Re: Pt. Scenario

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

Paul,

I couldn't agree more!!!

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

-----Original Message-----
From: Paul M. Wright, Jr. <pmwright@home.com>
To: flightmed@flightweb.com <flightmed@flightweb.com>
Date: Friday, January 04, 2002 11:42 AM
Subject: RE: Pt. Scenario


>> 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.
>> >
>
>I'm glad you brought this point up and I had a couple of additional
thoughts
>to offer.  First is that the air medical company is often able to get their
>claim in ahead of even the small hospital.  Minimum liability automobile
>coverage in Arizona is about $15k and with air ambulance rates being what
>they are, up to 2/3 of that amount can be paid out just to settle the
>transport claim.  That being the case, the small hospital and the air
>medical company are competing for the same small pot of money and I think
>one would have to be naive to think that decisions are not influenced by
>that competition.
>
>Second, I think we forget that the demographics of trauma patients differ
>with the setting.  In the rural areas, most trauma results from auto
>accidents or industrial injury and patients in both categories almost
always
>have resources from which to recover medical costs.  In the urban areas,
>particularly the inner cities, most trauma is crime-related and the
patients
>tend to have less resources available to cover medical costs.
>
>Additionally, one other trend in hospital finance with regards to trauma
>patients covered by HMO plans is to provide the care and accept payment
from
>the HMO at contract rates but then also file a lien against any money
>received by the patient in connection with that accident to recover the
>difference between the HMO contract rate and the hospital's full rates.
>This can make a big difference as HMO contract rates are often half, or
>less, of the hospital's "list" price.  This practice is being challenged as
>"double-billing" but as far as I know it is still going on.
>
>Like it or not, decisions about transport destinations often *are* about
>money so I think it is useful to avoid unproven axioms such as "trauma
>patients always lose money for the hospital" and concentrate instead on
>understanding the financial side of healthcare and using that knowledge to
>influence decision-making in a way that benefits our patients.  Simply
>raging against the machine or pretending money doesn't matter isn't going
to
>get us where we want to be.
>
>regards!
>
>paul
>
>
>Paul M. Wright, Jr.
>Mesa, AZ
>
>
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