expanding the emergency room model: \'central care system\' could help americans gain universal health care access
There are many reasons why emergency rooms are overcrowded.
As millions of Americans do not have enough access to primary care providers, emergency rooms have become primary care systems and safety nets for people who do not have insurance, no insurance and no other health care.
Overcrowded and overworked staff, ERs is on the verge of collapse in many places. (
See my other article about ERs here: emergency room in our country).
In fact, many people are closed.
Demand for emergency department care has increased as the number of patients in hospital emergency rooms has increased by 32% over the past decade.
We see a huge influx of people seeking emergency room care for many reasons.
For beginners, the fastest
According to the 2010 census in the United States, the growing age group in the United States is people over 65 years old, and emergency room visits for older people are growing at an alarming rate.
We also lack primary care physicians, and because of the low reimbursement rate, the proportion of health care practitioners who do not receive medical insurance and Medicaid is getting higher and higher.
What bothers these problems is EMTALA (
Emergency medical and Active Labor Act)
In 1986, emergency rooms were needed to treat all people regardless of emergency or income. Two-
When the doctor\'s office is closed, the third emergency visit takes place after business hours.
For those who are unable to get care for these various reasons, the emergency room is usually the only place where it can be turned, and double doors always open for them.
Under the Affordable Care Act or Obamacare, primary care physicians are unable to meet the needs as more people have insurance and want to see a doctor.
Since the patient was unable to make an appointment with his or her doctor in time, they turned to the emergency room for care.
The waiting time has caused a dangerous delay for the most serious patients, as the examination room in the emergency room is packed with other people who also need medical care.
The most dangerous and crowded emergency room narrow corridor will make it difficult to create space between the person who coughs blood in the corner and the crying child whose arm is broken.
Ambulance for Life Patients
In the United States, threat conditions are currently transferred from the nearest emergency room on average every minute because there are no examination rooms that can be treated.
To be seen, a key patient may have to be transferred to other \"more empty\" hospitals a few miles away.
We have seen patients lose consciousness of heart disease in the emergency room waiting room, and some patients have to endure the humiliation of receiving disease assessments such as diarrhea in the corridor.
In short, space is limited and the system is almost beyond its limits.
An incidence of more than one
Car accidents on the highway, shootings in shopping malls, and even the next flu epidemic, can allow emergency rooms to grow from maximum capacity to beyond the number of patients they can properly care.
The sad reality is that any one of us could be taken away by an ambulance, only to learn that the ambulance must continue to another hospital, because the nearest emergency room is full, another major emergency cannot be accepted.
In a critical situation, every moment is important, so the patient
People in need
Who will lose the most in this case
Despite the increasing demand for emergency care, the supply of emergency rooms is decreasing.
Over the past decade, the financial burden has caused hundreds of US ERs to close their sliding doors forever, leaving people with no option for emergency care.
The increased financial burden for emergency rooms is mainly due to the low reimbursement rates.
Keep in mind that according to EMTALA, the emergency department has to treat anyone in need of care, many of whom cannot afford the cost of the hospital.
Even for those with insurance, patients often owe a portion of their bills, and sometimes they have to choose between paying for the hospital and buying food for their families.
In addition, medical insurance pays a small part of the medical expenses, thus further reducing the medical expenses that the hospital can recover.
The amount of dollars charged by the hospital is mainly the cost of the facilities, not the cost of going to the emergency room doctor.
• Emergency rooms are crowded • counters
Intuitively, the problem may be that the solution expands the emergency room model and sending more patients to ERs can control costs and improve access. To do this, we must properly transfer patients to primary doctors using the \"central medical system\". why do doctors choose to specialize in emergency medicine?
According to statistics, the average emergency doctor provides nearly $140,000 a year in free charity care.
According to these statistics, it is fair to say that doctors choose emergency drugs not for money, but to make changes to those in need.
Regardless of income, these doctors are committed to taking care of everyone and find their work rewarding on a personal level.
In contrast, if the gas station is authorized to provide gasoline for each car and a large part of the gas is not compensated, the gas station will eventually be forced to close.
First aid is efficient and managed to treat more than 0. 13 billion of sick patients who spend trillions of dollars a year using less than 2% of health care each year in the United States.
Unfortunately, when the emergency room provides care to everyone during the day or at any time in the evening, less than two cents per dollar of health care is spent on emergency care, any one of us could be the next patient as we are all only one heartbeat away from an emergency.
Another reason for the reduction in available first aid care supply is that very good doctors leave clinical practice because of a high level of responsibility in medical accident litigation.
This has resulted in a shortage of key on-call experts who have limited their services due to high liabilities and low compensation in case of emergency.
So what about a tearful parent when her child is in urgent need of neurosurgeons, plastic surgeons, or other specialists who are no longer on call?
In addition, doctors who continue to treat patients in hospital emergencies can defend themselves by ordering unnecessary tests or procedures-x-
Ray and CT scan, for example-
But doing so would expose patients to potentially dangerous radiation.
The medical liability reform should reduce this defensive medical treatment of doctors who are afraid of litigation, thus reducing costs and improving the efficiency of patients and providers.
Many people misunderstand that doctors order additional examinations because they get more compensation, but in fact, if they don\'t do research, these doctors are afraid of medical accident litigation.
This kind of reform is necessary to maintain any medical system in our country, not only for doctors in practice, but also for reducing medical costs.
What is the anatomy of the solution?
It may sound a bit counter.
Intuitive, but I suggest sending more people to the emergency room.
However, the emergency room needs to be developed to cover mental health and primary care clinics, creating a \"central medical system\" that will allow more people to be seen rather than providing emergency services only.
24 emergency rooms available
Provide hourly care for those in need of emergency medical care, and also for those who are unable to see it during normal outpatient time due to work schedules or other issues.
In the emergency room, the infrastructure already exists and can be seen 24 hours a day, 7 days a week for anyone with a common cold, mental health problems, heart disease and stroke; obtain labs, x-
X-ray and CT scan (
CT or \"cat\" scan).
It is logical to use something that has worked.
Think of emergency care center or mini care center as a dangerous fantasy
Clinics can eliminate overcrowding in emergency rooms.
While emergency care facilities are equipped with competent medical staff and use the best technology for many injuries and diseases, they lack the overall expertise and resources to deal with real emergencies.
In order to save money or time, it is very likely that the wrong patient will spend his life going to the emergency center.
Urgent care centers are in great need and should continue to be provided but cannot replace emergency care. Today 24-
One-hour lifestyle, we can buy groceries, travel around the world, tweet messages to thousands of people, and even exercise in the gym at any time, day or night.
Health care must be adapted to the needs of rapid development.
The world we live in.
When the patient enters the hospital Central care system, they will be subject to the primary examination first
In the area where the staff will decide the level of urgency that he or she needs to be seen.
A person with a heart attack will be immediately sent to the emergency department, but a child with bronchitis will be directed to see another qualified doctor quickly in a nearby clinic or emergency care.
Similarly, patients with problems that do not require emergency treatment will be required to make an appointment with a doctor at the local clinic within a few days.
We have a daily list of things to do with family, work, entertainment and other obligations.
We prioritize our goals.
List frequently and take care of the most urgent and important needs first.
It may sound a bit counter.
Intuitive, but the solution I propose is to send more people to the emergency room.
In a medical environment, the term for priority determination is \"triage \".
The triage system is the reason why you can wait for a few hours in the emergency room, because you must first see patients who need emergency treatment.
With the central care system, there will be physician assistants and nurse practitioners to deal with less urgent issues, thus reducing the waiting time.
In this way, more people can be seen appropriately without sacrificing the quality or timeliness of care.
Digital platforms like liveClinic.
Com can also be used to make a virtual connection with someone\'s own primary care doctor.
Of course, patients who need to look at providers in less serious situations will still spend some time in the central care waiting room, as they currently do in the doctor\'s office and emergency care clinic.
Using this time to educate people will improve their understanding of home therapy for common diseases such as disease prevention, healthy living, vaccination, influenza and colds, and other health-related issues.
When people wait for providers of the Central Medical System, the introduction of basic health education may help them to avoid or manage chronic diseases and other common health problems more effectively.
If we \"educate with waiting\", this information can be spread through word of mouth and has the potential to benefit the community as a whole.
Traditional primary care in outpatient clinics should continue to exist outside the hospital.
Patients can make an appointment with a primary care doctor for a regular check-
Or manage any chronic health problems.
But for serious diseases or injuries, the central care system can be provided 24 hours a day to meet these needs.
The Central care system will also be able to arrange future appointments for patients to have their regular doctor see a doctor during normal outpatient time.
In any business, tasks are usually assigned based on experience and skills.
The owner of the grocery store has a lot of responsibility, but of course he has a lot of staff and they have all kinds of jobs in the store.
If the owner spends part of his time on the shelves or bagged groceries, the work left to the owner will be ignored and backward.
The central medical system will also be more efficient.
Getting rid of the deep-rooted mindset of professional roles is essential to simplifying medical work, which will lead to a better separation of cognitive and technical aspects of care.
This means that nurses should not do work that can be automated or commissioned to technicians, and doctors should ask nurses to perform certain tasks so that they are free to take care of other patients.
Effective use of all human and automated resources is critical to maintaining productivity, curbing costs, and providing appropriate care.
This also means digital information.
It is critical that an efficient, universal electronic medical record system that still contains patient secrecy.
If someone is traveling hundreds of miles from home, suddenly injured or sick, and has no response, when the person arrives in the emergency department, er, the doctor is unable to access his medical history, drugs or other factors that may affect his emergency treatment.
If there is not enough knowledge of the patient\'s medical history, it may lead to wrong treatment or misdiagnosis.
Hospital staff, for example, do not know what medicine the person is taking and may prescribe another medicine in the emergency room, which may lead to a dangerous interaction with the patient\'s current medication.
Having a complete and clear understanding of someone\'s history is essential to ensure proper treatment.
This can be done digitally.
In the process of developing the Central Medical concept, it is also necessary to solve the problem of soaring medical expenses.
In order to solve the cost problem, we must first recognize that the \"cost\" of care is not necessarily equal to the amount of the bill.
For example, although the cost of pressing the \"on\" button may be similar, the cost of CT scans for patients and insurance companies ranges from less than $500 to more than $10,000.
Although the effort to do a scan is similar, the amount of the bill usually varies greatly depending on the type of facility in which the scan is performed (
For example, a hospital emergency room, an independent clinic, or an outpatient clinic).
The amount of the bill also varies depending on whether the patient has insurance, the area or area of the body being scanned, and whether the comparison is used for scanning.
Also keep in mind that half of the ER bills have never been paid, meaning they have to pay a higher amount to cover some of the losses to keep the facility in operation.
After the above changes make the whole system more efficient, this difference in the amount of bills and the actual cost of performing CT scans may be reduced.
No matter where or when a scan is performed, we must consider the fixed cost of purchasing and maintaining the equipment, paying the cost of the technician who performed the scan and the radiologist who evaluated the results, and the cost of maintenance facilities.
Nevertheless, the price gap between CT scans and other types of tests is large and needs to be evaluated to better balance the cost of care for all boards.
Innovation in the United States determines what kind of country we are;
It has pushed us to the richest population in the world, and today it must be used to address the health care crisis that threatens the personal and economic well-being of Americans.
With Obamacare being abolished and replaced and/or modified in some way, I hope that the makers of the legislation, taking into account the efficiency set out above, have increased the economies of scale that will be gained through integration.
This will lay a solid foundation for American future universal health insurance.
When we see the development of health care reform in the United States, we need to consider the issues raised.
Our country must change to meet our health needs and our needs must change to meet our health needs.
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MD, please go to sudibose.
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