we told todaze Lympians so

State government is about to start refusing to pay for repeat visitors to emergency rooms whose conditions don’t truly rise to the level of emergencies.

Starting Saturday, Medicaid won’t pay for more than three ER visits in a year for a patient’s nonemergency conditions as defined by the state.

A list of more than 700 diagnoses put into that category has drawn fire from hospitals and doctors’ groups over inclusions whose symptoms seem awfully similar to emergencies:

• Shortness of breath and some types of asthma attacks.

• Kidney stones.

• Hypoglycemic coma.

• Nonspecific chest pain or abdominal pain.

• Nonspecific congestive heart failure.

If a condition is left unspecified, that means it turned out to not be connected to a more dangerous ailment such as a heart attack or stroke. But doctors say that result can’t be known until patients are treated.

“Do (patients) know the difference necessarily between heartburn, heart attack, a blood clot in my lungs and a sore rib?” asked Dr. Stephen Anderson, president of the American College of Emergency Physicians’ state chapter. “These people shouldn’t be sitting at home trying to self-diagnose.

“My worry is, the message we’re going to be sending is the wrong message, which is, you should not be coming to the emergency department; you should be staying away,” said the Auburn Regional Medical Center doctor.

The state Health Care Authority sent letters to patients on Medicaid, the federal-state health insurance for the poor, warning them the government wouldn’t pay for their nonemergency treatment after three visits.

The agency is trying to save an estimated $72 million in federal and state Medicaid spending, as directed by state lawmakers who tried this spring to crack down on emergency room misuse.

Kinda rhymes with peath danels

24 Comments!

  1. Posted September 26, 2011 at 12:17 pm |

    They are trying to do the right thing.

    most of the people who wander into the ER are either drug seekers, or people on welfare or illegals who want free non-emergency medical treatment.

    They get treated first because they will sue if they don’t. This can all be blamed on a federal judge who ordered hospitals to treat these slugs. Medical service for the uninsured is expensive because they are the ones who the hospital can soak to pay for this.

    Before this, welfare medical cases were shipped off to the county hospital, and they got the book thrown at them if they were faking it or bumming service.

  2. Posted September 26, 2011 at 12:25 pm |

    They could save three times that amount if they’d control the borders. I think that’s a good place to start.

  3. John A
    Posted September 26, 2011 at 12:41 pm |

    While I applaud an effort to stop people from drug-seeking or going to the ER for stubbing a toe on a chair, this just seems an overreach. For three years, I lived below a couple one of whom needed an ambulance ride to the ER at least once a month.

    I recently had major surgery (a double bypass). I see the surgeon on a fairly regular basis, and have a blood test at least once a week. Who does my doctor tell me to call IMMEDIATELY should I suspect a problem? A 24/7 ER (no, not all ERs are, there is at least one hospital ER nearby which is only open “normal” business hours), not him, even during office hours. If an actual problem is detected, the ER will call him, or on their own specialist[s].

    Too, in the last ten years I have gone to an ER three times: always crowded, most not in great distress (er, some of those were actually bleeding, but not in “great” distress), yet I do not recall any who seemed not legitimately in need.

  4. DougM (jackassophobe)
    Posted September 26, 2011 at 1:25 pm |

    I think the point is:
    gov’t health care —> bureaucratic medicine
    They will have a budget, treatment costs, so treatment will be rationed.

  5. Laurence
    Posted September 26, 2011 at 2:05 pm |

    Reminds me of that old adage: He who pays the piper, calls the tune.

    Doctors work for those who pay them which is mainly the government or insurance company. The government has some say so as to ins-co practices but no one can tell the government how to behave.

  6. Alan outback bacon czar
    Posted September 26, 2011 at 2:07 pm |

    Our ER is usually full of kids with snotty noses. I think that’s what they are trying to curtail.

  7. SherryM
    Posted September 26, 2011 at 2:18 pm |

    ^ Yep! and the bureaucracy begins. I think there are things that should not be on the list and that there are a lot of people milking the system. But this heath care stuff is like a numbers racket that you are forced by law to play, if you do not play you are punished, if you want to be intendant about it they wine about it costing everyone else more money. Never mind the fact that them spreading the costs around is what cost people more money and opens the door to bureaucrats. The whole thing snowballs and we end up with a 300 page form and a 1 year waiting list to have a tooth puled. UGH!

  8. Merovign
    Posted September 26, 2011 at 2:19 pm |

    Congestive heart failure is not an emergency? WTF?

    Seriously, this is what happens when you depend on the government for your health care. You end up suffering at home like the British or dying in filthy wards with no nurses like Cubans.

  9. geezerette
    Posted September 26, 2011 at 2:42 pm |

    What if you need a breathalyzer for your tonsils?

  10. SondraK, TEA Party zombie
    Posted September 26, 2011 at 2:56 pm |

    ..the point is:
    gov’t health care —> bureaucratic medicine
    They will have a budget, treatment costs, so treatment will be rationed.

    THANK YOU DOUG.

  11. apotheosis
    Posted September 26, 2011 at 3:16 pm |

    Wait wait wait…hypoglycemic coma isn’t an emergency?

    Because I thought any kinda coma was sorta serious.

    Note: I am not a doctor.

  12. SondraK, TEA Party zombie
    Posted September 26, 2011 at 3:19 pm |

    ^ Yea, and not being able to breathe but I’m not a doctor either.

  13. apotheosis
    Posted September 26, 2011 at 3:27 pm |

    I learned all that first aid and CPR and stuff for NOTHIN’!

  14. SherryM
    Posted September 26, 2011 at 3:44 pm |

    Cuz the DMV and the post office are so efficient! Brought to you by the original Big Brother, and in part by We are from the government and we are here to help.
    Coming soon! They will sell you the rope to hang your self while we will gladly give you the rope for free” and “In the workers paradise all are equal (some are more equal than others)

  15. Fat Baxter
    Posted September 26, 2011 at 4:37 pm |

    Well, I better watch my quota now. I was in the ER last month for one of those “nonspecified chest pain” thingies and numbness in my upper left arm. But never previously having had a heart attack, I thought I’d better play it safe and go in.

    I guess the next time, I’ll just wait until it feels like an “Alien” chest-burster trying to birth itself.

  16. SondraK, TEA Party zombie
    Posted September 26, 2011 at 5:01 pm |

    “Everybody knows that it makes no sense that you send a kid to the emergency room for a treatable illness like asthma, they end up taking up a hospital bed, it costs, when, if you, they just gave, you gave them treatment early and they got some treatment, and a, a breathalyzer…”

    “Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government’s latest attempt to protect the Earth’s atmosphere…”

  17. Colonel Jerry USMC
    Posted September 26, 2011 at 5:01 pm |

    I am not a doctor, but I will play one—-after the fucking revolution 8^{

    For heart attacks and/or comas, *I* will write the emergency steps and the order executed,

    For instance:
    1) Examine the patient to see if he/she is a “useless eater”.
    2) If “yes”–wheel chair to out door vending machines.
    3) If “no”–admit and operate, if time is of essense.
    4) Primary source for organ harvest will be vending machine area.
    5) Non-medical ER exception: If voted for Obobo => vending machine area.

  18. Paul
    Posted September 26, 2011 at 5:02 pm |

    You would be amazed at how many people on Medicaid or Medicare come in to clinics to basicly talk to someone.

    They are lonely so they come in for some conversation. Little aches and pains, and how they are tired, and wonder of their hiccups are life threatening.

    And that runs the bill up for everyone else!

    How do I know? My mother worked at a clinic for 20 years. She saw them every day doing stuff like that.

    They were not sick. Just bored and lonely. Retirement can be a bitch.

  19. mech
    Posted September 26, 2011 at 5:12 pm |

    I remember something called “Triage” where cases are sorted according to severity.

    At one time when I was at the university, the campus clinic was closed or too busy or something and they told me to go to the medical center just off campus–at the door to the ER one could go one direction to the ER and another direction to a clinic for the small stuff like the cough I had. Quick, cheap and effective. If a condition was severe enough, one could be wheeled across to the ER.

    Even without an educated public, the sorting at the door can save some taxpayer money right away.
    Nurse practitioners, physician assistants and even paramedics can take shifts to lighten the load.

  20. Anna830
    Posted September 26, 2011 at 5:27 pm |

    Yep, patients definitely need to be weeded before going through the ER. As a past medic I transported many people and I mean MANY able bodies to the ER via ambulance. We had to take them or risk a law suit. Then we wheel them past the actually near death patients to park them in the rooms near the other GOOFERs (GET OUTTA OUR F’ING ER)
    It’s pathetic.
    While doing my ER training I bet out of all the ER patients seen maybe 30% were actual emergencies
    and YES, Alan… most were snotty nosed kids with non English speaking parents

  21. LLoyd
    Posted September 26, 2011 at 7:03 pm |

    “…people who wander into the ER are either drug seekers…” And I saw pa-leny of them too Kristophr #1. And they are as you would expect some of the biggest cons walking the planet. They’re are people that are going to abuse the system.

    The inclusions have the qualifier of 3 in a year which having been through it myself, should be alerting the hospital to doing what they have to do to STABILIZE the patient by the 3rd visit for the same symptoms/emergency.

    Broward County FL, where I live has a nice program for the indigent or for those on a means tested basis. You go in, show your income/expenses and then they have a sliding scale, they give you your number and your off. No problem. And the system is very good. Then when I became eligible for Medicare, (I began on SSDI) I had to come off their plan and submit under Medicare–same system only now I was caught in the 20% co-pay. Now I have Humana which is a HMO with a Medicare contract–same Dr’s that hounded me for co-pays BUT NOW– ITS ZERO. And I got no complaints.

    Now this Guy—-he got complaints! This is a ROR REAL pic. He is in the Canandian H/C and this was when Hiliary began her push for H/C:

    Image Hosted by ImageShack.us

  22. Lord of the Fleas
    Posted September 26, 2011 at 9:54 pm |

    This debate in the US is quite fascinating. We had Medicare (our term for the one-size-fits-all, no-options-allowed system) shoved down our throats in 1965. (I was 12 and don’t remember the debate directly, but the key to forcing it on us was in our tax system, which is different from yours somewhat.) It was predicted to be a disaster, and it is. (Witness LLoyd’s photo…)

    You have the opportunity to stop this crap, and you had better do so. Medicare up here is no longer a political policy or program – after forth years, it’s a fucking religion, worse that Social Security down there. And in my personal view, a fixation on medical care ranks right up there with illegitimacy and welfare dependency as an indicator of serious societal decay.

    It’s only one of many serious threats to the Republic, but it’s a key.

    Don’t fuck it up.

  23. dick not quite dead white guy
    Posted September 26, 2011 at 10:24 pm |

    ..the point is:
    gov’t health care —> bureaucratic medicine
    They will have a budget, treatment costs, so treatment will be rationed.

    THANK YOU DOUG.
    Corollary: bureaucratic medicine = bigger administration = less efficiency, increased cost overall and wasted money. Massive bureaucracy is massively wasteful.

  24. Claire: barbarian, etc
    Posted September 27, 2011 at 7:54 am |

    We had to take them or risk a law suit.

    *BING*BING*BING*
    Why the whole system was grinding to a clogged halt anyway. Yet it still worked better than the bureaucratic method…