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    Sunday, February 18, 2007

    Redirecting Healthcare: Massachusetts is trying to get patients to see their doctor for urgent (not emergent) care instead of going to the emergency room.

    That sounds lik a good idea, but after reading this, I think I'm moving to Massachusetts:

    A new state report said that the average charge for an emergency room visit that could be handled by a primary care doctor was $976 in fiscal 2005. That compares with $200 to $300 at a health center.

    A doctors visit at a community health center costs $200-$300? Even the highest visit code in Ohio doesn't get a primary care doctor that much money.

    Then, too, for the initiative to work, it's going to take an awful lot of patient education:

    Interviews with patients in the overflowing Brigham emergency department one night last week suggest that community health centers will face major challenges in changing behavior because of the complex array of reasons that lead patients to the hospital.

    ....Matilde Fernandez, for example, woke up with a sharp pain in her stomach. At 8:30 a.m., she had called the Brookside Community Health Center in Jamaica Plain, but her doctor, who was working a half-day, was booked. The health center offered her an appointment with another doctor, but she decided to go to the emergency room because she thought she'd need an ultrasound and other tests that the health center does not provide. "They'd have to send her somewhere for another appointment to diagnose her," said Fernandez's son, Daniel, 15.
    So, they drove to the Brigham at about 1 p.m., and at 7, Fernandez, 39, still lay in an emergency room bed waiting for the results of a blood test. She said it was worth the wait to have all the tests done at once in one place.

    Some insurers also place fewer restrictions on the ordering of expensive tests in the emergency room than they do in doctors' offices.

    Walls said he hears the one-stop-shopping rationale from many patients. "If they need an X-ray, they'll get it, they'll get whatever they need," he said. "And they know they will have the answer when they walk out."

    posted by Sydney on 2/18/2007 06:01:00 PM 3 comments


    Patient education is good. High ER copays are better.
    Either Matilde and Daniel can easily afford their copay, or they don't have one.

    This is just a "tragedy of the commons" writ small.

    By Anonymous danie, at 9:55 AM  

    "She said it was worth the wait to have all the tests done at once in one place".

    :) It's good it was not deadly. But there are many what depends from speed.

    Maybe when it'll become a ordered system it'll work properly.

    By Anonymous AleS, at 7:45 PM  

    we were just notified that effective May 1st, all doc's on staff are going to be treated to a "new and improved" system in which all CT's and MRIs requests will have to be run through gauntlet of reviews before allowed to proceed. Caveat: this will not apply to ER visits. Guess what's going to happen. Yup. All the patients are going to go through the ER instead of their PCP's in order to get tests in a more timely fashion. So come May 1st ER's will increasingly become the referral source for the mundane.

    By Anonymous Anonymous, at 10:06 PM  

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