<p>It’s a very thought-provoking poll. But you can’t just go on what one news source says, with focus on a local hospital or two.</p>
<p>Since January 1 of this year, the volume of emergency patients in your emergency department has:
Increased greatly - 9%
Increased slightly - 37%
Remained the same - 27%
Decreased slightly - 20%
Decreased greatly - 3%
Not sure - 4%</p>
<p>That’s with an 8% response to the survey, of whom only 44% claimed a leadership role in their hospital or some level of ACEP. Note that, except for the 12 and 18% quoted for Norton and L’ville, I don’t think we know what these increases amount to. Eg, what is a “slight increase?” 31% said they saw an increase in Medicaid patient emergency visits. 33% said same or decreased slightly- and 36% didn’t know. And so on.</p>
<p>If it’s not a true emergency, the patient can wait until the urgent care is open. Around here, urgent care centers are open very late at night, after doctor’s offices have closed.</p>
<p>However, it is a problem, as others have mentioned here, that many doctors don’t take Medicaid. What about the urgent care centers? Do they take Medicaid?</p>
<p>It’ll be a good idea to publicize the existence and hours of urgent care centers, for the new insured as well as everyone else. If you have something acute but not urgent, and the urgent care center is open and takes your insurance, you’re better off there than at an emergency room. It’ll probably be just as fast. </p>
<p>You can look online at urgent care clinic operating hours in Lousiville, since this came up from that local newspaper. But just as I wince at people relying on one news report, I wince at people telling us how it works “around here,” if it assumes it works that way everywhere. </p>
<p>CF, the whole things needs to be looked at. Are there enough walk-in places, are they conveniently located, staffed and with good hours? Medicaid or Medicare should be ok. At this point, we don’t even know how many practice docs are really turning down Medicaid patients. That was just a question here.<br>
…</p>
<p>Here ya go, someone can run with this, if wanted: *Title VI of the Civil Rights Act of 1964 (Title VI) is a Federal law that protects persons from discrimination based on their race, color or national origin in programs and activities that receive Federal financial assistance. For example, if you are eligible for Medicaid or other health or human services provided by agencies or organizations that receive Federal government funding, those entities cannot deny you access to their programs or activities because of your race, color or national origin. * At least the Baptist Health netowrk of urgent care centers cites Title VI on their site.</p>
<p>The article talked about Norton Hospital in Louisville, and reported that they were getting three or four more patients every day since the ACA started. </p>
<p>People on Medicaid often don’t have cars. I know a bit about being carless, since I myself rarely drive. The thing to realize is that for the carless, places that look close are not close. </p>
<p>I think the hospital they’re talking about is Norton Brownsboro. Norton also has several urgent care centers, none of them near the hospital. The nearest urgent care facility I can find is Baptist Urgent Care. They don’t say on their website whether they take Medicaid. To get from Norton Brownsboro to Baptist takes over an hour by bike, and over two hours by bus.</p>
<p>Going to the urgent care center is sometimes not as easy as it sounds.</p>
<p>I dunno, None of us live in Louisville.<br>
It’s too much to check the distance to each but the bottom line is whether they are as convenient to the people now heading for ER. Norton has its own “immediate care” centers. The plain old “Norton Hospital” is downtown and about a mile from one IC center (open to 6pm.) Brownsboro has one adjacent, open to 9pm. Not going to check them all. </p>
<p>Norton is also encouraging patients to visit ICC for non-life-threatening. Norton takes Indiana and KY Medicaid. Baptist was where I got steered to the Title VI wording. </p>
<p>I don’t get the Title VI reference. That just says, if a doctor takes Medicaid, they can’t discriminate: they can’t take white patients and refuse the black ones, or take Christian patients and refuse the atheists. But they can refuse all Medicaid patients. And that’s the issue we’ve been discussing.</p>
<p>Sounds like it’s partly a matter of education/advertising, then. An urgent care center is better than the emergency department, if you don’t have an emergency and if the urgent care center takes your insurance. It’s not like patients are being turfed out of the luxurious emergency room to the spartan urgent care. Newly insured people need to find out about the resources now available to them.</p>
<p>This is pretty simple, really.They are not paying anything so they have no incentive to price shop. People who get bills are in fear of the ER because it comes with a big price tag. Urgent care centers are considerably cheaper. Maybe, you would drive across town if the cost savings is several hundred dollars. But, if you don’t pay, you don’t care about that fact.</p>
<p>As I said none of us live in Louisville. If you want to check your local area, go for it. At least one Norton ICC states it takes Medicaid. I’m not checking them all. And Baptist states: “It is the policy of Baptist Health and its affiliates to comply with the provisions of the Title VI of the Civil Rights Act of 1964, to the end that no person shall, on the grounds of age, sex, race, color, religious creed, ancestry, disability/handicap, national origin, ability to pay or because a patient is covered by a program such as Medicaid or Medicare, be excluded from participation in, be denied benefits of, or otherwise be subjected to discrimination in the provisions of any care or service. This non-discrimination policy applies to patients, visitors, physicians and staff.”</p>
<p>Anyone want to dig deeper, be my guest. The point was volume to ER. A related question was does UCare take medicaid. Actingmgt says maybe not. No one will know without checking further.</p>
<p>It’s not a matter of price though. Urgent care centers are better than emergency rooms, for non-emergency care. But you can’t drive across town if you don’t have a car. People go to emergency rooms or urgent care when they are sick. If you’re sick, you’re not going to be in the mood to take a two hour bus trip or a ten mile bike ride.</p>
<p>I don’t know if urgent care centers are better than ER’s. It totally depends what’s wrong and they can’t always treat everything in those places. Some ER’s have long lines and some are virtually deserted most of the time. But, I still think it’s cost driven. People often don’t go to the ER when maybe they should due to cost issues. It’s an interesting dilemma, actually. The people who abuse the ER and use it as a clinic are the non-payers. That’s just a fact and I have no idea how to change it. It won’t be easy.</p>
<p>The not being able to go to the doctor because you don’t have a car is a new one. Maybe next we need the Affordable Car Act. Sigh.</p>
<p>But you’re not suggesting that someone go to urgent care for a problem urgent care can’t treat. For the problems urgent care can treat, it’s usually going to be better than the emergency room because you don’t have to wait for all the emergencies to be treated.</p>
<p>New to you, maybe, but that’s just because you aren’t paying attention and don’t know the reality of poor peoples’, disabled peoples’ and seniors’ lives. Certainly not new to anyone who has devoted more than a millisecond of thought to what it’s like not to have a car.</p>
<p>That’s a matter of education and developing new habits. By “education” I mean the need for the facilities and the insurers to educate their new patients as to what their options are. A person who has never had insurance – or Medicaid - before may not not know where the facilities are or where to go when they need urgent care, or even what the difference is between urgent care & the emergency room. And there isn’t always an obvious difference – in some places the urgent care is combined with the emergency room, and in many places the urgent care facilities don’t really maintain late hours. It’s not always easy to figure out where they are in any case. </p>
<p>One very easy way to help with the transition would simply be for the emergency rooms to stock brochures listing the urgent care options that they could give to all patients who turn out not to have needed emergency care. That’s something that could be handed to the patient on the way out – “next time, go here.”</p>
<p>But do keep in mind that it’s not always obvious whether a person needs urgent or emergency care. I remember sitting with my son for hours in an emergency room for abdominal cramps – he was in such pain that I rushed him to the nearest hospital at midnight, thinking he could have acute appendicitis – 4 hours later his pain had subsided on his own, we gave up waiting, and just came home. I’m sure that if a doctor had gotten around to seeing him, the diagnostic code would have reflected that it was no emergency – but I didn’t know that when my kid was clutching his belly and groaning and crying in pain.</p>
<p>Well, Ma. has had universal heathcare for many years, and apparently ER use is much higher today than prior to Romneycare. Education didn’t seem to work there.</p>