas, sliced his left pointer finger on July 4 when his knife slipped cutting tightly wound zip ties off a toy for his year-old daughter. He debated cleaning the wound up and sticking a bandage on it, but he went to a free-standing First Choice Emergency Room a few miles from his house. He asked beforehand how much it would cost, since he is a veteran and didn’t have separate insurance, and says he was assured it wouldn’t be too bad. He received five stitches and, later on, the bill: more than $5,000. The company discounted it to $2,888.

“You drive by them all the time. There’s a bunch of these little pop-up clinics,” Piccola said. “If they would have told me [how much it would cost], I wouldn’t have gone – I’d have gone home and wrapped it up and waited for the scar.”

Adeptus Health, the company that owns First Choice Emergency Room, declared bankruptcy in April. It declined a request for an interview.

Richard Yount embarked on his career as an emergency room entrepreneur as Texas’s access to emergency care was hitting rock bottom, given a failing grade by the American College of Emergency Physicians. He had watched other hospital services, such as imaging centers, being spun into separate, lucrative businesses.

“You had not a lot of competitors and you had all the patients you’d ever want, and they paid a lot. Money just fell in your lap,” Yount said. “I watched this train go by for 30 different services, and I only caught onto the caboose.”

Yount’s insight was simple: In addition to the physician’s bill, hospitals were paid a “facility fee” to cover X-rays, CT scanners, laboratories and round-the-clock staffing by physicians and nurses. Freestanding emergency rooms shared many of these costs, since they strive to deliver the same care available in a hospital ER, and the facility fee made the business viable.

By situating in well-off neighborhoods, they could largely avoid patients who couldn’t pay. Without a hospital affiliation, they cannot bill Medicare or Medicaid for emergency care, and many carry warnings on the front door that they do not accept those less-lucrative plans. And as a start-up, the free-standing ERs weren’t encumbered with the high administrative costs of a hospital.

Complicated cases, such as surgeries or trauma, could be sent by ambulance to a hospital, but stand-alone emergency room operators argue they can see people faster, keep them out of the hospital altogether and save money.

Yount, 68, is a jumble of contradictions. He is an unapologetic capitalist who operates four free-standing emergency rooms in Texas and is in the process of finding a site in Las Vegas to build a “microhospital” – an ER with some inpatient beds.

He is also a Bernie Sanders supporter and a strong believer in universal health care whose office is still decorated with light-blue signs from the Vermont senator’s presidential campaign.

“I can believe in one thing on a macro level, as to what this country needs to do. But if I want to operate, I’m operating within the current system that we have. So I make the economic decisions based on the current system we have,” Yount said. “Doesn’t mean I have to like the current system – and I don’t.”

Yount says the start-up costs are about $5 million. In the early days, the business could break even with just seven or eight patients a day. The break-even point today is up to eight or nine, and Yount expects the number to rise as pressure from insurers increase.

The model appeals to many physicians and nurses.

“The mind-set is totally different here,” said Aaron Schwartz, an emergency physician at Elite Care. “In the hospital, it’s driven by surveys and scores, efficiency and throughput times and volume. … We can spend as long as the patients want us to spend with them.”

Some patients appreciate the convenience. Miguel Balli, 24, of Houston had spent a miserable night, vomiting and ill, when he showed up at Elite Care one Monday morning. Within an hour, he was getting an IV drip and beginning to feel better.

“These setups are a lot more beneficial for the patient as far as time concern and quickness and availability,” Balli said. “If you’re not the most serious person at the ER, if you’re not the one bleeding out or having a heart attack, you’re probably going to get last on the totem pole.”

The problem is the flip side of the success: People who would have thought twice before navigating down to Houston’s crowded medical hub, the world’s largest medical center, have a surfeit of options right in the neighborhood.

In Sugar Land, an affluent suburban city south of Houston, there is St. Michael’s Emergency Center, right next to Emerus 24HR Emergency Hospital, a former free-standing ER that’s been converted into a small hospital. In the driveway, two identical signs look like mirror images, each directing people with an “EMERGENCY” in a different direction. A mile away, in both directions, are two hospitals.

The ease of access is a good thing if it is moving people to seek care for symptoms that would be dangerous to ignore.

Many free-standing emergency room operators say they do their utmost to stress to people that they are in an emergency room, with emergency room prices, and they refer patients with minor conditions to urgent-care facilities. The buildings have “emergency” signs on them and are required by state law to carry written warnings that they will charge a facility fee – although the amount is not disclosed.

But Ho of Rice University has found a big overlap in the types of conditions for which people seek care: three-quarters of the 20 most common diagnoses at free-standing emergency rooms were the same as at urgent-care centers. A slightly smaller overlap existed for hospital-based emergency rooms.

“It’s fine if it generates the value of the price that is paid, but if it’s not generating that value, then all it does is raise costs for everybody,” Ho said. “There needs to be more transparency in terms of the cost. Why should it be comparable to what a hospital ER is charging?”

But even as free-standing emergency rooms defend themselves, the model appears to be evolving, in part in response to the confusion. Yount provided a tour of what he says is the future: a large free-standing ER that stands apart from shopping malls and wouldn’t easily be mistaken for an urgent-care clinic.One of his competitors, Emerus, switched to building “microhospitals.”

Free-standing emergency rooms blame insurers for big bills, arguing they deny claims or underpay them. Insurers, in turn, blame the facilities for charging high prices.

“There’s this misleading factor, or I’d go so far as to say deception,” said Shara McClure, a vice president at Blue Cross Blue Shield of Texas. “A member who’s having an incident, having an acute condition, they go into these free-standing ERs thinking they’re a cost-effective solution.”

The Texas legislature is considering bills that would help protect consumers from surprise bills and regulate the industry.

That points to the biggest lesson emerging from Texas’s experiment.

“We need to do more to make prices extremely visible to patients,” said Schuur, of Brigham and Women’s Hospital. “But it also calls into question the ability of patients to be smart consumers, particularly in the time when they have what they perceive as an acute health-care need.”

Read more:
Free-standing emergency rooms offer costly convenience – Stillwater News Press

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Free-standing emergency rooms offer costly convenience – Washington Post

HOUSTON Not far from neighborhood streets lined with million-dollar homes here lies an open-air mall where people go to eat, shop and when needed get emergency medical treatment. People pull up to the front door, park next to a gleaming antique ambulance and enter a waiting room that feels more like a graceful hotel lobby than a holding area for sick people.

It isnt a clinic or an urgent care its an emergency room, without the hospital.

When lawyer Richard Yount opened the facility, called Elite Care Emergency Center, in 2009, the idea was simple: Emergency rooms were crowded, with miserable waits and rushed doctors. He could fix that and make a lot of money by carving the department out of the hospital, putting it in a neighborhood where people without insurance were unlikely to show up and charging hospital-level prices.

There was just one problem: People assumed it would be cheap, especially at first. No matter how many times you tell people youre an emergency room, they have a tendency to think: If youre in that kind of an environment, youre an urgent care, said Yount, who now operates four free-standing ERs.

Free-standing ERs, stand-alone facilities where people can receive acute care any time of day, have increased in Texas in recent years as a result of a 2009 law that permitted the establishment of emergency rooms independent of hospitals. They join a host of other on-demand facilities including hospital ERs, hospital-owned satellite ERs, microhospitals and urgent-care facilities where people can receive care, especially if they have robust health insurance.

Texass wild west of competition, with lit-up signs advertising SHORT WAIT TIME FOR LACERATIONS and highways punctuated by warring billboards, is a leading example of how an emerging wave of convenient medical-care options for Americans can also create confusion and lead people to seek expensive treatment for conditions that might not merit it, pushing up costs across the health-care system.

Across 32 states, more than 400 free-standing ERs provide quick and easy access to care. But they also are prompting complaints from a growing number of people who feel burned by hospital-size bills, like $6,856 for a cut that didnt require a stitch or $4,025 for an antibiotic for a sinus infection.

Emergency care requires costly imaging and laboratory equipment and facilities that are open 24 hours a day and staffed round the clock by a physician and the costs reflect that. Prices for an average free-standing ER visit have grown and are now similar to hospital ERs, but patients with the same diagnosis rack up bills 10 times higher than at an urgent care, according to an analysis of one insurers Texas data by Rice University economist Vivian Ho. She found use of the facilities in Texas more than tripled between 2012 and 2015.

The high cost raises the question of whether people are seeking out more expensive care only because its convenient, not because its necessary.

If there had not been a close, convenient emergency department, would that person have gone to an emergency department, or sought care somewhere else? said Jeremiah Schuur, an emergency medicine physician at Bostons Brigham and Womens Hospital who studies the industry.

Texass flowering of free-standing ERs leads a debate about whether convenience makes people healthier or needlessly drives costs up a central dilemma in health-care innovation. Health-care specialists want people to seek care thats necessary. But with U.S. health-care spending surpassing $3trillion this year, new attention is focused on how making health care a better consumer product might simply increase its use. Research shows, for example, that walk-in retail health clinics and telephone medicine, which might seem to replace more expensive options, actually tend to slightly drive up health-care spending.

The vast majority of people who get sick on a monthly basis dont go get care, dont even think about getting care and among those who do think, I should go get care, only two-thirds of them end up getting a visit of some type, said Ateev Mehrotra, a physician and researcher at Harvard Medical School who did that research. There is an enormous market of people out there who … choose to get care when its convenient.

Texass crowded landscape of ERs and clinics may seem like a consumer paradise, in which people are able to shop around. But it lays bare a simple truth: Its hard to shop when no one knows what anything costs.

Bryan Piccola of Frisco, Tex., sliced his left pointer finger on July 4 when his knife slipped cutting tightly wound zip ties off a toy for his year-old daughter. He debated cleaning the wound up and sticking a bandage on it, but he went to a free-standing First Choice Emergency Room a few miles from his house. He asked beforehand how much it would cost, since he is a veteran and didnt have separate insurance, and says he was assured it wouldnt be too bad. He received five stitches and, later on, the bill: more than $5,000. The company discounted it to $2,888.

You drive by them all the time. Theres a bunch of these little pop-up clinics, Piccola said. If they would have told me [how much it would cost], I wouldnt have gone Id have gone home and wrapped it up and waited for the scar.

Adeptus Health, the company that owns First Choice Emergency Room, declared bankruptcy in April. It declined a request for an interview.

Money just fell in your lap

Richard Yount embarked on his career as an emergency room entrepreneur as Texass access to emergency care was hitting rock bottom, given a failing grade by the American College of Emergency Physicians. He had watched other hospital services, such as imaging centers, being spun into separate, lucrative businesses.

You had not a lot of competitors and you had all the patients youd ever want, and they paid a lot. Money just fell in your lap, Yount said. I watched this train go by for 30 different services, and I only caught onto the caboose.

Younts insight was simple: In addition to the physicians bill, hospitals were paid a facility fee to cover X-rays, CT scanners, laboratories, and round-the-clock staffing by physicians and nurses. Free-standing emergency rooms shared many of these costs, since they strive to deliver the same care available in a hospital ER, and the facility fee made the business viable.

By situating in well-off neighborhoods, they could largely avoid patients who couldnt pay. Without a hospital affiliation, they cannot bill Medicare or Medicaid for emergency care, and many carry warnings on the front door that they do not accept those less-lucrative plans. And as a start-up, the free-standing ERs werent encumbered with the high administrative costs of a hospital.

Complicated cases, such as surgeries or trauma, could be sent by ambulance to a hospital, but stand-alone emergency room operators argue they can see people faster, keep them out of the hospital altogether and save money.

Yount, 68, is a jumble of contradictions. He is an unapologetic capitalist who operates four free-standing emergency rooms in Texas and is in the process of finding a site in Las Vegas to build a microhospital an ER with some inpatient beds.

He is also a supporter of Sen. Bernie Sanders of Vermont and a strong believer in universal health care whose office is still decorated with light-blue signs from Sanderss presidential campaign.

I can believe in one thing on a macro level, as to what this country needs to do. But if I want to operate, Im operating within the current system that we have. So I make the economic decisions based on the current system we have, Yount said. Doesnt mean I have to like the current system and I dont.

Yount says the start-up costs are about $5 million. In the early days, the business could break even with just seven or eight patients a day. The break-even point today is up to eight or nine, and Yount expects the number to rise as pressure from insurers increase.

The model appeals to many physicians and nurses.

The mind-set is totally different here, said Aaron Schwartz, an emergency physician at Elite Care. In the hospital, its driven by surveys and scores, efficiency and throughput times and volume. … We can spend as long as the patients want us to spend with them.

Some patients appreciate the convenience. Miguel Balli, 24, of Houston had spent a miserable night, vomiting and ill, when he showed up at Elite Care one Monday morning. Within an hour, he was getting an IV drip and beginning to feel better.

These setups are a lot more beneficial for the patient as far as time concern and quickness and availability, Balli said. If youre not the most serious person at the ER, if youre not the one bleeding out or having a heart attack, youre probably going to get last on the totem pole.

A misleading factor on costs

The problem is the flip side of the success: People who would have thought twice before navigating down to Houstons crowded medical hub, the worlds largest medical center, have a surfeit of options right in the neighborhood.

In Sugar Land, an affluent suburban city south of Houston, there is St. Michaels Emergency Center, right next to Emerus 24HR Emergency Hospital, a former free-standing ER thats been converted into a small hospital. In the driveway, two identical signs look like mirror images, each directing people with an EMERGENCY in a different direction. A mile away, in both directions, are two hospitals.

The ease of access is a good thing if it is moving people to seek care for symptoms that would be dangerous to ignore.

Many free-standing emergency room operators say they do their utmost to stress to people that they are in an emergency room, with emergency room prices, and they refer patients with minor conditions to urgent-care facilities. The buildings have emergency signs on them and are required by state law to carry written warnings that they will charge a facility fee although the amount is not disclosed.

But Ho of Rice University has found a big overlap in the types of conditions for which people seek care: Three-quarters of the 20 most common diagnoses at free-standing ERs were the same as at urgent-care centers. A slightly smaller overlap existed for hospital-based emergency rooms.

Its fine if it generates the value of the price that is paid, but if its not generating that value, then all it does is raise costs for everybody, Ho said. There needs to be more transparency in terms of the cost. Why should it be comparable to what a hospital ER is charging?

But even as free-standing emergency rooms defend themselves, the model appears to be evolving, in part in response to the confusion. Yount provided a tour of what he says is the future: a large free-standing ER that stands apart from shopping malls and wouldnt easily be mistaken for an urgent-care clinic. One of his competitors, Emerus, switched to building microhospitals.

Free-standing ERs blame insurers for big bills, arguing they deny claims or underpay them. Insurers, in turn, blame the facilities for charging high prices.

Theres this misleading factor, or Id go so far as to say deception, said Shara McClure, a vice president at Blue Cross Blue Shield of Texas. A member whos having an incident, having an acute condition, they go into these free-standing ERs thinking theyre a cost-effective solution.

The Texas legislature is considering bills that would help protect consumers from surprise bills and regulate the industry.

That points to the biggest lesson emerging from Texass experiment.

We need to do more to make prices extremely visible to patients, said Schuur, of Brigham and Womens Hospital. But it also calls into question the ability of patients to be smart consumers, particularly in the time when they have what they perceive as an acute health-care need.

Excerpt from:
Free-standing emergency rooms offer costly convenience – Washington Post

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