Let's Rate Emergency Rooms

[Hopes]

Originally Posted by Katiana

I don't know if it's the ERs that want people to go elsewhere. The insurance companies would prefer you go elsewhere, and the "health planners" prefer that, too. There's this big emphasis these days on a "medical home", which means a relationship with your own health care provider.

Maybe insurance is different where you are now, but my most recent health insurance policies (three different companies over the past three years) have eliminated the primary care provider structure. I'm no longer required to go to one place or to have one doctor manage my healthcare. (Of course, I still do because I've been with the same doctor for 20 years!) If I want to go to an urgent care clinic, my co-pay is the same. I only pay a higher co-pay for ER visits.

Originally Posted by Katiana

You're supposed to call them in the evening and on weekends.

I only call the doctor if I know it's something that can be treated over the phone. I don't bother calling if I know I'll be sent to the ER. There's no reason to do so anymore. My insurance does not require a doctor's approval for an ER visit. I don't even have to notify my insurance provider of ER visits within a specific time period (like 48 hours) like I was required to do a few years ago. There's no reason to waste their time when you're knowledgable enough to know when to go to the ER and when not to.

Originally Posted by Katiana

I do get discouraged when, on a Monday moring, a patient says to me, "I knew you weren't open on weekends to I took her (him) to the ER, and he had a viral sore throat." We have a call system, and we do see people in the office on the weekends. Also, sometimes a call will eliminate the need for the visit in the first place.

Sounds like you work for a pediatrician. That's the way most pedistric offices operate in Pittsburgh. Most adult doctor's offices don't have any weekend hours, and the doctors do NOT go into the offices to see you no matter what is wrong with you. They always send patients to the ER if they're not open. The entire phone call is a waste of time unless it's something that can be treated over the phone.

I know when something is life threatening and needs an emergency room visit, is something potentially minor but needs to be seen because it could be an emergency condition, and when things can wait a couple of days until the doctor's office opens. Unfortunately, it takes 4 to 6 weeks to get an appointment with my doctor so I've been trying urgent care as an alternative for routine type sick visits.

I'm not giving up my doctor simply because he's so fantastic that it's difficult to get an appointment with him. I need a good quality doctor to manage my specific ongoing health issues. I'm happy to see anyone to treat routine illnesses such as an infection, allergic reaction, injury, etc. I'm damn glad that insurance companies aren't forcing patients to be restricted to one provider anymore.

If healthcare reform goes through, I'm sure this will become a bigger problem because patients will have a more difficult time getting appointments with their regular doctors for sick visits (like I do with mine.) I can't see any solution except to open clinics to treat less serious conditions that require treatment within a few days.

[Hopes]

Originally Posted by greg42

I mean, if I have some kind of infection right now (sore throat, coughing, everything points to viral so I'm not looking to go anywhere) I can't imagine going to the ER this weekend for that.

I wouldn't so anywhere for viral---unless I had problems breathing or became dehydrated. Then I would need to be in the ER even if the doctor's office was open. LOL

Originally Posted by greg42

It's interesting. Based on my two recent ER experiences (one as patient, one not), I would conclude that ERs are very busy on Saturdays and not so much on weekdays during the day. Does anyone else find this to be true? Not sure we have a big enough sample.

I was told years ago that ERs are busier with injuries when people have recreation time. They are more likely to get hurt playing baseball than sitting in an office or classroom.

[Katarina Witt]

Originally Posted by Hopes

Maybe insurance is different where you are now, but my most recent health insurance policies (three different companies over the past three years) have eliminated the primary care provider structure. I'm no longer required to go to one place or to have one doctor manage my healthcare. (Of course, I still do because I've been with the same doctor for 20 years!) If I want to go to an urgent care clinic, my co-pay is the same. I only pay a higher co-pay for ER visits.


I only call the doctor if I know it's something that can be treated over the phone. I don't bother calling if I know I'll be sent to the ER. There's no reason to do so anymore. My insurance does not require a doctor's approval for an ER visit. I don't even have to notify my insurance provider of ER visits within a specific time period (like 48 hours) like I was required to do a few years ago. There's no reason to waste their time when you're knowledgable enough to know when to go to the ER and when not to.

Our insurance does have a different co-pay structure for office, urgent care, and ER visits. We're not required to go to our PCP for referrals, etc.

What I was saying in that regard is that the health planners, not necessarily the insurance companies, want everyone to have a "medical home", which is usually some form of a GP, internist, family practice doc, pediatrician, etc. It is fine to "waste the doctor's time", b/c that is what s/he is getting paid for. ERs are an expensive way to get care.

Sounds like you work for a pediatrician. That's the way most pedistric offices operate in Pittsburgh. Most adult doctor's offices don't have any weekend hours, and the doctors do NOT go into the offices to see you no matter what is wrong with you. They always send patients to the ER if they're not open. The entire phone call is a waste of time unless it's something that can be treated over the phone.

Yes, I do work for a pediatrician. To tell you the truth, I don't know if my own family practitioner has a system like that. When DH got sick one weekend, we just went to Urgent Care b/c I figured that's where they'd send us anyway, similar to what you do.

Unfortunately, it takes 4 to 6 weeks to get an appointment with my doctor so I've been trying urgent care as an alternative for routine type sick visits.

That is pretty amazing for sick visits. We can almost always get in the same day if we are sick during the week. I did have trouble getting DH an appt. both with an orthopedist and a urologist in a timely fashion, recently.

If healthcare reform goes through, I'm sure this will become a bigger problem because patients will have a more difficult time getting appointments with their regular doctors for sick visits (like I do with mine.) I can't see any solution except to open clinics to treat less serious conditions that require treatment within a few days.

No one knows what will happen with health care reform. To do the above, there will have to be more doctors, nurse practitioners, PAs, etc. That cannot happen for several years, due to these people needing to be recruited, trained, etc. It will take a minimum of 10 years to increase the physician supply. It's going to be interesting!

[Hopes]

Originally Posted by Katiana

It is fine to "waste the doctor's time", b/c that is what s/he is getting paid for.

But doctors aren't getting paid to talk to patients on the phone.

Originally Posted by Katiana

ERs are an expensive way to get care.

Totally agree. That's why I wanted to try urgent care for the issues that needed to definitely be seen right away. It didn't work out though.

Originally Posted by Katiana

That is pretty amazing for sick visits. We can almost always get in the same day if we are sick during the week. I did have trouble getting DH an appt. both with an orthopedist and a urologist in a timely fashion, recently.

It's not the norm around here. My doctor is just in high demend and doesn't accept patients anymore. There is an option to be seen by medical students, but last time I tried it, I was there for four hours---and I had an appointment! Missing more than a half a day of work for a sick visit is not an acceptable alternative.

Originally Posted by Katiana

No one knows what will happen with health care reform. To do the above, there will have to be more doctors, nurse practitioners, PAs, etc. That cannot happen for several years, due to these people needing to be recruited, trained, etc. It will take a minimum of 10 years to increase the physician supply. It's going to be interesting!

Agreed. Interesting is an understatement!

[Tallysmom]

Originally Posted by Hopes

But doctors aren't getting paid to talk to patients on the phone.

In "managed care" they are. With a lot of plans doctors are cut a monthly check just to have you on their plan.

[Katarina Witt]

Originally Posted by Hopes

But doctors aren't getting paid to talk to patients on the phone.

Taking call is part of your doctor's job. Even if they don't charge separately for phone calls, part of each office charge includes everything the doctor does, e.g. phone calls, paperwork, etc.

[Hopes]

UPMC clearly figured out this was a serious problem in the area.

I just received an announcement in the mail that UPMC has opened an After Hours Primary Care Clinic in Cranberry.

The hours are 5-9 Monday thru Friday and 9-5 Saturday and Sunday.

It's not urgent care. It's primary care---just after hours.

They say there is no need to call your doctor's office, and going to this clinic doesn't change your relationship with your doctor.

I guess all UPMC family practice and internal medicine doctors will share the responsibility of staffing this facility on a rotating basis.

It opened on January 2nd.