Posts Tagged ambulance

Something Less than an Ambulance — will it fly?

ambulanceER doctors never ask the question but often think: “Why did you call an ambulance for a sore throat?!”  The trip costs at least $1000 and stands a chance of not being covered by insurance.  The ambulance crew feels bad they don’t have a more appropriate option but if you call an ambulance — you get an ambulance.

Kaiser Health News reports the South Metro ambulance company in a suburb of Denver Colorado is trying a new service.  An ambulance that is basically an ER in a box.  Equipped with lab tests, bandages, sutures and a few medications they go to a home to treat a problem rather than transport a person to the ER.  It costs about $500 — at this point, it is something insurance will not cover.

Here are two extremes:

  1. A single parent picks up their child from a family member after working 2 jobs at fast food restaurants.  The parent just got the jobs after 3 months of being unemployed.  The primary care doctor’s office is closed and the parent is expected at work in about 7 hours.  But, the child has a fever and a sore throat. The bus they usually catch to go to the hospital does not run after 8 PM.  The parent calls an ambulance.
  2. A woman drops a martini glass and cuts her finger.  Her husband thinks she needs stitches but he has some after hours stock trading to do before bed.  He tells the butler to call an ambulance and get the problem resolved.

The first case is common for Medicaid families.  No resources, no car, and not much to lose by calling an ambulance.  But, something to gain by not missing time at a new job and it helps the child on both counts.  The ambulance and ER visit may cost Medicaid over $1000.  But, during the day a visit to primary care might only cost $50.

The second case is crying for concierge care.  The family has the cash to pay for someone to come to the house and put a few stitches in a finger.  But, instead the problem clogs up the ER that should be dealing with heart attacks and car wrecks.  Again, if the problem happened earlier in the day a primary care office or urgent care clinic could have solved the problem.

One could see Medicaid having a fleet of mobile treatment units just to limit the financial losses in the ER.  Actually, a good idea.  Both cases might have solved their problems by taking a taxi to an urgent care clinic — if one was open.

Will the “ER in a box” find a place? — at least a place where someone will pay them?  The idea leans toward the concierge model.  No insurance is going to pay for an ambulance when a taxi will work.  No insurance company will pay extra just for the convenience of one patient.

Nice idea, but it’s not likely to fly financially.

, , , , , , ,

Leave a comment

Clinic of Last Resort — the ER

erdoorDeath can be caused by not having a car.   If a sick person does not have transportation the effects can be serious.  And, lack of insurance makes the problem worse.

A new study reported in Health Affairs  finds closure of inner-city ER facilities causes more deaths.  Poverty, advanced age, immigrant status, and lack of insurance were correlated with the increased mortality.

Poor people count on the ER as the clinic of last resort — our health system is designed that way — call an urgent care clinic and ask what services are available — “it depends on your insurance” is the answer — “you better go to the ER” is the advice if you have Medicaid or don’t have insurance.

Why wait until the last minute?  Because, there is always hope the health problem will get better, the chest pain will subside, the blood in the stool will stop or the arm weakness will vanish.  Once the heart attack hits, the bleeding is worse,  or the whole side of the body is paralyzed  the chances of death are much higher.

If you don’t have money one of the greatest concerns is NOT getting admitted — how do you get home, how do you pay for outpatient medications and how do you pay for the ambulance ride ($1000)?  The logic is simple: wait until you are REALLY sick.

The ambulance-to ER-to-operating-room is usually a very profitable supply-line of patients, so lots of resources have been lavished to make the system work.  If the ambulance-to-ER system brings diabetes, pressure ulcers and urine infections it drains a hospital’s resources, and finally leads to ER closure.

A good health system would provide transportation, guaranteed urgent care, medications and transportation home for a low-cost package price.  The unloading of the ER might actually save the ER, save patients with true emergencies, and save poor patients who get care earlier.  Wow — and what if that urgent care center was right next to the ER so if there really was an emergency it could be handled.

But no, all that would require planning and a health system where hospitalization was an overhead expense, not a profit center.  So, the only viable solution in the US:   include vouchers for ER visits with Cadillac  purchases or golf club memberships.

, , , , , ,

Leave a comment