Tuesday, October 21, 2008

Paying to Wait?


So, yes, it definitely sucks to wait 19 hours before seeing a doctor. Yes, broken legs hurt. Unfortunately, unless there is cardiovascular compromise, they're not an emergency to the same degree as that of a heart attack, stroke, major trauma, etc. Perhaps $136 is a bit steep to charge the patient, but then again, that helps cover the electronic kiosk where she checked in (equipment, software, and maintenance), the salary of the nurse who evaluated her, the chart that was generated for her (not sure if it was paper or EMR), and the upkeep of the lobby and clinic rooms. I don't know whether $136 is high, low, or appropriate.

Unfortunately, what do you expect in an emergency room that saw over 143,000 patients in 2005? (http://www.parklandhospital.com/medical_services/er.html) And this patient, by declaring her intention not to pay, is just adding to the strain on large public hospitals like Parkland. Did she plan to pay for her xrays and cast?

Waiting 19 hours sucks. Not knowing how long you'll be waiting sucks, but is par for the course in the ER. If you say "20 minutes" or "2 hours" and then a massive MI comes in or a patient codes and takes up all the staff, then the waiting patient gets mad anyway. Lose-lose situation.

Just another example of our imploding healthcare system.

Addendum: an opposing viewpoint from The Happy Hospitalist.

1 comment:

Anonymous said...

Parkland is a tough place. It is a good hospital that gives good care, but like many locations, it is overwhelmed. Back when I was in training (about 10 years ago), there were times when the ER would get backed up because the HOSPITAL was backed up (i.e. patients couldn't be moved up to the ICU's because the units were full). ER nurses were effectively becoming ICU nurses...even floor patients occasionally were "housed" in the ER because there were no beds upstairs. It becomes impossible to see patients in the ER when there are no beds/rooms to bring them back or nurses available to assist in care (those times usually happened in the winter months, btw).

I have moved out the Dallas area, but see scathing reviews of Parkland without much empathy or sympathy for a system that is over-burdened. Should Parkland just shut the doors when the ER is too full? That would solve the problem of patients expecting to be seen. Way back when (I think there were dinosaurs roaming the halls), the long wait times were never a reflection of callous docs or staff....it was a reflection of everyone trying to move as fast as they could in a system that just had too many patients, not enough room and not enough providers on some nights/days. If you pick the night that every other person rolling in via ambulance has a blood pressure of 65 or is a serious over-dose on random mind-altering drugs....it's going to take a while.

It does seem inappropriate to charge that much for a patient that wasn't seen by a doctor. Keep in mind, though healthcare operated like a lawyer's office, each encounter (nursing vs. doctor) would be billed. Patients would truly be shocked if doctors billed for time on case (and I mean ALL the time -- face to face time, plus nursing assessment, plus staff interacting with insurance companies to get approval for tests (including ALL of that wait time on hold.....)....just my jaded opinion too early in the morning.