Apparently 9 patients accounted for 2678 ER visits in a 3 year time period. I know that I have some regulars that I will run on at least once a week (I am sure the sphere can attest to similar).
Unless I am mistaken, this is 1 ER visit every 3 days for these 9 individuals. There are so many issues here. As a healthcare provider, the first thing that strikes me is the enormous burden that these people put on the system. The burden is more than just the financial costs. Often times these people occupy beds in the ER that close that bed to patients with true medical emergencies…or occupy the ambulance rather than sombody having a heart attack. The burn-out factor on the health care personnel is tremendous as well.
Considering that the majority of these people have psych issues and/or substance abuse problems, I wonder what sort of savings would be realized if we treated these folks appropriately the first time through the door. I know that often times these people don’t really want to be helped so it probably doesn’t matter what we would do.
I saw this and was going to post here, but I was busy at work…
There was an interesting piece in the New Yorker a couple years back about a similar problem, a guy called “Million Dollar Murray.” Murray was costing millions because he was homeless and was constantly in and out of the ER. Just as in this example, these things follow a power-law distribution when plotted on a graph…or that is, instead of the problem looking like a bell curve with the majority in the middle, the real problem tends to be a cluster of very few people at the far end causing the majority of the problems. The proposed solution was to take someone like homeless Murray, who was costing millions in health care expenses, and put him up in an apartment. Providing him a home actually kept him off the street, kept him from getting sick, kept him from fighting, and kept him out of the ER. It was actually far cheaper in the long run.
Unfortunately, these sorts of solutions have little appeal because you are giving special treatment to those who don’t really deserve it.
Why send a bill to someone who you know will never pay it? Why waste the postage?
These folks often come and just want their “pain” taken care of. Often with the drug and dose they know by name. These frequent fliers all get nick names and do nothing but burden the system, staff, and facilities. (I heard a story of a local guy who would put things in his rear, and show up at ED for removal…often).
Proper treatment? Send them out on the streets and let them fend for themselves. What is really cool is women who will show up to ED and want a papsmear. Or, the guys who want to just get a physical for their pre-employment for a local land scape company.
How about when we see them we can castrate them, or give them a ligation? Keeping them from breeding would be a good start.
They know, walk into the ED and they will get service…as the hospitals MUST treat them. It is high time the medical world start telling these people to hit the road.
Are they not paying for services? I suppose some don’t have money to pay, but aren’t they charged for services?
They may be “charged” but they aren’t paying anything. This isn’t uncommon, although the numbers may be on the (very) high side. The chronically alcoholic-homeless use the ER more frequently than most pop aspirin.
An anecdote: A few years ago, in the span of one working week (4 days … Wednesday thru Saturday) I sent the same alcoholic homeless woman to detox 3 times, which shouldn’t even be possible given that detox is supposed to be 72 hours. I sent her early in the shift on Wednesday, midshift on Friday and then late in the shift on Saturday (technically Sunday morning). Each trip “cost” in the neighborhood of $2k; she never paid a single cent as she didn’t have a cent pay. This woman has since died … she was found on the street, dead. With a BAC at autopsy off the chart.
I don’t know what the solution to this and other similar problems might be. I will say this, and I am not proud of it, I am in short supply of empathy, sympathy and compassion for those who live their lives in this manner.
**What would a professional in the health industry, like yourself, suggest we do with these people? **
To be honest with you, I don’t know. All real solutions that I can come up with either cross the line of human decency or cross the line of their civil rights.
If you ask me the morning after I get off of work when I was out all night carting them to the ER, I would probably vote in favor to fuck them all and just let them rot in the street. I know that this is not the right attitude though.
Charge the for the services. It’s amazing how that somehow slows demand for medical services.
exactly. if shit ain’t free, it’s amazing how many problems disappear.
also for someone homeless, they are essentially getting sheltered, medicated, food, people to wait on them hand and foot, etc. why wouldn’t they go to the ER, it is the best gig going!
in college i had to take my girlfriend to the ER one Friday night, she was really really sick with a high fever, blown up sore throat, vomitting. just…sick.
it was amazing to me that she was about to collapse yet people (patients?) were there eating Wendy’s, socializing with one another, and basically having a family reunion. all in the ER waiting room. who knows how many were holding up beds while my friend was about to go in a comma.
it burns me up. something needs to be done. and it would only get worse if healthcare was free for everyone. what a freaking mess. those who can’t pay get care anyway. what is the point.
Charge the for the services. It’s amazing how that somehow slows demand for medical services.
** exactly. if shit ain’t free, it’s amazing how many problems disappear**.
Exactly,
While working in the USC Medical Center ER prior to deploying to Iraq I was assisiting in treating a older gentlemen who rolled his Show Car. As the ER Doc and I were stopping the bleeding he was worried about his wife and who he should give his insurance info to, the Doc’s response was “Hey this is County NO ONE PAYS HERE.”
Charge the for the services. It’s amazing how that somehow slows demand for medical services.
it burns me up. something needs to be done. and it would only get worse if healthcare was free for everyone. what a freaking mess. those who can’t pay get care >anyway. what is the point.
Why do you think it will get worse? Canada, UK, etc, with free healthcare, do not have worse homelessness problems. And most homeless are not chronic homless.
But the biggest problem is that we’d have to require all doctors and medical personnel to renounce the hippocratic oath, because it will require ER doctors to let people die. And how do you do that consistently? Do you do it with children? Anyone over 18? How do you know they’re chronic homeless, and not just having some kind of psychotic break and their family is looking for them? Do we create a “dying wearhouse” where you just place people to die and every day you go in to cart off the downers?
All that said, something does need to be done. My wife is a nurse, and on the front lines, so I know all about it every day.
Second behind the chronic homeless are the mordibly obese. OMG, the stories about the obese.
it burns me up. something needs to be done. and it would only get worse if healthcare was free for everyone. what a freaking mess. those who can’t pay get care anyway. what is the point.
I’m inclined to agree with you. There is already a fairly large segment of patients that I transport to the hospital that go to the ER simply because they think they can get seen faster than if they made an appointment with their primary care doctor. As a result, we bring in tummy aches, ear aches, stuffy nose, etc. to the ER BY AMBULANCE. The funny thing is that we often take them out to the triage area/waiting room and they have the gaul to be incensed that I’m “not doing my job. Don’t you know how long I will wait out here?” I think that having free healthcare will only add to the sense of entitlement that some people already have.
There is also a segment of the population that just doesn’t get it. A couple of months ago, I ran on an 18 year old who called 911 because he had a stuffy nose, chest congestion, fever, nausea/vomitting (in other words a cold) and wanted to see the doctor. We picked him up and took him to the hospital. I assessed him and tried not to engage him in too much conversation. However, he asked as we were pulling into the hospital parking lot who pays for the ambulance ride. I told him that he is responsible for the bill as he is 18 years old, but that it is possible his medical insurance would pay for some or all of it. He said that he did not know if he had insurance or not and then asked how much the ambulance ride was. I told him it was about $550.00. Now he starts to panic. Then I told him that the ER visit was probably going to start at around $500 too. Now we are wheeling him in and he doesn’t want to go…in fact he just wants us to take him home. I finally told him that it was too late for us to take him home and that the taxpayers would probably end up footing the whole bill for him if he didn’t have medical insurance. He didn’t even say thanks.
My most frequent flier is a homeless guy that lives behind the local grocery store. Seizure disorder, noncompliant, drinks daily, verbally and physically abusive to anyone in his vicinity. We must treat him, on average, 3 to 4 times per week, for going on 5 years now. He’s made numerous trips to detox, falls off the wagon within nanoseconds of discharge. No support structure, but no demonstrated effort made to commit himself to change. He’s resigned himself to this fate, and is perfectly happy to live in the cracks where others periodically fall. We affectionately refer to him as Spackle.
He’s the exception to the rule, though. Most frequent fliers rack up their miles courtesy of family members who have no means of providing transportation to their chronically sick relatives, or who abuse the 911 system because they think ambulance transport means shorter wait times in the ER (which is faster and, when you’re not required to pay up front, cheaper than a visit to their primary care MD). Rarely, in my experience, is it the case that improper or incomplete care is provided to patients in need; it’s almost always a combination of ignorance (or indifference), and poverty.
That said, for every frequent flier that arises from those fertile grounds, there are hundreds (if not thousands) who don’t abuse the system in any way whatsoever. I choose to work in predominantly poor areas for this reason - most of the calls we run are for decent, hard-working low income families who truly need assistance, and are grateful for the help they’re given.
hey i’ve said it before, it is the low lifes who drain on society. those who committ crimes, and generally DO NOT PRODUCE that are causing most of the problems in America. these people produce nothing and are more expensive than the average bear because they utilize so many endless resources.
we’ve talked about addition, just how expensive it really is. between addiction and psychosis, with a layer of stupidity on top, one could argue these are the 3 most expensive plauges of society today.
Your experience is very similar to mine. "“Spackle”…that is pretty funny. I can only imagine how he got that name (HAHAHAHAHA).
My city is divided. We have one section which is fairly well-off. A lot of retirees with insurance. Definitely an older population with the commensurate elderly type of medical problems. That station goes out on about 6-7 medicals a day.
The other section (where I work) is less affluent. Mostly blue collar, kind of red-neck sort of area. We border Detroit. We have a couple of roads that are pipelines to and from the big city. Crime is a little higher. We go out on 8-9 medicals a day and are completely nuts on Friday nights. We have many more 911 abuse-type calls. Many more OD’s. We even have a guy that is our version of Spackle (except that he lives in a treed lot behind McDonalds).
I think that the effect I am most worried about is that some care-givers get burned out taking care of these people and then it flows over to other patients. I am not saying that it is right or justified, just that I am sure it happens…even if it is just for the remainder of that shift. Professionalism will get you so far, but the reality is we are only human.
I’m not entirely sure this is true for a certain cohort of ER attendees. There was a tool developed by Columbia called the PARR tool to id patients that were at risk of reattendance and how to predict whether it would happen. These patients fell in to different groups, your addicts, people with chronic conditions such as COPD, Diabetes and other long term conditions and then there was third group if I recall.
The problem with this is that ID’ing who will attend is not necessarily the problem, you know that BOB attends once / week, the issue is when. Primary care here has tried to address some of this through visits by district nurses and other staff but the problem is you can leave these patients at 2 in the afternoon and they are being transported to hospital at 3.
I agree there are huge numbers of inappropriate attendances, there are also some people that have conditions where some form of treatment is appropriate, just perhaps not in a ER.
***I wonder what sort of savings would be realized if we treated these folks appropriately the first time through the door. ***
What would a professional in the health industry, like yourself, suggest we do with these people?
Out them. Publicize what they are doing, and ask the general public if the public would like to continue paying for their care. If not, turn them away at the door.
Would never happen, but it’s nice to dream.
Removing civil liability or EMTALA punishments for patients who abuse the system and present for free care would also help.
I agree there are huge numbers of inappropriate attendances, there are also some people that have conditions where some form of treatment is appropriate, just perhaps not in a ER.
Of course. But some people will still go to the ER. It is clear that psych issues and chemical dependency issues cannot be handled in the ER.
Acute symptoms are appropriate with some chronic diseases. But with many of the chronic diseases (IDDM, CHF, morbid obesity, etc.) there is a non-compliance factor that also needs to be taken into effect.
Seriously, just charge $25 for the visit upfront. I think that is enough to deter the stupid visits.
I had to take my dog to the 24 hour emergency room. I walked in the door and had to give them my credit card for a pre-paid $175 fee before they would even see my dog. Why should people medicine be any different.