Special Focus
hold more "value" in the eye of the con- sumer.
Studies in other countries showed that even a nominal fee that comes from the patient's pocket reduces excessive utiliza- tion. Many people think twice about the necessity of their trip to the ER if they have to spend even a small amount of their own money. Perhaps we should con-
sider a nominal charge. Solutions I think about at 3 am in the
ER: • Hold the users accountable. In Cali- fornia, just about everyone has a cell phone. Apply a charge to their cell phone bill. I am sure they will be much more motivated to pay their cell phone bill long before they pay any
ER bill.
• Our local fire department announced they would no longer roll on every EMS call if dispatch deemed they were not needed. Good idea!
• Better idea: allow dispatch to use ad- vice nurses who can advise patients, arrange for follow-up appointments, and alternative modes of transporta- tion.
• Encourage more treat-and-release policies for EMS so that they do not have to transport every patient, but still get reimbursed for the encounter.
• Allow on-scene EMS to assess the need for ambulance transport.
Having worked in ER over 20 years, I understand how the ER has become our nation's safety net for health care. I also understand that to even talk about look- ing into ways to protect and husband our health care resources (which include everyone from first responders to ER nurses and doctors) gets people all riled up. Nevertheless, I do believe that if we are not part of the solution, we are part of the problem.
Ok, now a challenge to my readers: you are out in the trenches, and no doubt run into similar situations. What are your sugges- tions? How can we fix our problems? Leave me a note, or email me, and I'll put some of the good ideas in a future article. EMS
Robert Donovan, M.D., FACEP, is an emergency physician working at a busy Level II Trauma Center in California’s Central Valley. He obtained his medical degree in Alabama before moving out west. In prior years, Robert has served as an EMS medical director and ED medical director. Currently, Robert is the medical director of PHI California, an air ambulance program; chief of staff for the Medical Center; and still works full-time in the ER. Robert has a broad background in both prehospital and hospital medicine. To contact Robert, email
robert.donovan@
ems1.com.
28 EMS PRO Magazine
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52