When former emergency physician Lisa Letourneau thinks about wasteful health care spending, one Maine woman with a stomachache comes to mind.
The woman, who suffered from anxiety and failed to take her medication, repeatedly showed up at one of the state’s hospitals worried about her stomach pain. Hospital staff, focused on getting patients in and out quickly, kept ordering more CAT scans of the woman’s abdomen to diagnose the problem.
By the end of the year, the patient had undergone 30 scans, which typically cost at least $2,000 each and also emit radiation that poses a cancer risk.
The woman is what’s known in the health care world as a “superutilizer” — a patient who makes frequent trips to the emergency department or returns for repeated hospital stays. Those patients are considered a major factor in skyrocketing health care costs across the country.
Hospital services are often the most expensive form of treatment and can fall short in addressing many patients’ needs, particularly people with chronic illnesses.
The Robert Wood Johnson Foundation, the nation’s largest charitable organization focused on public health, has launched a nationwide campaign to identify and better care for superutilizers. The foundation recently announced Maine Quality Counts, a regional health care collaborative headed by Letourneau, as one of six recipients across the country to each receive a $200,000 grant under the initiative.
Maine Quality Counts has in turn chosen MaineGeneral Health, one of eight health care teams in the state that’s already working with the collaborative to address the neediest and most expensive patients, to take the lead on the grant. Doctors in Kennebec County will develop a model for identifying and caring for those patients that eventually will shape a statewide strategy.
Today, the woman with stomach pain is a less familiar sight at the hospital, Letourneau said. Local health workers call the woman regularly to ask if she’s taking her medication and to make sure she’s feeling well.
“It’s trying to do the right thing for people, which is often less care, and it happens to be less expensive,” Letourneau said.
While some costly medical treatments, such as for trauma or cancer patients, are unavoidable, wasteful procedures and services can be averted when health professionals at the primary care level closely oversee and coordinate patients’ treatment, she said.
“It’s all about having a relationship with somebody that you know and that you trust,” Letourneau said. “That person does the right thing for you, but no more than the right thing. It’s linked to this whole concept that the American public is gradually waking up to, which is that too much care is not a good thing either. Thirty CAT scans is not good for that woman.”
While the average American accounts for about $6,000 in health care spending a year, superutilizers can run into the hundreds of thousands of dollars and up annually, Letourneau said.
Those patients are behind an oft-quoted statistic that 20 percent of patients represent 80 percent of the country’s health care spending.
The foundation grants will help MaineGeneral and the five other health organizations to replicate the work of Dr. Jeffrey Brenner, a Camden, N.J., physician lauded for his progress with superutilizers, said Barbara Crowley, executive vice president at MaineGeneral Health.
Brenner and his team dramatically reduced hospital and ER visits among his patients by making regular home visits and encouraging patients to quit smoking and cook more, among other approaches.
The experiment led to a more than 50 percent reduction in patients’ average hospital bills.
Avoiding unnecessary hospital visits can stem from simple steps, such as getting glasses for a diabetic patient who can’t see well enough to administer her insulin shot or arranging transportation for people who can’t afford to make it to a doctor’s appointment, Crowley said.
Many of the most expensive patients also need treatment for mental and behavioral health problems, she said.
“We should work to find those individuals who — if we could provide them better care management, better navigation, better support for what their needs are — we can improve their quality, we can improve their access, and we can lower overall costs,” she said.
I have read this article and find it insulting to say the least. Insulting as I do Not have health insurance nor can afford it Plus the cost of a regular dr. visit plus insurance. I see this for what it is. If you have money you have health care. If you are on welfare, you have health care. If you are not on either plan, you have to pay as you go. No money , no go. SO thanks Obama. I will NOT NOT NOT pay for your Mandatory Health care plan. NEVER. Nor will I vote for you.
I simply would like America back to the land of the Free and Home of the Brave. You,. President Obama. have LOST my trust………………………
When did you ever trust Obama? You sound like you have been building a lot of anger for a long time. Please don’t try to blame Obama for all the problems in the world. It comes across as a little unbelievable.
Never said I blame Obama for all world woes. NEVER. I do not like nor trust him. Period. I also do NOT agree with the Supreme Court’s final decision about Obama Care. That is a RIGHT that has been taken from us. Anger you address, you do NOT want to go there. it is pure DISGUST for this lying and disgusting excuse for an administration. I do NOT vote for anyone based on skin color either. You chop chop, should discuss Obama with the Families whose loved ones were MURDERED last month at the Embassy. NO passing the Blame on that to Hillary,. Obama surely HAD something on either her or Bill. Just do not go there with me.
You should chill, dude. Your lack of credibility is showing.
Your tactic does not work here.
Consider this, then: Obamacare was modeled after Rmoneycare, which Willard fought for and won for Massachusetts. Can any of you understand how illogical your complaints are, when you continue to support the latter???
I understand about the Romney care in Mass. as know personally many wealthy people who took full advantage of that . To me ,that is stealing. My views are far from illogical as I call it as I see it. Prisoners get more medical care than many, and we pay their bill. Something is very wrong with that.
i dont care for EITHER OBAMA OR ROMNEY
I have found it doesn’t really matter if you have insurance. No one in the medical business wants you cured, there’s no money in cures, it’s called ‘Managed Health Care’ They manage to keep you alive and miserable at a big expense for awhile. Thats why there hasn’t been any cures but we’ve managed to put space ships on Mars and we’ve figured out what Mummies ate 3000 years ago and figured out ways to spread (old and new) diseases, damage death,destruction to humans.
Question why a months worth of pills can cost over $1000.00, the insurance makes deals with doctors, hopitals and pill makers to an unfair advantage to lower middle class. I say be rid of insurances, lower medical care.
You are so sadly CORRECT. I believe as you do. And will add that too often doctors, put people on meds that they know little about, thus creating a guinea pig…………….
Affordable Health Care will help those with no health care that are not currently on MaineCare or ‘welfare’.
All people (including you) have a right to health care.
But what will the quality of care be? We are heading toward a two tier healthcare system where the very rich get the very best and everyone else gets to stand in line. There used to be a middle class standard for coverage but that, like many other middle class benefits, are slipping away.
You can criticize Obamacare all you want, but doing nothing was a far worse option.
You are right that doing nothing is far worse than something else. It is just that Pelosi statement of Not Knowing WHAT was in the Obama Care, and After it would be passed, THEN everyone could read it and find what it entailed. Does that not bother you that she had the nerve to make her statement? It should. Doctors are ordering too many MRI’s and CAT scans, that OFTEN a simple x-ray will show the woe. Just saying.
No, what bothers me is that people obsess over irrelevant remarks.
Irrelevant remarks/ Please explain.
Because the same people who harp about Pelosi’s remark are the same people who talk about death panels, etc. There is no death panel aspect of Obamacare, NONE. But the fact that people continue to lie about that proves they don’t care about the truth and it proves they don’t care what’s actually in the bill. So I think it’s hypocritical to castigate Pelosi for that remark at the same time they refuse to care about what’s truly in the bill themselves.
Not only that, but we should debate the bill on the merits. The merits of Obamacare isn’t dependent on what Pelosi says about it. That’s the irrelevant remark — it adds absolutely no substance to the debate.
Pelosi did not say that to the general public, or to congress. She said it to a group she was addressing before the bill’s provisions had been firmed up. They were trying to debate provisions that no one yet know would be in the bill or not–the bill had not been finalized by a long shot, at that point.
No dancing around Pelosi’s statement. You may love and worship her but does not mean others have to do the same. Time to see the light of day.
The rich can’t pay for ALL the doctors in the world…..eventually medicare WILL fail and doctors will have no other choice but to lower their medical treatment service fees to a level that is affordable to the middle class on an open market or they will have to find another profession
government involvement in health insurance is UNSUSTAINABLE
You are correct. Let’s get rid of the VA hospitals and medicare. Let’s see how that works.
Everyone should have access to the best health care available.
The rich get the best and those with no insurance are up the creek without a paddle in most cases. A standard should exist that actually is implemented to work in the best interest of all.
Except we live in a real world. The new standard for the best care available will decline. It has to. Its in the math. The middle class standard will be lowered.
Everything is in decline. The GOP wants to take this country giant steps backwards instead of moving forward.
what in God’s name is ‘health care’?
are you reffering to medical treatment?
and the second you declare that someone has a ‘right’ to a service (i.e. another person’s labor) is the second you instill a system of slavery to provide said service
Personally, I think it is immoral to use government in order to force one person to provide a service to another…..all transactions should be voluntary
That’s your opinion and you have the right to it, as I do to mine.
Health care, medical treatment if you want to discuss semantics go ahead.
As a citizen of this country we should all have a right to equal and proper health care/medical treatment. I don’t believe that is immoral.
Gadael, Your opinion that I should pay for your RIGHT to health care is scary. Please get what you can afford, That’s how I do my medical care I wish could do better but That’s the way I buy everything, just what I can afford!
All people should have the ability to access quality health care in this country, one way or another.
If you get cancer, and you “can’t afford” cancer treatment, what will become of you?
As a citizen of this country we should all have a RIGHT to equal and proper housing, or food, or legal services, or entertainment, or fill in the blank with anything.
Actually, as citizens of this country, we all need to think more carefully about RIGHTS—what are they, how do we get them, how do we keep them.
If we think carefully about the rights talked about during the founding of our country, we will see that the rights they talked about (and fought and died for) were things that had no monetary cost—life, liberty, speech, religion, the right to assemble and petition for redress of grievances, the right to keep and bear arms (note–not a right to have a gun provided to you), the right to vote, the right to be secure in your home from unreasonable search and seizure … …
We don’t have a right to compel JackXT, Joe Blow, Jim Doe, or anyone else to pay for our food, housing, or medical care. To compel them by force, , against their will, at the point of a gun, is immoral.
If you don’t want health insurance don’t buy it.
Please Gad—it’s not a right just because you say it is a right—saying it over and over does not make it so. I am willing to listen to any RATIONAL argument, by which you could convince me (and others) that it is a right. But saying it over and over is NOT a rational argument.
We have a right to life, and we have a right to the pursuit of happiness. But we do NOT have a right to happiness, or food, or to take other people’s money to pay for our medical treatment.
…
I think we should all be civil here (and in civic discourse in general). Not all commenters here are particularly civil.
I think that medical treatment for those who cannot afford it should be provided by charity—by doctors, by hospitals, and by private voluntary contributions. I also think that it is immoral and unethical to deprive others of their property, in order to give it to others, no matter how needy, or worthy, or photogenic. And note well, in our system, those funds collected by government are in fact collected at the point of a gun, even though the gun is seldom visible.
I contribute what I can afford to charities—I try to pick ones where the bulk of the collected money goes to recipients not to fundraisers. Some rich folks give lots of money to charity—some do not. (And some rich folks give to charities that I think are awful, and even un-american) But it IS their money, and I think they should be able to dispose of it as the like.
If, one day, YOU do not have insurance and you aren’t a millionaire, do you want your own sudden medical needs (e.g., a brain injury or cancer) to have to be set aside until you can cobble together the money from friends, a rich uncle, a local church (that might already be cash-strapped), and dollar bills slipped into a jar at the local convenience store? Do you truly expect physicians and hospitals to work without being paid (do YOU work without being paid?) simply because you need medical care?
A word to the wise: better make sure everyone in your fmaily loves you, is wealthy, and outlives you; and better keep on the good side of the head of charitable contributions of your local church (and once you’ve done that, better not move–you’ll have to start cozying up to a new church fast, in case you get sick within a few months of the move).
you are required to have car insurance by law…… yet, Drive license is not a right…. Frankly the cost of heath care is high due to equipment and labor… your doctor went to school for 7 or more years.. and they rake in almost a million dollar debt because of it… so yeah doc need to make half a million a year just to pay for their school loan… so if federal gov wants to cut cost… maybe we should look into paying 100% for the education for nurses, docs, mental health. If they failed school, yes they need to repay… it will help the overall cost. but that just me eh!
The skyrocketing price of health care is due to insurance company profits. Worse, when their investments don’t perform well in the stock market, your insurance premium goes even higher.
Yes, that’s exactly right. But there is one other culprit that applies to our pharmacueticals companies, and sometimes practitioners………greed.
Then let hospitals refuse service to those who can’t pay.
Having the right to get health care when you’re ill = “Slavery”?
If you mean that you can’t bear the notion of some of your money going to subsidize some other person’s health care, keep in mind that
1) If you have health insurance, you’re probably (I hope) paying more in premiums than you receive in services, so part of your premiums go to the CEO’s salary and part of them go to help other people insuraed by that company, who are ill; and
2) You and I pay for health care for people who do not not have insurance but show up at the ER. Our own medical costs and insurance costs are higher because of this.
Liz. please look into Swedens system of poplulation care of health. You may see the light.
I am in agreement with you but detest being told that I have to have a health care plan. That is more government in our lives. That is Socialism and that is Obama.
86’d
I am glad you brought Sweden into the discussion. You are so Correct. Please keep talking about the Swedish way of health care and lives they lead. BRAVO.!!!!!
Obamacare is “Boogeyman” and you must avoid it at all costs, or it will climb out from under your bed and eat you up in the middle of the night!
Shiverme timblers. Bless you for your failed attempts. But in thinking of your statement, of Obamacare being a Boogeyman’ LOLS and almost True.
I agree that all people have a right to healthcare. I am saying I do not like being told by the government. That is Socialism.
Your fear of “socialism” may put you and people you care about at risk of not being able to get medical treatment when it is needed.
If someone told you that driving a car = “socialism” would you decide you had to start walking everywhere?
Substitute “bogeyman” for “socialism” and you’ll see how the Republicans are trying to manipulate you.
I assure you that Republicans are not trying to manipulate me. LOLS. I also see your points. I am not here to fight. Just stating my view.
If you happen to get hit by a bus and show up at the ER HammockBear – who do you think is going to pay for your treatment? Us.
If you had any clue at all, you’d realize that you just made a perfect argument for universal coverage (or as you likely know it, Socialized Medicine).
And the only reason WE are on the hook for the cost is due to the immoral government involvemnet in healthcare insurance to begin with. Prior to 1965 charities and hospitals covered the cost of those who could not afford to pay. Thanks to brillant folks such as yourself, we are now ALL on the hook for the cost, which has done nothing but but explode healthcare insurance and medical treatment costs through the roof since the mid-1960s. And now we are at the point where just having ‘health care coverage’ is not a guarantee that you will receive medical treatement for your illness, due to the exploding costs driven by government subsidization.
And claiming that the next step should be socialized medicine is about as backwards as you can get, if you actually want to provide medical treatment to all those who need it. The problem with socialized medicine is that sooner or later, you run out of other people’s money to spend on YOUR medical treatment, and then you’ll turn to violent means to obtain further
Wait. Who paid for the ‘charity’? How did the hospital pay for the employees and technology to treat those patients?
Hospitals picked up the cost. Just magically absorbed it. Right. Sort of like when a company gets sued and someone walks away with millions. Just found money, right? Wrong. It’s simply passed on to the other customers. Hospitals are no different.
Yes, that was my point. A business can’t meet payroll and pay bills by giving away product.
Yet for some reason (hint: we believe everything that annoying black box in most living rooms tells us during dinnertime – “Got this? Got that? Go see your doctor!” “Did you get a flu shot? You know you might die if you don’t!” – etc., etc., etc.,) people still seem to march on in to the local ERs carrying a bug in a bag and convinced they’re going to die a slow painful death.
No one should be surprised that it’s nearly impossible to get affordable health care.
What amazes me about this is, what do you expect? This is America, free enterprise rules. Why is gas $4.00 / gallon? Because people will pay $4.00. Why does beer brewed in Portland cost 9.99 a six pack. Because people will pay it. These companies are doing what they’re supposed to do, maximize profit on behalf of the shareholders. One should not be surprised that the health care industry is no different.
This just in from Reuters news service:
(Reuters) – People living in countries with government-run healthcare systems like Sweden and Canada are far more confident than Americans that their families can get good, affordable care, according to a 22-nation survey released on Thursday.
For full article:
http://www.reuters.com/article/2010/04/15/us-usa-healthcare-poll-idUSTRE63E2TO20100415
There are so many flaws with your argument, that I’m not even sure why I’m bothering. Let’s start with the idea that your charity based system does nothing to prevent people from getting sick in the first place. And nothing to prevent their minor illness from spiraling into one with major expenses.
Are you suggesting that the best approach to providing healthcare to the poor is to wait for them to become so sick that they show up at the most expensive place on earth (the emergency room)? That’s nuts.
Under our present system, employers get huge tax breaks for providing health plans. By participating in a pool, the cost of premiums is more affordable. But not everyone works for one of those employers. That leaves many people out in the cold unable to join insurance pools even if they can afford health premiums. Individual plans are very expensive. And that’s not fair. What Obama did is not socialized medicine. He made health care a right for Americans, not a privilege for some.
Thanks for your view . Glad I wore my hip boots to read it. What you state about No guarantee that people will recieve medical treatment is indeed a Great statement of truth. It reminds me of a late friend whose son had cancer. The only option for the 10 year old was experimental. His case went before a board of 12 people who DECIDED if he could have that treatment. He was DENIED. No insurance and even If he had insurance, it would not pay. So, this story hit the news and in less than 5 hours, over 300 thousand dollars was raised for this child to get that treatment in Seattle. A senator donated his jet to fly the child and his parents to Seattle and then the senator paid for an apt. 2 blocks from the hospital for the family to stay near their son.. That senator, was Ted Kennedy.
Somehow we all need to work together to create a fair and practical way for everyone to have health care. I am against Socialized medicine and also know that many cutbacks can and should be made in the medical facilities.
A father did not have insurance (probably because the for-profit model is so expensive), and you’re aware that a for-profit insurer would have denied treatment to a child with cancer… so you speak in FAVOR of the for-profit system?
Absolutely Not. My point was that an innocent child’s health of live or die, was in the hands of 12 strangers who had a difficult decision. BUT., that is so intolerable in this country. I do NOT favor a For-Profit system. I do not claim to have all the answers. But I do feel strongly that Mandatory Obama Care is not the way to go. Incidently, that child had 4 siblings. The father was a single parent. The morning his son died in his arms, the father who had promised his son they would be together forever, went and committed suicide within 2 hrs. after his son died.
That has happened more often than we know, the caregiver is so involved, and cannot go back on the promise of being together forever. Currently the health professionals are now aware of these situations and do keep a keen eye on the caregivers.
Pharmaceutical mfrs. are a huge part of the money grab game. Then the insurers. The Greed is obvious and we still have no good solutions.
I will say it again. I pay for my own health care.
You are naive if you think you’re paying for your own health care — you’re paying for the care provided for many others who do not have insurance at the same time. The price you pay “as you go” is determined by what the health care provider has to recoup in costs for all patients. You’re subsidizing people without insurance regardless of whether you realize it. If everyone had the same insurance — free from the driving force of profit — everyone’s prices would go down.
I sure hope you’re a multi-millionaire. The cost of treating a severe heart condition, or a traumatic brain injury, or some forms of cancer can approach a million dollars. So if you have more that that, you still might be able to keep a roof over your head after paying the bills.
My financial business is private. You make very valid points,Liz. However, I have seen nothing to change my opinion.
You have a very simple “would like” indeed, but let’s hear it for those days of freedom and bravery! By the way, when were those days? Were they before, after or in-between: slavery as a constitutionally guaranteed institution; genocide or expulsion and confinement of native tribes; voting rights for women; elimination of poll taxes; voting rights for all citizens, regardless of race and ethnicity; the whole Jim Crow legal apparatus? When was that golden era, I wonder? Maybe it is more a case of where than when: Hollywood, for instance, or on the set of Gunsmoke or Dragent or Disney’s Frontier Land.
Maybe the golden era ended the day the Shrub left office in 2009. Lots of folks have had trouble with that inauguration day, though only the crudest use the very politically incorrect term to express the feelings they have about it. Not that anyone using these columns would have those feelings -certainly not here in Maine, a state whose graveyards are well supplied with Union dead.
Good health to all who those who are able but refuse to insure themselves. May their pockets be brimming with cash, for there is no reason for the rest of us to do it for them
I pay as I go. I will not accept the govt. telling me that I have to pay into the Govt. plan.
I thought you said you can’t afford to pay…………?? Guess WE pay for YOU.
What do you NOT understand/ I said that I pay as I go to the Dr. It is Mandatory Insurance that I will not pay and currently the insurance options available are Not affordable for me. I expect Nothing from you or anyone else.
Insulting????? Depends who is on the receiving end & who is paying for the uninsured. What is not to understand about this article.
You have to understand whine, that for the majority of those who hate Obamacare, English is a second language…as witnessed by their complete lack of reading comprehension.
And who do you refer to as, “Their complete lack of reading comprehension’?
Insulting to all Americans in the form of pushing more government mandated rules at us. I most definately understand the article.
We the TAXPAYERS pay for the Uninsured and the ENTITLED ones. and the PRISONERS………..time for a Change.
Do you really think this problem started the minute Obama got into office? Ha. I don’t intend to vote for him either, but to lay the blame only on his table is laughable.
The proverbial train has hit a brick wall. It’s been rolling on down the tracks for decades now (and through many administrations).
Does the place you work for even offer an affordable ‘in’ to an insurance plan?
You are right on the mark in saying this has been happening for decades. The medical technology is advancing and thus drives up the cost of medical care which is most logical. No , this problem started years ago as the technology began to advance. My woe with Obama is the Obama care being Forced on to us. That is more government in our lives. I am self employed and pay as I go. Small businesses do not always have the money for health insurance plans.
you are so uninformed! The BDN didn’t like what I really said, so they deleted it!
not many people do like what you say as I have seen in comments.
I have only been commenting for the past two days?? And you were not on any of the comment sections I was commenting on, so you are full of yourself. Your true colors have shown through in your comments on this link.
Well pardon me. I was referring to the many comments I have read from you in regards to other articles. so mister, get over yourself.
So is this part of your “humble apologies”?? And I’m no ” mister”… hence the name Maine Girl…
Please note the actual time of day I posted the apology……..again, I am sorry.
Thank you.. however, we totally disagree on this subject. I am married to an ER physician, and I, myself have worked the past 15 years in the ER’s in this state. I worry everyday that if something medically happens to us, we will have lost everything. the number one reason most Americans claim bankrutcy is for medical bills. I did so in my 20’s with 69k in medical bills, Even now in my 40’s I am still “paying for that”….. I was hit by a drunk driver while a student without insurance. This country has got to get a grip! ALL other wealthy/civilized countries have universal healthcare.
We really Are on the same page. A good friend who was an orthopedic surgeon had to stop his surgeries due to the high rate of malpractice ins. for he and his partner. that is in NJ. But we know this is Everywhere USA. I too had an accident and with No insurance and being in a different state , there was no way I could get a payment plan. Had to pay 500. up front Just to see the ortho dr. and then pay Up front for all surgical time and titanium ,supplies etc. then cash of over 300. per twice week PT. If I had a 5 thou deductible, I STILL would have had to pay cash. THis is the part that is in need of change. To top this off, when my accident happened and I went into the ER, I heard little English spoken in the Wait area and most were mothers with sick kids.
I do not claim to have a solution but it is internet discussions that I hope WILL find a common agreable solution. My bitterness is from me still paying my bill and I simply do not trust the Obama care plan as the People are ONLY now really getting to discuss this.
My humble apologies, I had you confused with another person whose writer name is similar to yours. Very Sorry………..
You might be one of those people who qualifies for assistance with premiums under Obama’s plan. If you vote for Romney, you probably won’t ever get any help. Please reconsider your position. President Obama made health care a right for everyone. Give it a chance to work for you.
A vote for Romney is a vote for honesty. Encough said.
The word “insurance” does not appear on this page until your comment. The word does not appear anywhere within the article.
The word, “insurance” does not apper on this page. You are correct. However, it is an underyling basic regarding a topic such as the article.
You don’t have health insurance, but if President Obama prevails you will have health insurance. So what’s your gripe? The fact that the ACA is mandatory is what makes it affordable.
How about those that fall in other spectrum, not enough care?
Many on MaineCare use the emergency departments as their prime source of health care. It is beyond criminal and happens all the time. I am not speaking about the elderly or handicapped, but rather, the people who have figured out how to rip off the system. The entitled with children in tow with no father(s) in sight, the really smart ones who hang a psychiatric diagnose around their child’s neck, (far easier than one might imagine), and believe me, the sky is the limit. No end to the numerous tests, therapies, out of home placements…sickening.
some in mainecare are not ripping of the system. some in mainecare arent getting the care they need. they go to ERS for that care .
You forgot to mention the Illegals…….. 3 yrs ago I had an accident and broke my wrist. as I went into the ER and as I left the ER, I heard very little English being spoken. Most were parents with sick children and noone would be turned away. Noone should. BUT. where is the solution to this that happens daily all across the country? Incidently. I needed surgery to repair my wrist. Had to pay 500 dollars JUST to see the orthopedic surgeon and then had to Pay in Advance, for surgery, and as I paid, I asked myself, who would be paying for those sick kids I saw in the ER Waiting Room. I also had to pay cash for each physical therapy visit. BUT, when paying cash, the discount is HUGE as it Lessens the paperwork and those whose job it is to do that paperwork, thus saving more money. Something to think about.
Going to the ER is not criminal.
You got that right!
” we can lower overall costs”. Surely you jest, if you are referring to the paying patient. The medical profession, hospitals, insurance companies, etc., yes. The paying patients, don’t hold your breath while waiting for relief.
If dr. offices would have more walk in hours and emergency appts. so many trips to the ER could be avoided.
The problem is that most people wait until they “can’t take it anymore” so by then it really is an “emergency” and the doctors office will tell them to go to the ER. Then there are people who think its an emergency and it’s not but they insist they must be seen this minute.
I agree sally, but you left out the large number of people (and I’ve spoken to doctors about this and they confirm it) who run to the doctor’s office over every little ache and pain. I get a lot of aches and pains too, but I have enough sense to take a couple of aspirin and it goes away. If it doesn’t, and it gets worse, THEN go to the doctor.
that means that there would be more drs. in each office to handle the work load
Why on Earth did the doctors give her 30 scans in a year? Don’t they maintain/ read the charts? What were they expecting to find the 8th, 19th 24th time?
Because after spending hundreds of thousands of dollars for software programs that hospitals purchase, training staff to put in a patient’s data everytime a patient walks into the ER. They still can’t figure out how totrain an employee hit the button and do a “Search on the name and social security number” to see what that’s patients’ history has been in the last 12 months. Amazing!
Something needs to be done with healthcare here in Maine.. I have been waiting for over a year pretty close to 2 as a matter of fact, for treatment on my back.. I started off with 4 herniated discs in my thoracic area now all 12 are herniated.. They have done nothing except do all kinds of tests and send me for M.R.I.’s. These tests that they have done have proven that i am getting worse and not better. Still they do nothing.. I am at the point where walking is so painful that i have been cooped up in my own house now for a month or so.. I don’t go out except to see my PCP or do groceries and all i do is drive then i don’t go into the store.. Even then it takes me 30 milligrams of percosset upon arrival to do just that.. The last outing a month ago i came home and took my pills and fell immediately afterwords and cracked a rib.. Another ride in an ambulance.. The er wants to know why they wont do anything for me and so don’t my PCP but they are not getting anywhere.. Today i found out that when i fell last month they did another M.R.I. and they found 2 more herniation’s in my lower lumbar and one bulging on a nerve.. They claim that has been the reason why my legs give out.. But still they do nothing except schedule more tests.. Now they want to do another skin biopsy to see if i have neuropathy, like that has anything to do with bad discs..
Okay now that you know the history i will get to the point, I have been to the er with complications over 30 times in the last almost 2 years it will be 2 years on Dec. 15 I have been through 4 hospital stays of 2 to 4 days, I have had over 6 M.R.I.s About 10 electrical stimulation tests, One attempt at physical therapy which made things worse, and i had to go to 30 days of treatment for narcotic addiction, only to be put right back on them, and i have had 2 skin biopsy’s to determine if i have diabetic neuropathy, and that has nothing to do with the damage in my back.. I have had 12 steroid injections in my lower back and that didn’t even hurt till about 3 months ago..
I hear people say that they abuse the system, well what about the system abusing the patient? I get so mad when people say or if i read an article such as this one, i guess it is okay for them to abuse the system but it isn’t okay for you to..
It sounds like it’s time for you to change your physicians. At some point you have to take charge of your own care. It sounds like they are just spinning. Maybe you need to get out of Maine. Who is your insurance carrier? Sometimes they can put you in the right direction…depending upon who it is, of course.
What I want to know is who the heck authorized THIRTY CAT scans? I’m seeing little common sense here. Wouldn’t someone start questioning the wisdom of this after the first few came up with nothing?
I know…what insurance company ok’d 30 scans in one year? I work in healthcare…do you know how hard it is to get one scan authorized????
And it’s always been Romney’s position that this should be an individual STATES concern. There is no contradiction in his opinion. But then.. you’ve been told other wise about everything he says haven’t you? True or not.
WTF….. 30 cat scans? when a simple blood test for H Pylori would have probably CURED
the poor woman, perhaps the hospital should to do a little self examination of their methods &
practices.
the hospital needs a scan
Interesting that MaineGeneral now wants to look at “wasteful health care” spending. Let’s talk for a moment, then, about how MaineGeneral (and other hospitals)pass responsibility for medical negligence back onto Medicare.
Hospitals carry insurance. That insurance is there to protect them when they make mistakes.
I had a 5-day visit turn into a 7+1/2 week one, directly due to their negligence. Did they take responsibility? NO! They handed over the entire costs to Medicare and my supplemental insurance, both of which paid the bill.
So when people want to talk about Medicare and how much it cost to maintain, they should remember that it is often the hospitals, themselves, creating unnecessary spending.
Many, if not most, of these “superutilizers” are on MaineCare. Too PC to say that, apparently.
Where is the proof to back that statement up?
Obviously you don’t know much about health policy. This has been a problem for years.
“The top 5% of highest cost MaineCare enrollees (17,182 members) accounted for $1.2 billion or
55% of total claim payments.”
http://www.statereforum.org/sites/default/files/maine_health_innovation_plan.pdf
http://www.maine.gov/dhhs/oms/pdfs_doc/vbp/CCHP_04062012_MaineCare_Report_pdf.pdf
There are some things ‘government’ does very well and health care is one of them. Medicare works for patients and remains, along with Social Security, one of THE most successful social programs this country has ever seen.
There are ways to streamline wellness and keep costs down for everyone. Certainly relegating those without insurance to seek what should fall under non-emergent ‘Primary Care’, instead, at the local ER is not the way to go. We see this. Yet that is what Mitt Romney most recently proposed along with no coverage for pre-existing conditions.
Insurance companies are an unnecessary ‘middle man’ nobody really needs. The administrative costs, alone, are hefty ‘overhead, above and beyond what is spent on actual claims.
They are not in the ‘Claims business’. They are in the ‘Premium business’ which, if people actually thought about it, they would see that eliminating them would save a lot of health care dollars.
There has always been, and always will be, ’boutique’ medical practices and concierge physicians available to people with deep pockets. At ‘Man’s Greatest Hospital’ (MGH) and elsewhere, there are entire floors dedicated to the wealthy in the US as well as the international elite who fly in from all over the world to see the best we have to offer. It’s nothing new.
The successful practice of Medicine is in many ways an art. It’s as important as the science for different reasons, perhaps. We simply have to be more ‘creative’, which is where the Affordable Care Act (ACA) comes in.
For those people who don’t wish to participate, they are slated to face fines. There are a lot of things that we do as a societal group that work toward ‘the greater good’. And I think, at some point, we are going to have a single-payer system. I don’t see how we can avoid it, really.
An insurance voucher system, as proposed by ‘Ryan-Romney’ will not work, in my opinion. Just as privatizing Social Security would never have worked under ‘Cheney-Bush’. These programs, especially for those nearing retirement have to be ‘bullet-proof’.
Obama 2012
By the end of the year, the patient had undergone 30 scans, which
typically cost at least $2,000 each and also emit radiation that poses a
cancer risk.
The article omitted whether the patient had private insurance, or Medicaid.
I have been on both sides of the coin. There was a time in my life I needed Medicaid. And another time I was without insurance (about one year both times) I have been working in the healthcare for over 30 yrs in the billing/insurance side. And I have seen alot of abuse. I agree with this article. There are alot of “nervous Nellies” who are hypochondriacs and who continuously seek medical care. they rack up the bills and then it is passed on to the rest of us. Then there are the ones who believe that having Medicaid (Mainecare) is a free ticket to the ER for whatever ails them. And we have those that utilize the ER for the right reasons. Some states have set limits on the Medicaid reimbursement. (limit 2 visits to the doctors within one month) (limit 1 visit to the nursing home), etc. the doctor can see the patients over and above this but they won’t be paid! I think it’s time we make those “nervous nellies” accountable and have them pay. Especially when the diagnosis is not deemed “medical necessity” for utilizing an emergency room. Something needs to be done. We need to stop blaming the doctors, the facilities, the president…..the blame goes to “us”. WE all need to be accountable….WE the people have put ourselves here. Severe changes have to be made and the change begins with YOU and ME.