Why wouldn't ER's donate money to local clinics?

[Evisju7]

I volunteer at a medical clinic that is 100% donation based. Lately, we've seen an influx of patients and apparently haven't been able to keep up leading to financial trouble.

This made me wonder: Why don't local ER/hospitals donate? The clinic keeps uninsured patients from going to the ER for minor issues. Doesn't this take a minor financial burden off ERs? Or do I have it all wrong?

And if ERs do have less cost because of the clinic's service, why don't they make donations?

(example: if an uninsured patient costs the ER $300 to deal with, when we take them, it's a $0 cost burden. So why don't they donate 1/3 of the cost, or $100 bucks a person, and save $200 per.) Completely made up numbers.. I have no idea what costs what.

---

Members don't see this ad.

 

[The White Coat Investor]

Truth be told ERs don't spend a lot of money/time treating stuff that could be treated in free clinics. For the most part, we treat different problems.
Now, if you were willing to stand around in my waiting room at 3 am, and pick off those 10% of people that "don't belong there" and walk them over to your clinic, I'd pay you for that. But you're only open 40 hours a week, and I'm open 24/7.

Good question though.

 

[Evisju7]

Truth be told ERs don't spend a lot of money/time treating stuff that could be treated in free clinics. For the most part, we treat different problems.
Now, if you were willing to stand around in my waiting room at 3 am, and pick off those 10% of people that "don't belong there" and walk them over to your clinic, I'd pay you for that. But you're only open 40 hours a week, and I'm open 24/7.

Good question though.

Really? My EM physician friend used to tell me of all the mundane cases he saw regularly. I understand some 'actual' emergencies come in, but there's a lot of BS that people come in with because they can't get treatment elsewhere.

but yes.. we do close at 5

 

[Birdstrike]

I volunteer at a medical clinic that is 100% donation based. Lately, we've seen an influx of patients and apparently haven't been able to keep up leading to financial trouble.

This made me wonder: Why don't local ER/hospitals donate? The clinic keeps uninsured patients from going to the ER for minor issues. Doesn't this take a minor financial burden off ERs? Or do I have it all wrong?

And if ERs do have less cost because of the clinic's service, why don't they make donations?

(example: if an uninsured patient costs the ER $300 to deal with, when we take them, it's a $0 cost burden. So why don't they donate 1/3 of the cost, or $100 bucks a person, and save $200 per.) Completely made up numbers.. I have no idea what costs what.

I can tell you this: if hospital businessmen thought dumping money into free clinics would somehow directly, or indirectly make them more money, then they would they'd be dumping like they dump carbon waste out of their Benz tailpipes. These are very smart people, and I'm sure they've thought of this. Make no mistake that hospitals' primary goals are to make money. Period.

Help people? Sure, but not if they're getting poorer in the process. Make dinero first. Once its been determined that will happen, then the "healthcare" can flow. Making money is what businessmen do best, and hospital businessmen are no different.

When they see the spine surgeon, they don't see a spine surgeon. They see: $$$$, like they're on Open Table looking for Wagyu Steak. Each dollar sign denotes how much they value someone based on how much money that person can generate for their next bonus, raise or promotion.

When they see the Cardiologist, they see $$$.

ER doctor: $$

Pediatrician: $

Nurse: ¢

Medical student: -

Free clinic: .


The Hospital CEOs and Administration's Primary Goal is only and ever to,

1- Make money.

2- Provide "healthcare" only as a means to the end of #1.

3-Support patient satisfaction only to the extent it supports goal #1. If patient satisfaction ever become a money loser, it would and will be eliminated from the corporate-healthcare lexicon as if it was a hemorrhagic plague to be eradicated.

4- Physician satisfaction is low on the list if present at all and only considered relevant if in crisis enough to affect goal #1 alone. So long as goal #1 can be met, all is well and goal #4 can be interchanged with the "physician revolving door" clause.

If goal # 1 cannot be met, Hospital closes doors and "Emergency" sign is replaced with "Space For Lease."

 

[link2swim06]

Just because there is an option of a free clinical that doesn't it will decrease ED flow. A lot of the uninsured aren't paying anyhow so to them what's the difference between the free clinic and the ED?

People go to the ER for reasons that cannot be explained by logic. I have seen chronic issue complaints that have been lasting for years with NO acute changes at 3am on the sunday. Why? The pt doesn't know...they just felt like coming in. The free clinic was there for years during the life of this compliant...regardless the pt went the ED in the middle of the night.

 

[Evisju7]

Your reminder is good. Business only looks out for no.1: money. Everything goes back to money with business. (I was talking to a friend about aviation safety once, completely off this topic. Basically the only reason consumer products/services are safe is to make the airline or company money.. and only to the extent of making money. When safety cuts into money making, safety gets cut back.)

But that was the point, I would think that free clinics would save someone money, because someone has to pay for those ER visits (I guess it goes back to taxes though.. I'm still trying to understand healthcare insurance policy; it's like a foreign language to me.) But whoever is being spared the cost should consider donating a portion of that to keep the service of free clinics, because I would think it would save them money in the long run.

I can tell you this: if hospital businessmen thought dumping money into free clinics would somehow directly, or indirectly make them more money, then they would they'd be dumping like they dump carbon waste out of their Benz tailpipes. These are very smart people, and I'm sure they've thought of this. Make no mistake that hospitals' primary goals are to make money. Period.

Help people? Sure, but not if they're getting poorer in the process. Make dinero first. Once its been determined that will happen, then the "healthcare" can flow. Making money is what businessmen do best, and hospital businessmen are no different.

When they see the spine surgeon, they don't see a spine surgeon. They see: $$$$, like they're on Open Table looking for Wagyu Steak. Each dollar sign denotes how much they value someone based on how much money that person can generate for their next bonus, raise or promotion.

When they see the Cardiologist, they see $$$.

ER doctor: $$

Pediatrician: $

Nurse: ¢

Medical student: -

Free clinic: .


The Hospital CEOs and Administration's Primary Goal is only and ever to,

1- Make money.

2- Provide "healthcare" only as a means to the end of #1.

3-Support patient satisfaction only to the extent it supports goal #1. If patient satisfaction ever become a money loser, it would and will be eliminated from the corporate-healthcare lexicon as if it was a hemorrhagic plague to be eradicated.

4- Physician satisfaction is low on the list if present at all and only considered relevant if in crisis enough to affect goal #1 alone. So long as goal #1 can be met, all is well and goal #4 can be interchanged with the "physician revolving door" clause.

If goal # 1 cannot be met, Hospital closes doors and "Emergency" sign is replaced with "Space For Lease."

 

[Siggy]

Something else to think about. Those non-pay patients may be filling up a gurney that would otherwise be empty (the RN, tech, lab, etc are going to be paid regardless), and at least the charity care will, at a minimum, be written off at full cost (which no one pays anyways) or bring in money from a state uninsured emergency fund. When a facility can't simply close at 5pm, the economics start to becomes skewed because of the sunk costs.

 

[TooMuchResearch]

Hospital systems have paid for housing and home nursing visits for homeless individuals with very high healthcare/ED utilization with some cost-saving success.

 

[pratik7]

You couldnt get rid of these people even if you tried. They either 1. Dont really understand what an emergency is. 2. dont want to make an appointment and wait more than a day to be seen.

We have people with insurance and PCPs who come to the ER for stupid complaints. This past weekend, someone called the ER to ask the wait time to be seen for their possible STD exposure. When we told them it is free at the county health dept and they can go on Monday, she said she had to be seen tonight because it was an emergency. Also had a mom bring in their child for a fever of 3 days at 5am when they had an appointment in 3 hours with their peds doc.


Cant fix stupid

 

[TooMuchResearch]

You couldnt get rid of these people even if you tried. They either 1. Dont really understand what an emergency is. 2. dont want to make an appointment and wait more than a day to be seen.

We have people with insurance and PCPs who come to the ER for stupid complaints. This past weekend, someone called the ER to ask the wait time to be seen for their possible STD exposure. When we told them it is free at the county health dept and they can go on Monday, she said she had to be seen tonight because it was an emergency. Also had a mom bring in their child for a fever of 3 days at 5am when they had an appointment in 3 hours with their peds doc.


Cant fix stupid

I don't know that I would fault a worried parent, even with the PCP appt in a few hours, for bringing the kid in. Would I have brought the kid to the ED? Absolutely not, but I have the luxury of the (intern...) MD stamp behind my name.

 

[sum dude]

Your reminder is good. Business only looks out for no.1: money. Everything goes back to money with business. (I was talking to a friend about aviation safety once, completely off this topic. Basically the only reason consumer products/services are safe is to make the airline or company money.. and only to the extent of making money. When safety cuts into money making, safety gets cut back.)

But that was the point, I would think that free clinics would save someone money, because someone has to pay for those ER visits (I guess it goes back to taxes though.. I'm still trying to understand healthcare insurance policy; it's like a foreign language to me.) But whoever is being spared the cost should consider donating a portion of that to keep the service of free clinics, because I would think it would save them money in the long run.

It's much cheaper to give the patients one way bus tickets to the other side of the state. Patients who don't pay real-but-functionally-theoretical bills sent to unused addresses are not going to wait 5 hours between 12-5 to be seen at a free clinic.

 

[Danbo1957]

Hospital emergency departments make money, otherwise they wouldn't exist.

 

[docB]

I have found that hospital admins will not even spend a little money if it will save them a much greater amount of money in the future, even the near future. I have been pushing some changes that would provide a 10x ROI savings in less than 90 days and it has gone nowhere. I was talking to the COO of one of the big national ambulance companies and he explained it really well:

"When you try to push a spend to save idea to anyone in a C suite they just don't believe you. They will never write a check for something that won't result in actual revenue rather than savings."

The only savings they ever believe is in their labor costs. That said let me amend Birdstrike's totally accurate post thusly:

I can tell you this: if hospital businessmen thought dumping money into free clinics would somehow directly, or indirectly make them more money, then they would they'd be dumping like they dump carbon waste out of their Benz tailpipes. These are very smart people, and I'm sure they've thought of this. Make no mistake that hospitals' primary goals are to make money. Period.

Help people? Sure, but not if they're getting poorer in the process. Make dinero first. Once its been determined that will happen, then the "healthcare" can flow. Making money is what businessmen do best, and hospital businessmen are no different.

When they see the spine surgeon, they don't see a spine surgeon. They see: $$$$, like they're on Open Table looking for Wagyu Steak. Each dollar sign denotes how much they value someone based on how much money that person can generate for their next bonus, raise or promotion.

When they see the Cardiologist, they see $$$.

ER doctor: $$

Pediatrician: $

Nurse: ¢

Nurse that can be sent home early, called off or otherwise short staffed: $$$

Medical student: -

Free clinic: .


The Hospital CEOs and Administration's Primary Goal is only and ever to,

1- Make money.

2- Provide "healthcare" only as a means to the end of #1.

3-Support patient satisfaction only to the extent it supports goal #1. If patient satisfaction ever become a money loser, it would and will be eliminated from the corporate-healthcare lexicon as if it was a hemorrhagic plague to be eradicated.

4- Physician satisfaction is low on the list if present at all and only considered relevant if in crisis enough to affect goal #1 alone. So long as goal #1 can be met, all is well and goal #4 can be interchanged with the "physician revolving door" clause.

If goal # 1 cannot be met, Hospital closes doors and "Emergency" sign is replaced with "Space For Lease."

 

[Birdstrike]

I have found that hospital admins will not even spend a little money if it will save them a much greater amount of money in the future, even the near future. I have been pushing some changes that would provide a 10x ROI savings in less than 90 days and it has gone nowhere. I was talking to the COO of one of the big national ambulance companies and he explained it really well:

"When you try to push a spend to save idea to anyone in a C suite they just don't believe you. They will never write a check for something that won't result in actual revenue rather than savings."

The only savings they ever believe is in their labor costs. That said let me amend Birdstrike's totally accurate post thusly:

You're right. If an idea that costs money and proposes to save money, is put into action and the savings don't materialize, then they're stuck with something that supposedly was to save money and now has made them poorer. They're smart in this sense, that they've likely seen many ideas pitched as "cost savers" that don't pan out. It's easy to look at labor cost and there's a direct relation between less hours worked = less hours paid. When it's a theoretical "savings" then the burden is on the pitchman to prove spending more dollars will actually save dollars.

 

[Arcan57]

You're right. If an idea that costs money and proposes to save money, is put into action and the savings don't materialize, then they're stuck with something that supposedly was to save money and now has made them poorer. They're smart in this sense, that they've likely seen many ideas pitched as "cost savers" that don't pan out. It's easy to look at labor cost and there's a direct relation between less hours worked = less hours paid. When it's a theoretical "savings" then the burden is on the pitchman to prove spending more dollars will actually save dollars.

The driver of pretty much all modern medical administration is a two step belief system (and the damnable thing is that belief 1 is actually quite accurate and belief 2 is usually at least defensible):

Belief 1: Throwing money at a broken process is horrifically expensive and doesn't produce the desired outcome.

Belief 2: All processes are broken.

There are a ton of corollaries that are generated from these two axioms.

Examples include (and feel free to add your own experiences):

Spending money on hiring consultants to tell you how to fix a broken process is good, but using the same money to implement the same fix proposed by internal staff is bad.

We can't add more nursing staff until we've optimized flow (possibly the most perfect excuse that exists in healthcare)

We need more provider coverage to reduce the damage in metrics caused by insufficient nursing resources (non-employee ED contracts only)

 

[Evisju7]

Not much in the way of long-term investments huh? It seems like instant gratification is the way money operations thrive. Thanks for the input everyone, it's interesting to read these viewpoints.

 

[Birdstrike]

The driver of pretty much all modern medical administration is a two step belief system (and the damnable thing is that belief 1 is actually quite accurate and belief 2 is usually at least defensible):

Belief 1: Throwing money at a broken process is horrifically expensive and doesn't produce the desired outcome.

Belief 2: All processes are broken.

There are a ton of corollaries that are generated from these two axioms.

Examples include (and feel free to add your own experiences):

Spending money on hiring consultants to tell you how to fix a broken process is good, but using the same money to implement the same fix proposed by internal staff is bad.

We can't add more nursing staff until we've optimized flow (possibly the most perfect excuse that exists in healthcare)

We need more provider coverage to reduce the damage in metrics caused by insufficient nursing resources (non-employee ED contracts only)

And they're right on that for the most part. Often many things that may improve practice quality or physician job satisfaction, may not save money. For example, increase nursing coverage (costs money) may not move patients through the ED faster (earns money) if there's no beds up stairs to move the patients into. More physician coverage may not generate more money if the ED is full, holding patients in the hallway and the added physicians can't move the patients, though each make may your and your staff's life easier.

Like you say, administrators and businessmen have found out that throwing money at a chaotic system will not necessarily accomplish anything other than make money disappear. A tornado with dollars thrown at it is still a tornado. Throwing money into a barrel full of chaotic and disorganized cats, does nothing but make a man poorer with an equally chaotic and disorganized, barrel full of cats.

Administrators and businessmen are very smart when it comes to dollars; extremely smart. They know exactly what they're doing, and they do it well.

 

[docB]

Spending money on hiring consultants to tell you how to fix a broken process is good, but using the same money to implement the same fix proposed by internal staff is bad.

So true. Prectically every time I interact with a consultant I get the impression that the only reason they are there is that someone in my administration and someone at their firm went to "B school" together.

We need more provider coverage to reduce the damage in metrics caused by insufficient nursing resources (non-employee ED contracts only)

Again, so true. My guys continually complain about stuff with the "highest paid" comment, e.g. "EMRs are just data entry. Why should I do that. I'm the highest paid guy in the department." I always point out that as far as the hospital is concerned we're the lowest paid person there at $0. If they could figure out a way to get us to sweep the floor and then fire housekeeping they would.

Not much in the way of long-term investments huh? It seems like instant gratification is the way money operations thrive. Thanks for the input everyone, it's interesting to read these viewpoints.

In all seriousness healthcare (and American business in general) work on much shorter timelines than in the past. Executives are expected to show big improvements in revenue in short periods like 12 to 24 months. You can't really make constructive changes or invest in something and see real, permanent ROI in that short a time. Even the Communists knew you needed 5 years.

 

[Arcan57]

In all seriousness healthcare (and American business in general) work on much shorter timelines than in the past. Executives are expected to show big improvements in revenue in short periods like 12 to 24 months. You can't really make constructive changes or invest in something and see real, permanent ROI in that short a time. Even the Communists knew you needed 5 years.

I think I had posted a similar thought before, but being anything other than the big boss in healthcare is a very unstable place. The system CEO is likely to do just fine (golden parachute as worst case), but everyone else has a finite amount of time to jump to the next level before their current level crashes. The easiest way to get rid of inefficiencies at a system level is to set goals that are x% improvement from baseline. If those goals aren't met, fire or threaten to fire the people responsible. If those goals are met, use the improved metrics as the new baseline for showing x% improvement next year. If someone comes in under budget, that's now your baseline for how much you have to spend to get y results. So while it may be possible to show significant incremental improvement FY over FY, it's going to be pretty rare. More likely is that once the low hanging fruit is gone, hospital CEOs and COOs turn to non-sustainable ways of driving down the metrics and hope that a spot above them opens up before low pay and low morale crater their current hospital.

 

[Deadlifts]

Some hospitals and academic centers have free or reduced cost health clinics in place. I don't know how the metrics work out in reducing unnecessary ED utilization though.

Like others are saying, though, even concepts like PACT that have a lot of evidence to support cost savings and health outcome improvements are a hard pitch to execs who think it isn't smart to spend to save.

 

[docB]

Some hospitals and academic centers have free or reduced cost health clinics in place. I don't know how the metrics work out in reducing unnecessary ED utilization though.

That's true. The scary part is that even if the metrics work the institution may not want them to. For example, the way the current system is set up, a hospital only has an incentive to keep uninsured patients out of its ED. If its shunting paying patients to its lower reimbursing clinic it has a disincentive to keep that program. Sad but true.