Re: Pt. Scenario

["Wesley Copeland" <wcemt@terraworld.net>]

Steve,

Yes, ego's do play a big part in our struggle here in Kansas, but money is a
far bigger issue to these small hospitals than you realize.  I will not
argue that overall trauma doesn't pay good, but the finacial losses are to
the difinative care centers.  In this area the largest number of severe
trauma patients come from auto accidents.   Here in Kansas it is required by
law to maintain a minimum level of auto insurance on all vehicles.  Due to
tight regulations, strict enforcement and harsh penalties for failure to
comply, it is rare to have an instance where the involved parties do not
have auto insurance (which pays medical exspenses to a predetermined maximum
ammount).  As you may know, auto insurance companies pay claims on a "first
come, first serve" basis, until the maximum payout is reached.  Therefore,
the scenerio plays out like this.  The small hospital gets the patient for a
couple of hours, they do a complete work up (which will just be repeated at
the trauma center) and then they send them on to an appropriate facility for
definitive care.  Within a couple of days the small hospital's billing
department makes a claim to the auto insurance and it is paid.  Meanwhile,
the large trauma center who still has this patient in their ICU, is
continuing to run up a bill, but can't file a claim until the patients care
is complete.  By the time the Trauma Center and rehab centers get around to
filing their claims, the small hospital has been paid and the definitive
care facilities are stuck with what little is left before the "maximum"
payout is reached for this patient.  The situation may be differant in your
area, but here money is a Big factor.

Wesley Copeland Sr., MICT, NREMT-P, CCEMT-P

-----Original Message-----
From: Robert Cole <EMCOLERS@adaweb.net>
To: 'flightmed@flightweb.com' <flightmed@flightweb.com>
Date: Wednesday, January 02, 2002 4:52 PM
Subject: RE: Pt. Scenario


>good discussion all, I would mention one thing in regards to "cost" to the
>small hospitals .  Trauma is by far one of the most money losing patient
>populations when compared to other agencies.  When you look at the
resources
>required for a trauma patient, the cost of personnel, OT, time away from
>other patients, etc...now look at the typical trauma patient is the
>uninsured
>and a major health care expense will cause them to declare bankruptcy...is
>make the expenses near unrecoverable.  I would think that if cost were the
>issue, small hospitals would love to send them on.  The reality (IMHO) is
>that Ego's play a far larger role.  What doc (or other health care
>professional) likes to admit they are over their head? I know that as a
>medic I have trouble admitting it.  It goes contrary to what I am.  Docs
are
>no different, often worse.  Its been that way since the early days of shock
>trauma.
>
>Robert S. "Steve" Cole
>Paramedic, CCEMTP
>Education Department
>Ada County Paramedics
>208-375-7079
>emcolers@adaweb.net
>
>"...A mind stretched with new ideas never regains its former shape"
>
>
>-----Original Message-----
>From: James.J.Misuraca@Hitchcock.ORG
>[mailto:James.J.Misuraca@Hitchcock.ORG]
>Sent: Wednesday, January 02, 2002 12:00 PM
>To: flightmed@flightweb.com
>Subject: RE: Pt. Scenario
>
>
>OK lets take this one out of the realm of the flight crew. Lets pretend we
>are
>Dr.Joe Elemdee at the Center Barnboard Health Center. The local ambulance
>has
>had several of these calls this year. To his estimation, none of them have
>been
>as severe as they sound when they are dispatched or when they patch in with
>scene info.
>"Do I take a chance and bring them here first or do I send them 30 miles
>away
>to Trauma Center without ever seeing them?"
>As one responent recalled her observation of the Kansas region we struggle
>with
>these issues in the Vermont/ New Hampshire region. Politics, goverment,
>weather, etc....
>have conspired to limit our scene response and cause us to struggle with
>this
>senario on nearly a daily basis.
>How can we make this sort of descion making less painful/ costly for the
>small
>providers? At what level of education or goverment protocol do we draw the
>line
>on excessive evaluation by centers that are not equiped to provide care?
How
>do
>we do this and appear to be the "adjuncts to improved patient care" that we
>know we are versus "the money hungry trauma scavangers in thier expensive
>toy"
>Excuse me, devils advocate
>
>_______________________________________________
>Flightmed mailing list
>
>


_______________________________________________
Flightmed mailing list