JustCare

Tag: Emergency room

  • When you need care quickly, should you use a health clinic?

    When you need care quickly, should you use a health clinic?

    Sometimes you may need health care quickly. And, the question becomes where to go for that care. If you can’t reach your doctor, should you get treatment at a health clinic or urgent care center rather than your hospital’s emergency room? In situations that are not life-threatening and when you are not in a crisis, to save time and money, you should consider seeking care at a health clinic or urgent care center.

    Is there an FQHC near you? If you do not believe you are in an emergency situation and your doctor is not available to see you, you should consider getting care at a federally qualified health center (FQHC) if there is one near you. These health clinics are administered by the federal government and provide free and low-cost health care. Today, there are nearly 1,400 health centers providing services at 11,000 service delivery sites throughout the US.

    Is there a free or charitable health clinic near you? There are more than 1,200 free or charitable health clinics across the US. You might check to see whether there is one near you.

    What about a commercial walk-in clinic or an urgent care facility? There are more than 7,500 urgent care centers (where you can usually see a doctor) in the US today. There are also more than 2,800 commercial walk-in health clinics (where you typically see a nurse) located at pharmacies and retail stores like Walmart and Walgreens.

    Why go to an urgent care facility or walk-in clinic instead of an emergency room? If you have a common problem, such as a fever, an infection, a stomachache or a deep cut, ask yourself these questions:

    • What does my doctor recommend? Call your primary care doctor to see if he or she is available to see you. It is always best to have your primary care doctor providing your care. If that’s not possible, find out where the doctor recommends you go for treatment.
    • Is there an urgent care center or walk-in clinic near me? If so, can it provide the care I need? And, will my Medicare plan cover my care?
    • What will I pay out of pocket? The cost of your care at a walk-in clinic or urgent care center is likely to be much lower than at the local hospital emergency room or ER. However, if you have traditional Medicare, and supplemental coverage, it should cover your ER care. If you are in a Medicare Advantage plan with a high deductible, your health plan may deny coverage if it decides it was not an emergency. And, even if it covers your care, you will likely save money by avoiding the ER.
    • How long am I willing to wait to get care? The wait for care may be much shorter at a health clinic or urgent care facility than at an ER.

    Keep in mind that quality of care you receive is likely to vary significantly depending upon the care you need and the skills of the health care provider delivering the care.

    Here’s more from Just Care:

  • Hospital care at home

    Hospital care at home

    More hospitals are training their emergency room staff in geriatric care and building geriatric ERs. At the same time, hospitals are increasingly finding ways to provide the kind of inpatient care available in hospital at patients’ homes after an emergency. Essentially, they are bringing the hospital to people’s homes, with support from the Centers for Medicare and Medicaid Services and private foundations.

    The “hospital at home” model relies heavily on technology that once was only available in hospital. Today, testing technology can be transported to people’s homes. In addition, body sensors can track people’s vital signs and transmit their data to doctors at the hospital. And video technology allows patients to have ongoing visual communication with hospital staff from the comfort of their homes.  

    Avoiding a hospital stay can improve people’s health outcomes. The risk of infection from antibiotic-resistant bacteria in hospital can be high. It is also risky to be in a facility filled with sick people who may be contagious. The likelihood of delirium for older patients in hospital is also very high, as they are out of their normal surroundings. My 95-year old father, a former physician, who is otherwise of sound mind, spent one night in a hospital ER and told me the following morning that he could not understand why staff had made him chief of pediatrics.

    Michelle Andrews reports for Kaiser Health News, that Brigham and Women’s Faulkner hospital has established a hospital at home program for patients in stable condition. As an alternative to inpatient care, the hospital transports patients home, where a doctor and nurse are waiting for them. They check the patients’ IVs and affix sensors to the patients’ body. They can tell whether patients sleep well or are up in the middle of the night. And, they can tell when patients no longer need medical oversight.

    The Johns Hopkins Schools of Medicine and Public Health have also developed a hospital at home model for qualified patients with particular conditions to check into their own bed for their hospital care. In this hospital at home model,  patients with certain types of pneumonia, congestive heart failure, chronic obstructive pulmonary disease and cellulitis, who would otherwise have to be hospitalized for treatment may never go to the emergency room. Doctors and nurses provide both diagnostic tests and treatment therapies to patients at home. It is intended to address the risks of treating acutely ill older adults in hospital, where they all too often experience adverse events, such as hospital-acquired infections, as a result of compromised immune systems.

    People in Australia, England and Canada have been benefiting from hospital at home programs for quite some time. But, in the US, insurers apparently have not come up with a model to pay for the services or a new definition of what it means for a patient to be “hospitalized.” 

    One small study found far lower costs for patients who participate in a hospital at home program than patients who are admitted to hospital, with no negative outcomes and similar patient satisfaction. Another study found that hospital readmission rates for hospital at home patients were about half as high as for hospital inpatients. Hospital at home care also makes it easier for family caregivers, who do not need to travel to the hospital to be with the people they love. But, insurers appear to be unwilling to innovate on this front. Right now, the hospital at home program is supported by foundation grants and the federal government.

    Here’s more from Just Care:

  • Risks of harm from surgery towards end of life often outweigh benefits

    Risks of harm from surgery towards end of life often outweigh benefits

    Medicare data reveals that almost one in three older adults have surgery in the year before they die. And one in four have surgery in the three months before they die. But, Liz Szabo reports for Kaiser Health News that the risks of harm from surgery often outweigh the benefits in people at the end of life. There may be no miracle cure, but you do have options.

    Dr. Rita Redberg, Director of Cardiovascular Care at the University 0f California–San Francisco Division of Cardiology, believes that doctors opt to operate rather than not because they often fail to appreciate what patients value most. They do not ask their patients. Yet, many patients at the end of life place a higher priority on quality of life than on a prolonged life in a nursing home.

    Doctors tend not to focus on the fact that older people fare far worse from surgery than younger people, for whom surgery can be lifesaving. Older people tend not to benefit in terms of longer lives or better quality of life. Indeed, functional decline is too often the consequence of surgery. The recovery rate for older adults is far slower than younger people, requiring them to spend twice as long in intensive care.

    One in five older adults die within a month of getting emergency abdominal surgery. But, surgeons may not want to, or know how to, communicate this information to older adults. Some are now using a best case/worst case framework for helping older adults share in decision-making about their care.

    The issue is extremely complex. It is easy to imagine that the surgery will not deliver the desired benefits. But, it is hard to turn it down if the doctor recommends it as an option. Maybe, you think, you will be lucky and the surgery will improve your condition. It is far more difficult to weigh the potential harms in the balance.

    Just the other day my 95-year old father went to the emergency room with a health care buddy after he took a fall. After waiting five hours for the brain imaging scan the ER staff claimed he needed, he called me for advice. He wanted to leave. I urged him to go home and get sleep. He was clearly of sound mind but totally exhausted. Instead, he spent the night in the ER, exposed to dozens of people in poor health and at risk of infection. His geriatrician discharged him the next day.

    My dad had tried to leave the ER after we spoke, but a doctor, not his treating physician, blocked his way. The doctor was adamant he stay for the test and for the night. And, though my dad is a retired doctor, neither he nor his health care buddy felt they could disregard the doctor’s instructions.

    Requiring people at the end of life to pay a portion of the surgery’s cost is not the solution. That simply rations care based on ability to pay rather than on need. It does nothing to move doctors to both help patients understand they have options and respect those options.

    Decision-support tools could be helpful for older patients to understand the risks of surgery, along with the best, worst and most likely outcomes. The mounting evidence suggests that fewer medical interventions and medicines often mean a longer and better life for older adults at the end of life–people need to understand that.

    Here’s more from Just Care:

  • Don’t sign a bank loan in the hospital

    Don’t sign a bank loan in the hospital

    Shefali Luthra reports for Kaiser Health News on how unsuspecting patients are signing bank loans in the hospital in order to pay their hospital bills. Some hospitals are partnering with banks as a way to help ensure they are paid in full for their services. While that may be good for the hospitals, it may not be good for the patients.

    One insured patient, Laura Cameron, was approached by a hospital employee about taking out a loan while strapped to her gurney in the emergency room. Cameron reported that she was pressured to believe that her only choice was to take out the loan or immediately to pay the $830 she was told she owed out of pocket. Fortunately, she turned the loan down and did not pay the hospital right then, as her total out-of-pocket costs with insurance turned out to be $150.

    Advocates suggest that patients should not be signing up for these loans so quickly. The loans, which are often no interest or low interest may sound better than they are. The loans can be tempting because they are available without credit checks or affordability tests. But, you may not need the loan and could be paying the hospital more than you owe. The out-of-pocket costs for the hospital stay may be lower than the hospital suggests, with the insurer’s negotiated price, as was the case for Cameron.

    If you have traditional Medicare and supplemental insurance, you may not face this situation during a hospitalization since you should have no out-of-pocket costs. With a Medicare Advantage plan, there is a good chance that you have high out-of-pocket costs. But, beware. An increasing number of hospitals are partnering with financial institutions as a way to ensure that they are paid in full for the care they provide. Many people with insurance have such high out-of-pocket costs that they cannot afford to pay them. Right now, about 15-20 percent of hospitals offer loans to patients.

    Advocates argue that patients with low incomes should not need loans to cover costs their insurance does not pay. The hospital should offer them assistance or charity care.

    Here’s more from Just Care:

  • Anthem penalizes patients who seek emergency room care

    Anthem penalizes patients who seek emergency room care

    Your heart is racing, your head is spinning, you have excruciating stomach pain. Should you go to the emergency room? Even with health insurance, you may end up paying the entire cost of your ER treatment, if it is later determined that you did not need emergency room care. Leslie Small reports for FierceHealthCare that, in select states, Anthem Blue Cross Blue Shield, the largest health insurer in America, does not cover ER care in these circumstances, penalizing patients who are afraid for their health and seek emergency room care.

    New Anthem policies now make some exceptions to Anthem’s general practice in Georgia, Missouri, Kentucky, New Hampshire, Indiana and Ohio of denying coverage to patients who seek emergency care when it turns out they did not need it. It will cover care for patients who are directed by their doctors to go to the ER, for patients under 15, for patients post-surgery or testing, and for patients traveling out of state.

    On its face, Anthem’s failure to cover emergency care when it turns out not to be needed is unconscionable, even with the new policy exceptions. Adults may not be able to distinguish between a heart attack and heartburn or hundreds of other symptoms that may or may not turn out to require emergency attention. Forcing people to absorb the full cost of their ER care if Anthem deems it unnecessary based on their diagnosis is tantamount to deterring people from using the emergency room when it might be critical.

    Most people visit the ER because they believe their condition is serious, but they usually cannot know for sure; they need trained professionals to make that determination. Even doctors in potentially emergency situations may not know whether ER care is needed. Moreover, the idea of needing to reach your doctor for permission to visit the ER, to ensure coverage, in the course of a perceived emergency, is preposterous.

    It is completely reasonable to encourage people to get needed care at the doctor’s office or a clinic, where appropriate, and not the ER. But, it is beyond unreasonable to deny people ER coverage altogether based on their ultimate diagnosis as a way to discourage ER use. It may deter them from getting necessary care or may put them at serious financial risk. As it is, through large deductibles and copays, insurers ration care based on people’s ability to pay, putting people’s health in jeopardy and lives on the line.

    As Michael Hiltzik writes for the Los Angeles Times, state regulators need to ban Anthem’s anti-consumer ER coverage policy swiftly.

    Here’s more from Just Care: 

  • Geriatric ERs: Better care, shorter stays

    Geriatric ERs: Better care, shorter stays

    Emergency rooms can be dangerous places, particularly for older adults who are generally more vulnerable than working people. For that reason, AP reports on an emerging breed of ERs, designed to provide better care and shorter stays for people over 65.  More than 100 hospitals in the US now have geriatric ERs or ER staff trained in geriatric care.

    What is a geriatric ER? It is an ER with nurses and other care professionals trained to meet the needs of people with Medicare. In a geriatric ER, patients are asked questions not traditionally asked to determine their mental status, their home situation, their social network and their care wishes. Among other things, the goal is to rule out delirium and determine how safe it would be to return the patient home quickly without a hospital stay.

    Doctors and other health care professionals recognize that hospitals are breeding grounds for delirium, infection and physical deterioration. The data suggest that some three in ten older adults leave the hospital with hospital-acquired health problems, unrelated to the cause of their hospital admission.

    Of course, it is important that no one be discharged home from an ER unless they will be safe. As a result, many doctors, fearing the risk of premature discharge, admit older patients into the hospital unnecessarily after an ER visit. To address this issue, hospitals are now training doctors to recognize that sending an older patient home is often safer than admitting that patient to the hospital. And, they are providing patients with the needed supports to be safe at home.

    In geriatric ERs, staff have the time and resources to arrange home supports for a patient. These supports can include home health aides, physical therapists, nutritionists and other care professionals. And, preliminary observational data of more than 52,000 ER patients suggests that geriatric ER care limits the need for an inpatient hospital admission.

    Medicare is encouraging these innovations, through financial incentives that both deter hospitals from providing unneeded care and promote quality.

    Here’s more from Just Care:

  • Two tips for keeping your emergency care costs down

    Two tips for keeping your emergency care costs down

    There were 451 emergency room visits for every 1,000 people in America in 2014, up more than 10 percent in the last decade. Medicare always covers emergency care. But, the ambulance trip and the emergency room visits can be very expensive if you are not prepared.  Here are two tips to keep your emergency care costs down.
    1. Find a local ambulance that your health plan covers and keep the number in a safe place.
      • If you have traditional Medicare, the government-administered program, find the number for a Medicare-certified ambulance. So long as you have supplemental coverage, your costs should be covered in full.
      • If you are enrolled in a Medicare Advantage plan, a commercial health plan that offers Medicare benefits, or any other commercial health plan, find the number for an in-network ambulance. Otherwise, your costs could be exorbitant. Unless your insurer has negotiated a price with an ambulance company, that company can charge what it pleases. No one controls the price of ground ambulance services. Kaiser Health News reports that patients in commercial health plans are increasingly facing sticker shock from the cost of their ambulance services.
      • If possible, avoid calling 911 for an ambulance because you may have no control over whether your insurer will cover the ambulance services or whether the ambulance will take you to an in-network hospital. Much like surprise medical bills that patients receive from out-of-network doctors who see them when they are admitted to their in-network hospital, bills from ambulance companies that are not part of a health plan’s network can be in the thousands of dollars. A January 2017 Health Affairs study finds that more than 125,000 of 500,000 ambulance trips in 2014 were out of network.
    2. Call your health plan to understand your out-of-pocket costs for emergency room care and what you can do to minimize them.
      • If you have traditional Medicare, Medicare combined with your supplemental coverage should pick up your costs.
      • If you are in a commercial Medicare Advantage plan, administered by a private insurance company, you will be covered for out-of-network care in an emergency for emergency room services. Your health plan cannot bill you more than $50 for those services. Medically necessary follow-up care is also covered when your health is endangered.
      • If you are not yet eligible for Medicare and enrolled in a commercial health plan, you are guaranteed some protections under the law; but, it is best to know your health plan’s rules.

    If Congress expanded Medicare to cover everyone in the US, as Senator Bernie Sanders and 15 other Senators have proposed, it would protect everyone from surprise medical bills, including surprise ambulance bills. For now, Representative Lloyd Doggett has introduced a bill that would protect patients from surprise medical bills.

    If you want Congress to expand Medicare to everyone in the US, please sign this petition.

    Here’s more from Just Care:

  • Exercise associated with fewer hospitalizations for people with and without heart disease

    Exercise associated with fewer hospitalizations for people with and without heart disease

    Heart disease (CVD) is the number cause of death and disability around the world. But, even with heart disease, exercise can help a lot. A study in the Journal of the American Heart Association looks at the relationship between exercise and heart disease, outcomes and quality of life. It demonstrates the value of exercise by showing that exercise is associated with fewer visits to the hospital for people with and without heart disease.

    Researchers studied 26,239 people. Almost half of them exercised for at least 30 minutes five days a week or more. It has been found that 150 minutes of exercise a week reduces the risk of death. Researchers in this study found that people with and without heart disease who exercised at least 30 minutes for five-seven days a week saved the health care system thousands of dollars; they spent less on health care and used fewer health care services–than those who exercised less.

    Put differently, people surveyed with heart disease who exercised at least 150 minutes a week visited the emergency room less frequently  (24% vs 31%) and had fewer hospital visits (21% vs 27%) than people with heart disease who did not exercise as much. People without heart disease and who exercised at least 150 minutes a week had the fewest visits to emergency rooms (9.1%) and hospitals (2.6%).

    Translated into proportional dollars saved, health care spending for people with heart disease who exercised at least 150 minutes a week was 20% less than spending on people with heart disease who did not exercise as much.  And, health care spending for people without heart disease but poor cardiovascular modifiable risk factors who exercised at least 150 minutes a week was half as much as people with heart disease who did not exercise as much.

    Here’s more from Just Care:

  • Beware of out-of-network ER bills

    Beware of out-of-network ER bills

    A new study by Zack Cooper and Fiona Scott Morton in the New England Journal of Medicine reveals that more than one in five emergency room visits involve out-of-network care. While most people choose emergency rooms at their in-network hospital, hospitals can and do often contract with emergency room (ER) doctors who are not in the hospitals’ insurance network.

    The problem of patients being forced to use out-of-network ER doctors is more serious in some parts of the country than in others. In McAllen, Texas, nearly nine of ten emergency department (ED) visits at in-network hospitals involved out-of-network ER doctors. In St. Petersburg, Florida, more than six in ten ED visits involved out-of-network doctors. But, in Boulder, Colorado and South Bend, Indiana, virtually everyone who visited an in-network hospital for emergency services received treatment by an in-network ER doctor.

    The cost to the 22 percent of patients who received bills from out-of-network doctors when they sought ER care was substantial. As it is, emergency room charges for in-network care are on average almost three times Medicare’s standard rate. But, out-of-network costs average eight times Medicare’s rate for services.

    If the patients’ insurers paid the in-network cost and left it to the patient to pay the difference, on average, patients would be expected to pay $622.55 for their ER care. That said, the costs can be far higher. The researchers found that out-of-pocket costs for one patient they studied was $19.603.30.

    What can patients do? Whatever your out-of-pocket costs, you should appeal to your health plans to pay them. If you followed the health plans’ rules and sought in-network emergency care, the health plan should pick up the additional costs. After all, you had no control over the doctors who treated you.

    The federal government has yet to address this enormous problem facing people seeking emergency department care in their health plan’s in-network hospital. Some states have passed laws holding the patient harmless for the additional costs imposed by out-of-network doctors and requiring the health plans to pay the difference. Of course, that rewards out-of-network doctors who charge exorbitant rates and ultimately drives up premiums for people in the health plans.

    New York requires insurers and out-of-network doctors to go through a mediation process to arrive at a fair rate.

    The best solution would be for Medicare rates or Medicare plus-a-small-percentage rates to apply to all providers, regardless of the health plan. It would help bring down costs for out-of-network care as well as in-network care. Health plans are hard-pressed to rein in costs. And, patients are not able to shop around for nonelective services, such as emergency care.

    Expanding Medicare to everyone in the U.S. is the easiest way to ensure fair provider rates, while giving people the choice of a plan that gives them access to their doctors and hospitals and the continuity of care they value.

    Here are more posts from Just Care:

  • Health information you can trust

    Health information you can trust

    A recent Altarum Institute study underscores the difficulties of finding health information you can trust. It focuses on how to improve access to health information for lower income people. As we at Just Care see it, most of the findings apply to everyone regardless of income. The findings also highlight the need for an online hub that unlocks trusted and helpful health and retirement information and makes it simple and easy to access–Just Care’s goal.

    Like most of us, lower income people turn to family and friends they know and trust, particularly people with health care expertise, for answers to health questions. These people tend to be people’s first stop when choosing a doctor, deciding when to get treatment or how to treat a condition. And, frankly, that makes sense.

    Institutional sources of information can also be helpful. And, the study suggests that people with higher incomes turn to them more. But, which should you trust? So much information is misleading.  Just Care relies on information from independent experts, non-profit organizations and government sources you can trust. It is designed to be a jumping off point to help people choose a doctor, or to decide when treatment is appropriate. But, when it comes to checking out a few options, who better than the people you know and trust to provide this type of guidance?

    According to the study, people with lower incomes tend not to plan ahead. Again, it’s fair to say that most of us don’t plan ahead as much as we need to and as important as it is to do so. The process can be daunting, time-consuming and complex. That’s why Just Care aims to make it easy and offers advice on planning ahead for a hospital visit, for end-of-life decisions or times when you are seriously ill and are unable to speak for yourself, and explains why you need a health care proxy.

    Just Care aims to offer simple advice, whether it’s on planning ahead for emergency room visits, for a weather emergency, enrolling in Medicare and supplemental insurance, for long-term care services and supports, or how to get one’s affairs in order in case of emergency.

    It can be hard to make planning ahead for health-related needs a priority. Most of us have many other things we need to do or would prefer to do. To save money, time and stress, we need to squeeze in a little time for it.

    Just Care is here to help. Our goals is to make your  work as easy as possible. Check out our Advice A to Z page when you have a few minutes to spare. And, let us know what you think and what advice you’d like to see on our site. You can email us at [email protected].