PrideNeverDie

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http://www.sciencemag.org/content/early/2014/01/02/science.1246183

We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.

with Obamacare giving healthcare coverage to many of the uninsured, ER visits should increase substantially.
 

TooMuchResearch

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I'm guessing they mean job security. But you're right - most EM physicians aren't thrilled by this fact, I imagine. Though getting jobs will only be easier in the future, if this is true.
Increasing the number of primary care visits in the ED won't increase the number of EM doc jobs. It may increase the number of ED PA jobs. Many EM docs are looking at it with a "well, I guess we'll see what happens" attitude because, hey, we will actually see what happens. And if it brings a lot more money into the ED, that puts a target on EM for fat trimming.
 

adr328

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Increasing the primary care burden of emergency medicine makes the field MORE appealing?? Not to me. This scenario basically describes what "urgent care" is.
 
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J ROD

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This should bring increase in ER and Urgent Care visits. But, I don't think those that went into EM want to see even more primary care BS. Or they would have went into a primary care field. Although I guess you can argue that EM is becoming more a primary care field with the patient population they treat. All I know is the more I look into EM the less it appeals to me. It went from my #1 to maybe #3 or 4.
 

alpinism

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Increasing the primary care burden of emergency medicine makes the field MORE appealing?? Not to me. This scenario basically describes what "urgent care" is.
Agreed. While most ED docs aren't surprised by this at all, most aren't very happy about it either.
 

Pietrantonio

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I think it sounds good in theory, but not so sure about this. I don't think the ER should be treated as a PCP facility. Hospitals aren't going to be reimbursed from readmissions within 30 days. How can these facilities continue to operate if we're not being reimbursed for our services? I work in the ER and it's so misused it's not even funny. Increasing that volume doesn't seem appealing to me. Again, I could be way out there with my thoughts.
 
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235009

Hospitals aren't going to be reimbursed from readmissions within 30 days. How can these facilities continue to operate if we're not being reimbursed for our services?
What do readmissions have to do with increased volume of nonemergent cases in the ED? ED visits aren't counted in that rule only inpatient hospital admissions and these people using the ED as their pcp are certainly not gonna be admitted to the hospital
 

Pietrantonio

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What do readmissions have to do with increased volume of nonemergent cases in the ED? ED visits aren't counted in that rule only inpatient hospital admissions and these people using the ED as their pcp are certainly not gonna be admitted to the hospital
I was under the impression that was the case too. I stand corrected. :)
 

badasshairday

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Guys don't be so dense. More insured patients, even if it is low reimbursement from Medicaid will boost ED doctors salaries. People without insurance come to the ER all the time because of EMTALA for primary care stuff. ED bills them and gets nada. So now they will get paid more often then not for patients utilizing the ED for non-emergent things. Overall medical costs will go up because Medicaid has to pay more for an ED visit rather than an urgent care or primary care visit. As long as Medicaid patients do not have to pay a dime (no copay, rather use ambulance than use a taxi to get to the ED for non-emergent condition, etc) they will drive up costs.

Thanks Obama.
 

badasshairday

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Guys don't be so dense. More insured patients, even if it is low reimbursement from Medicaid will boost ED doctors salaries. People without insurance come to the ER all the time because of EMTALA for primary care stuff. ED bills them and gets nada. So now they will get paid more often then not for patients utilizing the ED for non-emergent things. Overall medical costs will go up because Medicaid has to pay more for an ED visit rather than an urgent care or primary care visit. As long as Medicaid patients do not have to pay a dime (no copay, rather use ambulance than use a taxi to get to the ED for non-emergent condition, etc) they will drive up costs.

Thanks Obama.
Yah and forgot to mention ED will see a boost in compensation for a short term and then our government will clamp down hard on reimbursements to providers even though it is the governments own fault.

Thanks Obama, you idiot.
 
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TheWeeIceMan

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YES, just what ED docs want, more Medicaid patients!
 
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badasshairday

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YES, just what ED docs want, more Medicaid patients!
Yes, Medicaid is much better than uninsured in the ED. Unlike private offices which can refuse to see patients, the ED cannot due to EMTALA. So if you are uninsured and don't care to pay your bills anyways the ED is "free". If you are medicaid patient, the ED is "free" also, but at least the government pays a few bones to the ED for the time and opening up to litigation.

I don't know if people have noticed, but ED is well-compensated specialty, despite having EMTALA in effect. Now with more medicaid patients (which were formerly uninsured), in theory, there compensation will go up even more.

ED as a specialty has flown under the radar for a few years now. They can make bank and work less than most docs, and are never on call. The true down-side is the variability in shift schedule though. Knowing the insides of how a private practice EM group works, I think Emergency Medicine as a specialty is hitting its golden age right now, despite the overall pessimism in most other specialties. Right now now the EM is in a boom, and for medical students it is a great choice; short residency, low work hours, high(er) pay, flexibility to have lots of hobbies/travel with the time off.
 
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TheWeeIceMan

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Yes, Medicaid is much better than uninsured in the ED. Unlike private offices which can refuse to see patients, the ED cannot due to EMTALA. So if you are uninsured and don't care to pay your bills anyways the ED is "free". If you are medicaid patient, the ED is "free" also, but at least the government pays a few bones to the ED for the time and opening up to litigation.

I don't know if people have noticed, but ED is well-compensated specialty, despite having EMTALA in effect. Now with more medicaid patients (which were formerly uninsured), in theory, there compensation will go up even more.

ED as a specialty has flown under the radar for a few years now. They can make bank and work less than most docs, and are never on call. The true down-side is the variability in shift schedule though. Knowing the insides of how a private practice EM group works, I think Emergency Medicine as a specialty is hitting its golden age right now, despite the overall pessimism in most other specialties. Right now now the EM is in a boom, and for medical students it is a great choice; short residency, low work hours, high(er) pay, flexibility to have lots of hobbies/travel with the time off.
Oh yeah, I know. I was just joking about Medicaid patients in the ED tending to be more "difficult."

Totally agree with EM being a great specialty to get into right now.
 

SCOTTYDAWG

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it's only a great specialty to get into if you enjoy being the filter on the ass end of society day in and day out. you couldn't pay me enough to do that job. no thank you sir.

radiology 4 lyfe biatches. ain't got to deal with no crack ho or drunk.
 

sazerac

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So, since all these patients will now have Medicaid insurance paying the bills, the hospital rates for the rest of us will go down significantly since we won't have to fund the uninsureds' care via higher markups on our own hospital bills anymore, right?

Right?
 
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Guys don't be so dense. More insured patients, even if it is low reimbursement from Medicaid will boost ED doctors salaries. People without insurance come to the ER all the time because of EMTALA for primary care stuff. ED bills them and gets nada. So now they will get paid more often then not for patients utilizing the ED for non-emergent things. Overall medical costs will go up because Medicaid has to pay more for an ED visit rather than an urgent care or primary care visit. As long as Medicaid patients do not have to pay a dime (no copay, rather use ambulance than use a taxi to get to the ED for non-emergent condition, etc) they will drive up costs.

Thanks Obama.
Will boost EM salaries? Haha. You mean boost hospital bottom lines.
 

TooMuchResearch

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Will boost EM salaries? Haha. You mean boost hospital bottom lines.
And when facility fees or other reimbursement get slashed, hospitals/corporate EM groups aren't going to suddenly adjust their bottom lines, but they can always slash EM doc pay. Maybe EM docs in small, physician owned groups come out in the black, but not the employee/corporate group majority.
 

KnuxNole

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You definitely see a lot of primary care stuff in EM, no matter what. After all, there are places with TONS of patients who say "Oh, I don't want to wait a month for the doc to see me, I can see YOU for freeeeee!" or "It's past 5pm, and I want to see you, plus my 2 kids who might have the sniffles!"
 

KnuxNole

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All of us should be on Medicaid. Then we can have free healthcare :D
 

badasshairday

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Will boost EM salaries? Haha. You mean boost hospital bottom lines.
Maybe you are right if you are an ER doc working as an employee for a hospital. Not so in Private Practice which is what I was talking about.
 

TooMuchResearch

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Maybe you are right if you are an ER doc working as an employee for a hospital. Not so in Private Practice which is what I was talking about.
Private practice EM is hospital employee, corporate management group contractor, or group partner. The vast majority are contractors or employees.