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Blue Cross Blue Shield of Georgia wants to stop people from using the ER for their sniffles. Noble idea…is there any way this won’t backfire?

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4 Responses to “Keep Your Broke Butt Out of the ER – Luv, Blue Cross of Georgia”

  1. Steve Parker, M.D.

    Inappropriate ED use is a problem only because costs are out-of-control high. The solution is to get costs under control, back down to reasonable levels.

    Reply
  2. Kinoons

    I am moving to a new employer in two months. They told me in my interview they have a ” navigator ” in their ER. If someone comes in for a BS complaint like a sore throat they get seen to meet the EMTALA requirement. They get informed the reason they are in the ER is not an emergency. We make an appointment for them at an urgent care that is also operated by the same system that runs the ER. At that time the ER bill is thrown out. They also check if the patient has a primary care and make an appointment with one in their system if the patient doesn’t. Also if the patient doesn’t have insurance they see if the patient is eligible for the hospital’s health plan as well. They claim this takes return visits in the next year down by 90% for the same complaint from the same patient. I am eager to see this process in action and if it actually works.

    Reply
  3. Alaina Davis

    I work at a Free Standing ED in AL. We are a 12 bed ED, 1 Dr, fully staffed nurses (usually 4 or 5, 2 in early mornings) Respiratory Therapist, Pharmacy (no out patient pharmacy), full on site lab, X-ray, CT, MRI, Ultrasound (also outpatient bone density and Mammo). we are a base for an ambulance service (if you are admitted to our main campus no charge for the transport). I work on the Imaging side doing Xray and CT at night, but we also offer outpatient services during the day up until 9pm (when the local after hours clinics and urgent care closes). it has been a while since I have looked at our Cath times, but about a year ago our patient arrival to being on the cath lab table was actually about 20 min. We have an average turn around time of I think 2-2.5 hours depending on the doctor working and the quantity of patients. Most people treat us like a 24hr urgent care, but we do get true emergencys like strokes, heart attacks, appendicitis, broken bones, MVA, and ob patients (we can deliver if we need to but we really dont want to).

    Also I dont know for sure if it is still happening with Medicaid/Medicare but a few years ago I asked a patient why she was coming in over and over for little things like “last week the ED said I had pneumonia and I still dont feel good” and never following up with her Primary. She said Medicaid had put a limit to 5 visits per quarter for primary care, but no limits for emergency or specialist. Do you think an insurance putting a 5 visit per quarter for ER and anything after that would be subjected to the ‘was it really an emergency’ panel of doctors would be more suitable?

    Reply
  4. William Wright

    As an RN in Ga I’m mixed about this idea, it’s a good idea on one hand, on the other it might delay care that people are already putting off.

    Reply

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