Abused EMS system
- Thread starter Guardian
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I don't think there is an easy solution to this problem. It's just a huge cycle that keeps going... and going... and going.
I have some ideas of course:
1. Community Education - I believe that many have no clue about EMS or the strain they put on the system when they call for BS. EMS has become the healthcare source or means of transport for many people with low income. I believe that a community education campaign, sustained from young kids to old folks, would help change some views.
2. Cheap Intermediate Care - The problems most people are going to the ED for could be taken care of at an urgent care facility, or wouldn't even be so bad if it was taken care of earlier.
3. Cheaper Healthcare - The reason why so many people are in the ER is because they can't afford continual healthcare, and allow minor issues to grow... and grow... and grow. Now how do we fix this I'm not sure, but it's part of the broken system.
4. Personal Responsibility - This one really kills me, and I may even start a flame war here. I'm going to try to be careful though. In order to have a system that works, the bills need to be paid. I can't stand when someone says "Detroit EMS didn't respond in time and x happened." Detroit EMS didn't respond in time because they only have x units, because probably fewer than 25% of the people actually pay for the service. Sure, they can't afford it. It's a huge cycle. They're behind and so many things already, and there is no way to get ahead when you're only making x dollars an hour or don't have a job, but someone needs to break the cycle.
Radical Changes - Our current system is broken, there is no question. What we need is a radical change in healthcare. Almost 50 million Americans don't have insurance. We're beyond making a change, we need to scrap the system and start over.
That's all I got.
I have some ideas of course:
1. Community Education - I believe that many have no clue about EMS or the strain they put on the system when they call for BS. EMS has become the healthcare source or means of transport for many people with low income. I believe that a community education campaign, sustained from young kids to old folks, would help change some views.
2. Cheap Intermediate Care - The problems most people are going to the ED for could be taken care of at an urgent care facility, or wouldn't even be so bad if it was taken care of earlier.
3. Cheaper Healthcare - The reason why so many people are in the ER is because they can't afford continual healthcare, and allow minor issues to grow... and grow... and grow. Now how do we fix this I'm not sure, but it's part of the broken system.
4. Personal Responsibility - This one really kills me, and I may even start a flame war here. I'm going to try to be careful though. In order to have a system that works, the bills need to be paid. I can't stand when someone says "Detroit EMS didn't respond in time and x happened." Detroit EMS didn't respond in time because they only have x units, because probably fewer than 25% of the people actually pay for the service. Sure, they can't afford it. It's a huge cycle. They're behind and so many things already, and there is no way to get ahead when you're only making x dollars an hour or don't have a job, but someone needs to break the cycle.
Radical Changes - Our current system is broken, there is no question. What we need is a radical change in healthcare. Almost 50 million Americans don't have insurance. We're beyond making a change, we need to scrap the system and start over.
That's all I got.
Wingnut
EMS Junkie
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MMiz said:
Those are the key words right there, couldn't have said it better myself. There has been a time or two where Jay or I have needed medical care and couldn't afford a visit to our regular clinic (and this is with insurance) and we've had to go to the ER. The even worse part about it is even though our insurance covers a lot of it, our end still ends up being 3 times more than the clinic would have been and it takes us forever to pay off the damn bill.
MedicPrincess
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Guardian said:
Thats kind of a cute question. Someone who still believes it can be fixed.
How about...
1. Rethink EMTALA! EMTALA has become almost as big of monster as HIPAA. Basically in a nutshell, most hospital lawyers have interpreted EMTALA to say if you go to a hospital that has an Emergency Department, they HAVE to see you. They cannot turn you away. You HAVE to get your treatment and your drugs your seeking. EMTALA does not say that. EMTALA says if you present to and ER, you are entitled to an eval by competent medical personell. Hospitals need to stop right there. Once people have had their screening, and it is determined they are not expierencing an medical emergency, the billing people should be able to come in and say "You have received your medical screening and our physician has determined you do not have a medical emergency. If you would like to stay and continue your treatment, I will need a deposit of $(insert figure here)." If they don't pay, they leave without their drugs. If they give up the cash, treat them.
One hospital here does that, and you know what, they are NEVER so busy they are overwhelmed. People know they cannot go there and use thier ED as a free clinic.
2. Allow EMS to refuse to transport again. Sure the liability is huge. But seriously, we transported a 16 y/o F who was having "chest pain when she coughed." We also carried her 3 children with us because she didn't have a babysitter or a car to drive herself. We are not allowed to refused to transport anybody. They call, we haul. Wouldn't want a lawyer to sue us.
3. Personal responsibility....don't even get me started. There is no such thing as personal responsibility anymore. No matter what a person does it isn't their fault. POOR THEM!! Oh if they weren't black/mexican/white/female/poor/abused/rich/mildly retarded/young/old/drunk/high/WHATEVER...then it would have never happened. BS!! Really...I need to stop, I can feel my BP rising....
Its broke. As long as anybody can sue anybody for anything and WIN it will remain broke. As long as I can get drunk, drive my car 100 MPH in to the back of someone seriously injuring if not killing them and get off because my lawyer is better then the states...it will remain broke.
As long as we continue to allow just anybody to breed....well its still broke.
Call me crazy, but i really don't think we have to scrap the entire system and start over. Quite frankly, thats unrealistic. I do think we can make small changes to really improve the system and thats what I'm looking for here, just little suggestions that might help. Also, "mildly retarded" is my new favorite term and i will use it often to describe my pts, thanks emtprincess
rescuecpt
Community Leader Emeritus
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The US doesn't have socialized medicine... officially. In NY we have a state-run insurance program that will give insurance to just about anyone who doesn't have it. Hmmm, anyone smell socialized medicine? Also, the whole ED thing - again, socialized medicine? The government should just say "yes, we realize this is the direction we are moving in, let's make it official"... and revamp the system. It seems to work well in Canada and Europe. Granted, I am not a proponent of entitlement, which is contrary to my idea of socialized medicine, but whatever, if it would help, then we might as well.
rescuecpt said:
Socialized medicine, now were at the heart of the matter. Public officials know that there are many people like me who disagree with socialized medicine and could argue that Canada and Europe's medical care has gotten worse after socialized medicine, especially when compared to the US (OK, just middle class and >). Not to mention, the whole capitalism thing goes right out the window. Because of this, the public officials are unwilling to "make it official." On the other hand, they are unwilling to do anything about EMS abuse because of the bleeding heart backlash that will ensue. So in short, our public officials, mostly the elected type, are cowards, but thats no surprise. The only solution that I foresee, is a change made on our part. We need to set our own courses and be the leaders who decide the future of our business and let the public officials talk which is the only thing they are good at doing.
EMS agencies should be able to decide that not all of our calls are real emergencies and not transport. After all, we (paramedics and more importantly Medical Directors) are the medical professionals. Why can't we draw more lines. When you go to the hospital, they don't give you every medical test in the book because that would be ridiculous (admittedly, they do give you way more tests than you need, for example, blood samples on every patient). They don't give you the hundreds of thousands of tests that they could conceivably do, so they can't guarantee that you are perfectly healthy when you leave. Even so, they do a pretty damn good job. This sh$*ty litigation is killing us. With the help of our medical directors, we should be more willing to go head to head with these pr*%ks in a legal setting for the sake of fulfilling our real mission and providing the proper care at reasonable prices. For those volies out there who run 2 calls or < a day, all i can say is, you probably need experience in the inner city before you can really appreciate where I'm coming from. OK, I'm done ranting and raving for now.........
Dr.R
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first of all, I'm not quite into your system, but as I understand you have lots of different inscurances, without similar covering.
in Austria EVERYBODY has insurance, you're forced by law to do that. practically they take the money from your pay-check before you even get it. your fee depends on your income and even an unemployee has inscurance, payed by the state.
you can of course get an additional insurance, providing more exclusive service at the hospital (means 1bed-room, bigger TV, little waiting time,...) and you may choose to get treatet by private M.D.s (who have no contract with the insurance company, mostly regarding plastic surgery)
but in fact EVERYBODY gets the same treatment. so if we respond a call, we know, they have insurance, covering for the transport... just depends on our contract how much money we get
well, I do not have secure informations about that, but our system's on since WW2nd and I can't see quality is getting worse. I admit great steps in new medical techniques and bio-science are made in US but, does everybody in US get those treatments?
the wide mass around here is treated at a secure high standard.
in Austria EVERYBODY has insurance, you're forced by law to do that. practically they take the money from your pay-check before you even get it. your fee depends on your income and even an unemployee has inscurance, payed by the state.
you can of course get an additional insurance, providing more exclusive service at the hospital (means 1bed-room, bigger TV, little waiting time,...) and you may choose to get treatet by private M.D.s (who have no contract with the insurance company, mostly regarding plastic surgery)
but in fact EVERYBODY gets the same treatment. so if we respond a call, we know, they have insurance, covering for the transport... just depends on our contract how much money we get
Guardian said:
well, I do not have secure informations about that, but our system's on since WW2nd and I can't see quality is getting worse. I admit great steps in new medical techniques and bio-science are made in US but, does everybody in US get those treatments?
the wide mass around here is treated at a secure high standard.
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Dr. R, let me just say this, our (yours and mine) routine medical treatment is about the same in both countries. Also, there is great medical research coming out of Austria, I know that. My belief is this, whenever government completely takes over something, the quality is going to go down because of a lack of competition and there will be less money to be made by public. Overall, our system is much better than yours simply because of money and capitalism.
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Dr. R,
First, welcome to the community!
Austria, and generally most of Europe, have significant taxes that pay for the healthcare and social services. Correct me if I'm wrong, but in the 80's wasn't the income tax up to 60% of one's earnings? Now I believe it is a tiered system that maxes out around 50%.
Also, I don't believe you can compare European healthcare to healthcare in the US. The qualify of facilities and services are much higher in the U.S. I'm not sure about Canada though.
As an EMT for a private EMS service, I often transport patients from the ultra-modern Level 1 Trauma Center to a not-so-great hospital in Detroit, because that's what insurance covers. I've had patients plead to stay, because they know their quality of care is much better at the suburban hospital. I've even told some patients, "Look, I shouldn't be telling you this, but I'd refuse transport to the new facility if I were you." Only one person has, who responded "I've been in the hospital 100+ times this year, and they do this every time. Of course I'll refuse."
First, welcome to the community!
Austria, and generally most of Europe, have significant taxes that pay for the healthcare and social services. Correct me if I'm wrong, but in the 80's wasn't the income tax up to 60% of one's earnings? Now I believe it is a tiered system that maxes out around 50%.
Also, I don't believe you can compare European healthcare to healthcare in the US. The qualify of facilities and services are much higher in the U.S. I'm not sure about Canada though.
As an EMT for a private EMS service, I often transport patients from the ultra-modern Level 1 Trauma Center to a not-so-great hospital in Detroit, because that's what insurance covers. I've had patients plead to stay, because they know their quality of care is much better at the suburban hospital. I've even told some patients, "Look, I shouldn't be telling you this, but I'd refuse transport to the new facility if I were you." Only one person has, who responded "I've been in the hospital 100+ times this year, and they do this every time. Of course I'll refuse."
Dr.R
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I agree, that less competition makes quality going down and whereever money is to make people are motivated to give even more than their best. but over here it's not that the state has taken control over our hospitals or insurance companies. but there are laws, such as the must-insurance, to provide a public health care.
and believe me, there is competition. since money is an important factor hospital-companies are keen to "clean" their staff (MDs, nurses etc..), even if that means to shut down whole hospitals (in a mostly rural country that's a great loss). not to mention urban regions, where patients have the possibility to choose between several hospitals, competition IS very high.
on the other hand a good MD/hospital will have more pt.s =more money
it's the same about EMS, there are several EMS-providers between patients may choose. the Austrian government (as well as US) only sets system's guidlines.
the advantage of everyone insured is, that ERs are only for real emergencies, first step for minor sick/injured people is their local so called "family-MD" treating those minor illnesses and if necessary sends pt.s to the hospital.
BUT of course US has to deal with very different, maybe much greater problems than we do over here. just to mention that even in Vienna gunshot-wounds are very rare. still we don't have to deal with that masses of refugees coming into our country and weakening the whole social/health-system...
differnet problems differnt solutions. would'nt dare to say our way is perfect or may work for you.
and of course there's a historical difference between our (yours and mine) points of view
I hope I did'nt tread on your toes! just wanted to give the discussian a different point of view.
and believe me, there is competition. since money is an important factor hospital-companies are keen to "clean" their staff (MDs, nurses etc..), even if that means to shut down whole hospitals (in a mostly rural country that's a great loss). not to mention urban regions, where patients have the possibility to choose between several hospitals, competition IS very high.
on the other hand a good MD/hospital will have more pt.s =more money
it's the same about EMS, there are several EMS-providers between patients may choose. the Austrian government (as well as US) only sets system's guidlines.
the advantage of everyone insured is, that ERs are only for real emergencies, first step for minor sick/injured people is their local so called "family-MD" treating those minor illnesses and if necessary sends pt.s to the hospital.
BUT of course US has to deal with very different, maybe much greater problems than we do over here. just to mention that even in Vienna gunshot-wounds are very rare. still we don't have to deal with that masses of refugees coming into our country and weakening the whole social/health-system...
differnet problems differnt solutions. would'nt dare to say our way is perfect or may work for you.
and of course there's a historical difference between our (yours and mine) points of view
I hope I did'nt tread on your toes! just wanted to give the discussian a different point of view.
Dr.R
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sorry, MMiz you've been faster with your post!
yes, that's the ~tax they get off your pay check every month...
and you're of course absolutley right. as I posted one above, problems are different therefore solutions need to be different...
I can imagine high class health care in US is in fact MUCH better, but as you said, how many can afford it....
yes, that's the ~tax they get off your pay check every month...
and you're of course absolutley right. as I posted one above, problems are different therefore solutions need to be different...
I can imagine high class health care in US is in fact MUCH better, but as you said, how many can afford it....
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Firechic
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Hello Dr. R and welcome! It will be interesting to gain a different perspective on EMS issues, please keep posting!