February 5th, 2011 by Veronica Sikka, M.D., Ph.D. in Health Policy, Opinion
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In 1986, when Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals and ambulance services were mandated by law to stabilize anyone needing emergency healthcare services regardless of citizenship, legal status, and/or insurance status.
This was instituted at the time to prevent the prevalent practice of “dumping” — refusing to treat patients because of insufficient insurance or transferring or discharging patients on the basis of anticipating high diagnosis and treatment costs. While the implications of this law are indeed very noble in providing undifferentiated care to all patients based solely on healthcare needs and not financial status, it has unfortunately led to many patients presenting to the emergency department (ED) for primary care issues.
The misconception is that the care in the ED is similar if not better (because of increased access to consult services and imaging) and quicker than waiting to see your primary care physician (PCP). A 2010 study published in Health Affairs found that 14 percent to 27 percent of visits to hospital EDs are nonemergent, such as minor infections, strains, fractures, and lacerations. The study found that all of these cases could have been appropriately triaged in urgent care centers or retails clinics.
England has a model that may be a potential solution. The healthcare goal of the National Health Services (NHS) is to “treat the right patients in the right place at the right time.” The NHS employs nurses and paramedics to handle 999 (their equivalent of our 911) triage calls with more appropriate triaging of patients based on acuity. Read more »
August 9th, 2010 by Edwin Leap, M.D. in Better Health Network, Health Policy, Opinion, True Stories
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This is my column in [the August 3rd] Atlanta Journal Constitution:
Secretary of Labor Hilda Solis recently produced an interesting public service announcement. In it, she stated that every worker deserves to be paid fairly for his or her labor (whether the worker is documented or not), and offered both a website and telephone hot-line which workers could use to report unfair payment by employers. (Incidentally, here’s the link: www.dol.gov/wecanhelp.) In the video, she stated succinctly, “You work hard, and you deserve to be paid fairly.”
Those of us who practice medicine completely agree. So we might reasonably ask if this announcement also applies to physicians who are undercompensated for their work. This routinely happens when patients are covered by Medicare and Medicaid, or by large insurance companies like Blue Cross/Blue Shield, which routinely negotiate unfair physician fees using their collective weight in bargaining. (Even as their executives bring home tidy bonuses that are clearly padded by denials). Read more »
*This blog post was originally published at edwinleap.com*
