ER CONSPIRACY THEORIES

As I have pointed out many times, a good deal of BS appears in the “news” media relating to health care. Few articles, however, reach the level of irresponsibility achieved yesterday in Slate:

Imagine you run a hospital. There are two competing sources for inpatient beds. The first source is patients who come in through direct and transfer admissions. They are more likely to come with private insurance and need procedural care, both of which maximize profits. The second source is E.R. patients, who are more likely to be uninsured or have pittance-paying Medicaid and less likely to need high-margin procedures. Do the math: If you fill your hospital with the direct and transfer admissions and maroon the E.R. patients for long periods, you make more money.

The authors of this disgraceful piece of agitprop would have their readers believe that the people who run hospitals deliberately allow people to languish in their ERs for financial gain. The suggestion is not merely slanderous. It is absurd on its face.

I have worked in hospital finance (at institutions large and small) for more than two decades and have never met an administrator or finance person (not one) to whom such an idea would even occur. Where I have worked, suggesting such a policy would get you fired.

Moreover, the clinical staff would have to be complicit in (or, at the very least, aware of) the implementation of such a program, and I have never worked with a physician or nurse (not one) who would countenance anything like the authors describe. 

Think about it. Can anyone imagine Shadowfax, Gruntdoc, Scalpel, Nurse K, et al, putting up with this kind of behavior from the people who run the hospitals in which they work? I sure as hell can’t. They would scream their heads off.

The reality of the typical U.S. Emergency Room is that it is one of the few truly egalitarian environments on the planet. Money or status have no bearing on how you are treated. As Kim at Emergiblog puts it:

Rich, poor, old, young, drug-seeker, homeless, insured or not (and we see everything, albeit at a less intense level than an inner-city hospital) if there is a bed in the hospital you get it – and you don’t wait in line.

Long ER wait times are a fact of life in every health care system worthy of the name, including single-payer and socialized systems. In fact, in places like Canada and England, it is so bad that patients are stacked in ambulances.

ER overcrowding in the U.S. has nothing to do with profits. ERs are crowded because our “leaders” in Washington have created incentives (via EMTALA and low PCP reimbursement) for people to use them as clinics.

The authors of this article paint a picture of U.S. hospitals that is wildly at odds with reality. They claim to be “practicing” ER physicians. If so, they are not only irresponsible, they are dishonest.

[HT Kevin,MD]

Comments 8

  1. SmartDoc wrote:

    You nailed this “Health Care BS” beautifully!

    Posted 25 Jul 2008 at 6:22 pm
  2. Nurse K wrote:

    1) Sometimes edicts come down from above that the budget doesn’t allow for overtime, so they don’t staff the floors and we back up despite having physically open beds. There is no such thing as “let’s only give beds to the VIPs, white people, and insured” though.

    2) I’ve made famous/prominent people wait in the lobby.

    3) Avoiding ambulance divert is a major goal for everyone dealing with numbers and finance because if the ER is full, we divert ambulances and lose something like $10,000/hour on average. No one would in administration would be stupid enough to devise policies to intentionally cause an ambulance divert situation if nothing else.

    Posted 25 Jul 2008 at 8:00 pm
  3. ERMurse wrote:

    Hospitals holding beds while patients wait in the ED. Absurd – Yes but its common in my neck of the woods. Hospitals do hold beds that are untouchable to the ED. They do it for their capitated patients that need to be transfered in after landing in other facilities. They do it for beds contracted to other facilities for specialized services. They dont talk about it and in my experience the official line is that they do not hold beds but they do. I can remember my experience working for a large academic medical center in California watching direct admit after direct admit role in while we had patients in the ED holding for up to two days. I gave some specific examples in comments about this over at emergiblog.

    Posted 25 Jul 2008 at 10:48 pm
  4. shadowfax wrote:

    Amen and well said.

    Posted 25 Jul 2008 at 11:05 pm
  5. GruntDoc wrote:

    I couldn’t agree more.

    Nice post.

    Posted 26 Jul 2008 at 6:18 am
  6. Sarah W wrote:

    ” Money or status have no bearing on how you are treated.”

    This is flatly false. Granting that a patients status or pocketbook or insurance coverage may not always affect every patient, nor will every treating physician consider status or money, money and status are not perfectly excluded and it is laughable to argue that this is the general case.

    One need only look as far as behind-the-scenes medical blogs, and Medical news and opinion gathering blogs such as KevinMD to find distressing evidence on a daily basis that money and statue affect patient care, as they affect treatment in almost every other walk of life.

    Posted 26 Jul 2008 at 10:20 am
  7. rogue medic wrote:

    Sarah W,

    Nobody wrote that they are “perfectly excluded.” They do not have a bearing on the disposition of ED patients. Much more likely to affect your care is the way you treat the ED staff. Occasionally a VIP will come in and administrators will ask for special treatment, but this is usually accomplished by making them feel special. It is not accomplished by kicking some uninsured sick person out on the street.

    You comment that the medical blogs prove otherwise is contradicted by all of the comments from the medical bloggers posted before your comment. Perhaps you read something between the lines, that is not written between the lines.

    Conspiracy theories are the way uninformed people deal with uncertainty.

    Posted 29 Jul 2008 at 9:30 pm
  8. cat wrote:

    No nurse or doctor is going to let someone wait while they “rake” in the money. in bad situations you do what you have to do. In overcrowded hospitals with no nurses allowed to work overtime because of budgets people suffer. and im very willing to bet that those nurses and doctors hate that part of the job when they are powerless to stop it. I give my thanks to all the hardworking medical teams who show they care by continuing to provide endless days and nights trying to help people who are helpless. Thank you

    Posted 22 Apr 2009 at 1:08 pm

Trackbacks & Pingbacks 4

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  2. From healthcaretoday.com on 25 Jul 2008 at 2:42 pm

    Health Care BS – ER CONSPIRACY THEORIES…

    As I have pointed out many times, a good deal of BS appears in the “news” media relating to health care. Few articles, however, reach the level of irresponsibility achieved yesterday in Slate….

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  4. From Bad Medicine » Do CEOs respond to incentives: the shocking, shocking truth. on 26 Jul 2008 at 2:57 pm

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