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Speed Racer

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Was discussing this with an attending the other day as we were lamenting the fact that our (my hospital) medicaid patients are clearly abusing the ED as a primary care office. We were registering FAMILIES the other day!!!

I think a copay for everyone regardless of insurance status, (5,10,50 dollars whatever, its not the point) would greatly reduce the needless BS ED visits. Call it a direct cost facility fee or some BS like that.

A nice example is that jet blue charges $1 for headsets these days...Im sure that doesn't cover the cost of manufacture, transport etc....it just reduces the number they give out.

If you do not deny anyone who does not copay, that would not violate Emtala?

Another thought....are long wait times in essence a surrogate copay system. ie if some one has to wait 6 hours to be seen then there complaint is more likely to be legit...

My patient population is so ridiculous....they all have medicaid and they roll in with iphones $200, Nike Air Max 360 $130 , not working or going to school (stuff I want but dont buy because as a doctor I cant afford) and they want prescriptions for tylenol so that the guvment can pay for it....I fear this is the future.
 

bartleby

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The wisdom behind a copay is to steer people to outpatient clinics where they will get more appropriate and less expensive care for their non-emergent condition. However, when the ED Copay is even $100 and your PMD's copay is $30, there isn't enough of a difference to make it worthwhile to go to the clinic. If the ED Copay was $150 and the clinic copay was $5, you might see some effect.
 
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GeneralVeers

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The wisdom behind a copay is to steer people to outpatient clinics where they will get more appropriate and less expensive care for their non-emergent condition. However, when the ED Copay is even $100 and your PMD's copay is $30, there isn't enough of a difference to make it worthwhile to go to the clinic. If the ED Copay was $150 and the clinic copay was $5, you might see some effect.

We should PAY people $5 to go to their PMD or outpatient clinic.
 

EM2BE

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When I was in undergrad, I had a $20 or $25 copay for an office visit and $50 for ED visits if not admitted. I knew I couldn't afford the $50 and I would wait for an appt. I guess some people are just too impatient to wait and figure it's worth the extra money they can't afford to spend.
 
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We have a copay, but, if people can't/won't pay it, they still get seen. As it is EMTALA-based, the patient has to be seen before the financial people get in there.

You know who pays the best, though? It's the Mexicans and central Americans. They'll pay the entire bill up front (as the financial people can give that to them right then), with a handful of cash, because the thought is: bill --> collections --> immigration --> deportation. As the undocumented drunk drivers find out, though, immigration isn't involved when they get arrested.
 

Speed Racer

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We have a copay, but, if people can't/won't pay it, they still get seen. As it is EMTALA-based, the patient has to be seen before the financial people get in there.

You know who pays the best, though? It's the Mexicans and central Americans. They'll pay the entire bill up front (as the financial people can give that to them right then), with a handful of cash, because the thought is: bill --> collections --> immigration --> deportation. As the undocumented drunk drivers find out, though, immigration isn't involved when they get arrested.

Maybe I am biased, but I love the Mexicans in my city. They work their butts off, while our citizens live lazily off the government. They are extremely polite and patient in the ED and actually come for interesting complaints. I have found (In my limitedly limited experience) That if a Mexican shows up to your ED its because they have a legit complaint and if anything your threshold needs to be lower as they do not whine.
 

Speed Racer

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The wisdom behind a copay is to steer people to outpatient clinics where they will get more appropriate and less expensive care for their non-emergent condition. However, when the ED Copay is even $100 and your PMD's copay is $30, there isn't enough of a difference to make it worthwhile to go to the clinic. If the ED Copay was $150 and the clinic copay was $5, you might see some effect.

I think the amount is beside the point. You don't want to punish people or dear god make a profit (because that would be amoral and evil). I just think FREE is a dangerous thing. Let the economists figure out what would be a fair amount.
 

Captainwada

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I think an ED copay should definitely be in place, esp. if non life threatening. Abuse of the system is a major reason EDs resources are drained.
 

BatmanMD

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Maybe I am biased, but I love the Mexicans in my city. They work their butts off, while our citizens live lazily off the government. They are extremely polite and patient in the ED and actually come for interesting complaints. I have found (In my limitedly limited experience) That if a Mexican shows up to your ED its because they have a legit complaint and if anything your threshold needs to be lower as they do not whine.

I couldn't agree more. Granted I work in Dallas/Fort Worth area and am pretty far from the border, so I hear those working near that area see a lot of pts that cross for free treatment and b/c of EMTALA, they have to be seen and treated.

The hispanic population is by far the most grateful, polite population that I have treated. An interesting comparision is the african-american population. I did residency in Detroit, where the population is HORRIBLE. They believe that they deserve the world, and expect you to fix everything now. I had one family bring their father in for CP. They wanted to go home after being their for 20 minutes! The sense of entitlement is amazing.

Compare to the south, with my very limited experiance, the population is different. They are appreciative (for the most part) and will listen to you. Education is abot the same from what I can tell, but just regional variations...

Sorry, I dont want to hijack the thread with this...:cool:
 

Jeff698

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You know who pays the best, though? It's the Mexicans and central Americans. They'll pay the entire bill up front (as the financial people can give that to them right then), with a handful of cash, because the thought is: bill --> collections --> immigration --> deportation.


Or, it could be that they came from a place that actually expects people to pay for the services they receive.

Just give a 'em a while to learn our ways....

Take care,
Jeff
 
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