LinkIn a bygone era in China, a physician was only paid if he kept his patients healthy. If they fell sick, he would not be paid. This is still the ethos in Chinese Medicine, and, of course, we don’t live in anything resembling that world anymore, nor should we. But I bring up that framing of “health care” as a gentle reminder of how far from ideal our for profit system has become. If a fraction of the money spent on procedures, hospitalizations, and ER visits were spent on clinic visits, home visits or even providing decent food our outcomes would be so much better. This story just underlines the difference in the two systems, where Medicaid tries to keep costs at a minimum, yet can barely pay for clinic visits due to the reimbursement structures, where for profit hospitals see huge mark ups on ER visits. You have to wait for an advertisement to read the story. Excerpts below.

Hospitals seek more ER patients even as Medicaid tries to lessen demand

By Phil Galewitz, Published: August 22

Complaining of abdominal discomfort and chronic bronchitis, 22-year-old Toshia Johnson, an unemployed mother on Medicaid, went to a hospital emergency room in Bend, Ore., more than two dozen times in the year that ended in June 2010. She was never admitted to the hospital and used the ER for routine care because, she says, it’s near her home and the care was free.

But in the first six months of this year, after entering a state-funded program designed to reduce unnecessary ER use by Medicaid patients in central Oregon, Johnson has gone to the ER just once, after breaking her tailbone. In the first half of this this year, ER visits by the 400 patients in this program have declined by more than half from the same period last year, saving Medicaid $1 million, officials say.

Efforts to reduce unnecessary ER visits by patients in Medicaid, the joint state-federal health program for the poor and disabled, are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals’ aggressive marketing of ERs to increase admissions and profits.

“Many hospitals are actively recruiting people to come to the ER for non-emergency reasons,” said Anthony Keck, South Carolina’s Medicaid director, citing facilities that tout their speedy ER service on highway billboards. “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims,” he said.

ER visits totaled 124 million in 2008, an increase of about 31 percent since 1997, according to the Centers for Disease Control and Prevention. The average wait time for treatment is 33 minutes, up from 22 minutes.



Dallas-based Tenet Healthcare Corp., a large hospital chain some of whose facilities have seen a surge of patients using the ER for primary care, recently began accepting online appointments to make it easier for patients to use the ER. It’s also promoting average waiting times on the Internet and on billboards. Spokeswoman Carol Britton says that there hasn’t been a “significant increase” in ER visits by Medicaid patients as a result of the promotion.

Medicaid officials in Washington state were so concerned by hospitals’ ER marketing that they issued new rules making it harder for hospitals to qualify for Medicaid bonus payments if they promote their ER for primary care. “They sure don’t help us when we are trying to get word out that the ER is not the place you go for primary-care diseases like treating asthma or diabetes,” said Jeffrey Thompson, chief medical officer for the state Medicaid program.

Sicker than most

States are focusing on Medicaid recipients in part because these patients use ERs three times as much as people with private insurance and twice as much as people with no health insurance, according to federal researchers...

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