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On Thursday Jeff appeared on 11 FOXNEWSRADIO affiliated stations across America as their Healthcare Policy Analyst reviewing President Obama’s Healthcare Reform Press Conference last Wednesday from the White House.

Saturday, June 20th at 10a.m. -11a.m. Jeff appeared on FoxBusinessNews distinguished panel of 4 discussing the Healthcare Reform draft proposal by President Obama. The lively TV show took call-in questions and discussion amongst the panelists.

Much work and negotiating on both sides of the aisle are needed before a final reform is passed. Neither party is going to be completely satisfied in the final outcome but by working together a bipartisan healthcare much needed healthcare reform is finally likely.

Again, it was reiterated that patients and doctors need to work closely together-consumer  empowerment in healthcare. Healthcare consumer literacy is so vital in this whole process. We can no longer be oblivious to all that has and is going on in the healthcare arena.

How To Use Hospital Emergency Rooms Wisely

By Carolyn M. Clancy, M.D.

August 19, 2008

Deciding whether to go to the hospital emergency room (ER) is often a clear-cut decision. For instance, if you thought you were having a heart attack or realized that your child just swallowed a bottle of medicine, you would go to the closest hospital as quickly as you could.

Many other situations aren’t as clear. Should you go to the ER if you have a high fever but can’t get an appointment to see your doctor right away? Does a twisted ankle need attention tonight or can it wait until your doctor’s office opens in the morning? Most ER visits take place after regular business hours (8 a.m. to 5 p.m.). That’s when 63 percent of adults and 73 percent of children younger than 15 arrive for treatment, according to the Centers for Disease Control and Prevention.

Deciding whether your situation is a true emergency can be a tough call when you feel sick or are in pain. To help you decide what to do, you can call your doctor’s emergency phone number and ask for advice. Some health plans offer advice from nurses over the phone that can help you make decisions about your care. These call lines can be helpful and are often available on a 24/7 basis.

It’s a good idea to find out how your health plan defines an emergency. Some plans require you to call your primary care doctor before you go to the ER, unless your condition is life threatening. If you don’t follow this policy, you could end up paying for the entire visit.

But don’t worry that you’ll have to foot the ER bill if you thought your condition or injury put your life at risk. Most States have enacted laws that forbid health plans from denying payment for ER care if patients believed they had life-threatening health conditions. Similar laws apply to people covered by Medicare, Medicaid, and other Federal health insurance programs. A major study found that these laws did not cause people to use the ER more often.

If you have a medical emergency and go to the ER, you should notify your health plan as soon as possible about that visit. If you are admitted to the hospital from the ER, you could be transferred to another hospital if the one you went to is not part of your health plan’s network. This is another good reason to find out about your health plan’s policies before you face a medical emergency.

Depending on where you live, you may have seen or used urgent care or retail medical clinics. These are often located close to hospitals or doctor’s offices or inside some drug or large discount stores. Many health plans have added these clinics to their networks.

Although urgent care or retail clinics are not able to take care of emergencies, they are staffed to handle conditions that require fast medical attention, such as sore throats with fever and ear infections. And, if you have a real emergency, the urgent care center will help you get to an ER for the care you need. If you can’t decide if you need urgent care, call your doctor’s office and ask for advice.

As much as I wish everyone had health coverage and a primary care doctor, I know that’s not the case. Many of the 47 million Americans without health insurance use ERs as their only source of health care. And some people who have health coverage but don’t have a regular primary care doctor do the same.

In fact, a 2005 report from my Agency found that children from poor families were almost twice as likely as kids from higher-income families to use hospital ERs. Our report also found that most children used ERs for non-emergency problems, such as asthma, bronchitis, cuts, bruises, and sprains. Medicaid, the health insurance plan for low-income Americans, pays far more for care provided in an ER than it does for care given in a doctor’s office.

Besides the higher cost, an ER visit usually isn’t recorded in a patient’s medical record. That’s why I advise patients who use ERs or urgent care clinics for primary care to create a personal health record. This can be a simple folder or binder that includes medication lists, lab results, and treatment records. Having these documents in one place can reduce the chance that important information about your medical history will be overlooked.

ERs can literally save your life when you face a medical crisis. Use them wisely so they can continue to serve this function.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

“Navigating the Healthcare Maze” book was mentioned by Montel Williams on his show today. www.airamerica.com. Also Jeff spoke and has been invited back for further commentary with Montel

      I just read an article that discussed “how to prepare to go to an emergency room (ER).” Among the       things  suggested were:

Bring a pencil and paper to write down all procedures they did to you – which makes sense if you have the   presence of mind.

List of pills you are taking – this list should always be in your purse or wallet any way.

Call your insurance company before you leave. What? This has to be a joke.

Nah, it’s not!! The author of the article was serious. But, in the real world, as an emergency is in progress, and you are awaiting an ambulance or scrambling to get someone into a car to get to the ER, “phoning” the insurance company isn’t very realistic.

These days, the ER has become “the” doctor’s office for millions of people.

So, while I am possibly bleeding from all orifices or having a heart attack, I’m supposed to take notes. Oh.  And before I do anything else during my emergency, I should phone my insurance company to find out if the emergency room I am going to is in their network. Calling the insurance company before I go to the hospital will take so long that there will be no need to go the hospital because I could be dead by the time I get an answer to my question (that is, if I’m able to speak in the first place).

Now, let me briefly mention the next problem with going to any ER: a clogged-up system. Many ER’s are so full of people jammed into the waiting room (at night and weekends in particular) who have no where else to go for treatment for flu, rashes, or any typical complaint that most of us would go to a doctor’s office to be evaluated. The numbers of people without insurance coverage coming to ER’s for such treatment is on the rise and it’s going to get worse. There is really no where else for them to go.

Under Federal Law guidelines every person has the right in the United States to emergency care, “regardless of your ability to pay.”

Federal Law applies to hospitals that participate in Medicare – which are the vast majority of hospitals in the United States

The term “patient dumping” is often mentioned in the press, but everyone has the legal right to emergency treatment!!

Things have got off track from the original intent of emergency rooms. They were tended to treat:

                   “a medical condition manifesting itself by acute symptoms of sufficient severity              including  severe pain such that the absence of immediate medical attention could reasonably be expected to result in:

                placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

                  serious impairment to bodily functions, or

              serious dysfunction of any bodily organ or part, or with respect to a pregnant woman who  is having contractions’ that there is inadequate time to make a safe transfer to another hospital before delivery, or that transfer may pose a threat the health or safety of the woman or the unborn child”*

*Emergency Medical Treatment and Labor Act

Walk-in clinics are not everywhere, especially not in rural areas. And in many cities where they do exist, many homeless and unemployed can’t afford the cost of treatment.

Remember, hospitals have to make money. So the availability of beds within the hospital for elective surgery coming in the front door will usually take precedence over ER non-critical patients being admitted. And the wait can be painfully long to get a bed within the hospital. Don’t be surprised if you or your loved one are left on a gurney back in the ER or in a hallway for long periods of time – whether you are insured or not.

So we have come to the point where you cannot necessarily blame the long wait you experience on the hospital.  By the way, the average wait is 1 hour and average total length of stay as an outpatient is 3 to 4 hours. Critical patients are coming to the right place and those less critical will have to wait. It’s as simple as that.

Shortage of beds  and a whole lot of different levels and degrees of illness all clog up the system. Let’s face it we cannot blame the hospital or doctors completely. The system is broken!

Someone said to me the other day that if you wanted to ensure you got immediate care in the ER simply “call 911.” Get an ambulance, rather have someone or yourself try and drive to the hospital. That will get you seen quicker than walking into the ER. Many have forgotten that the ER is for EMERGENCIES.

Many people think that when you go to the ER and didn’t have insurance you still got treated and didn’t have to pay.

Not so.

If you’re not having an emergency, then the ER doesn’t have to treat you. Payment for your ER visit is between you and your insurance company – if you have insurance. If you don’t have insurance you have to work out a payment plan with the hospital or beg forgiveness for getting sick and hoping to get a break in amount you’re charged.

Can you believe this: that HMO’s “illegally” demand pre-authorization for ER visits. How crazy is that? So while I am having my heart attack I am calling my HMO to get pre-authorization to go to the ER. Sure!

Give me a break. This is America. I love my country, but our healthcare system is broken and a terrible embarrassment.

One suggestion: let’s come up with a new name for the ER. How about the ED Room (Emergency Dysfunctional Room)?

Over the last week I did a number of live and taped national radio shows…from Connecticut to New York to North and South Carolina to Denver to Seattle to Washington to New York and onwards and lots more to come.

One show was planned for 20 minutes, but when the phones started ringing off the hook at the studio..I stayed on the air for the full hour..and then invited back for another further hour due to the enormous number listeners lined up to talk. People want to share their horrific experiences and get practical tips. Unfortunately it seems like people are experiencing horror healthcare experiences and realizing often too late that they need to be more assertive and take back their bodies and insisting on answers and being more careful of the diagnosis and treatment they automatically accept.

Absolutely amazing call-in stories and listeners seem desperate for advice.

NOT ONE CALL-IN IN ANY STATE I TALKED TO COMPLIMENTED THE HEALTHCARE SERVICE THEY RECEIVED!!

Obviously I knew I was going to get the horror stories but these stories were totally largely about unacceptable healthcare experiences. WOW!!

I’m not a doctor, I am a consumer-patient who happens to have extensive healthcare business worldwide, retail experience and one who understands the importance of service and quality. I also have plenty of personal experience with the system and understand the frustrations that people face. We have survived the hospital experience on a number of occasions.

This last week made me realize the time I spent on writing ‘Navigating the Healthcare Maze-What You Need to Know” was worth the effort.

Callers were looking for my feedback and plain logical common sense and support for them to keep up their persistence-which are the keys they were looking for. Here is a sampling of the questions the callers asked:

Sample questions included:

• How do you handle doctor arrogance?

• How does one identify a good or bad hospital?

• What is a “good” doctor?

• What do you do when there is no clear-cut doctor communication on the diagnosis?

• How do you handle the “run-around” activity commonly found in healthcare practices?

• Infections contacted at the hospital can lead to death. How can we be prepared?

• Medicare maze to get authorized payment seems to be getting tougher. Any suggestions?

• Sheer neglect by the nursing staff has lead to patient deaths. How can patients and their families avoid this?

• Inconsistent levels of hospital care aren’t new, but it seems to be growing. What can be done?

Over the next few days I am going to address each of the above questions.

ANY QUESTIONS OR USEFUL TIPS-PLEASE SEND YOUR
COMMENTS AND SHARE WITH US

~Stay Well My Friend!