Comments on VelociDoc Urgent Care Blog: American College of Emergency Physicians Attacks U...

i came across this post and the guest editorial at...

2011-06-07T13:00:43.066-05:00

i came across this post and the guest editorial at urgent care news after reading about the 8% non-urgent number. it instantly made me start a post of my own since everyone knows 8% is bogus. anyway, still in editing, take a look if you like:

http://burnedoutmedic.com/2011/06/cdc-and-acep-say-only-8-of-ed-patients-are-non-urgent

Clearly, none of the physicians or editors who pro...

2011-04-27T17:30:57.999-05:00

Clearly, none of the physicians or editors who provided the public platform for this savvy PR placement have had to endure the commonly long waits in overly crowded ERs which provide no reassurance to the patient who is in excruciating pain due to an active UTI or can't hear because of a case of otitis. In either case, the patient can head straight to the Urgent Care, see a doctor quickly without feeling like neglected cattle, get his or her dx and Rx and head straight home or back to work, unlike a typical ER visit, which requires its own recovery phase. Oh, and of course, the insurance office copay in the Urgent Care is usually a much more welcome obligation that the inflated ER copay that is usually 3x as expensive. As an experienced marketing and public relations professional with expertise in the healthcare field, let's take note that the article is indeed a savvy PR placement, likely driven by ACEP's PR vendor, who didn't know that mentioning the Urgent Care phrase would have satisfied at least a small bit of the credibility requirements of the position being taken.

Fantastic to see such a vigorous response from ACE...

2011-04-26T12:37:45.322-05:00

Fantastic to see such a vigorous response from ACEP! I encourage readers to simply read the TIME Magazine editorial. Yes, there is no direct attack on urgent care. Instead, the public is encouraged to use the ER for minor problems (specifically a young woman with a urinary tract infection). ACEP is well aware that these are the very kinds of cases that overload hospital ERs and have created a national crisis with average ER waits of 4 hours.

Ignoring urgent care in this conversation is an "attack" by omission, much the same as having a polite discussion in your living room but ignoring the elephant sitting in the corner sipping tea.

For example, ACEP states “Considering that two-thirds of all emergency visits occur after normal business hours, most of these patients have no place to turn for care other than the ER." What nonsense! Again, ACEP completely ignores the elephant in the room. Most urgent cares are open 30-50 hours beyond "normal business hours," and these hours cover the vast majority of hours for unnecessary ED visits. ACEP is doing a disservice to emergency physicians and the American public by informing the public that their only viable option after-hours is the hospital ED.

Below is the press release that Dr. Stern has cons...

2011-04-20T15:37:47.116-05:00

Below is the press release that Dr. Stern has construed as an attack on urgent care. Read it and decide for yourself.

ACEP Slams 'Blame the Patient' Trend

Data From Massachusetts and South Carolina on Emergency Patients Do Not Add Up

Washington, DC — Aiming to stop a trend in which emergency patients are blamed for the nation’s high health care costs, Dr. Sandra Schneider, president of the American College of Emergency Physicians (ACEP), today issued the following statement:

“We are disturbed by reports coming from Massachusetts and South Carolina that suggest emergency patients are responsible for the high cost of health care. Emergency care amounts to only 3 percent of all the health care spending each year in the United States. Focusing on emergency care as a source of waste in the health care system is counterproductive, as are efforts to keep a small subset of emergency patients out of the ER.

“Most distressing is the rhetoric in South Carolina directed at Medicaid patients, who have been characterized as ‘abusers’ of the health care system. Medicaid patients are usually the most vulnerable members of society because of poverty, illness or both. These are patients who need the most help, not the least. A legislative effort in South Carolina to keep these patients out of the emergency department is built on incorrect and discredited data, as well as quotes by ACEP member Dr. William Gerard that were taken out of context and used without his permission. There is also no indication that it would actually save the state money, though it would accomplish the goal of discouraging sick people from seeking medical care they desperately need. It’s very bad medicine.

“Studies show that most emergency patients classified as frequent users – who make up only 8 percent of all emergency patients – have complex physical and mental health problems and a usual source of medical care outside the ER. The Robert Wood Johnson Foundation reported in 2009 that these patients use the emergency department as ‘a supplement rather than a substitute’ for other medical care.

“Another target, non-urgent emergency patients, actually comprise less than 8 percent of the nearly 124 million emergency patients who seek care every year, according to the Centers for Disease Control and Prevention. But the CDC points out that non-urgent does not mean unnecessary, as these patients require medical treatment in 2 to 24 hours. ACEP worked for 17 years for passage of a prudent layperson standard to require health insurance plans to base coverage of emergency care on a patient’s symptoms, not the final diagnosis. Last year’s health care reform legislation applies this standard to virtually all health plans. Patients should not be diagnosing themselves.

“Considering that two-thirds of all emergency visits occur after normal business hours, most of these patients have no place to turn for care other than the ER. The Robert Wood Johnson Foundation cast doubt on the idea that diverting non-urgent patients from the emergency department ‘to other settings would produce significant cost savings.’"

In addition, Dr. Schneider said the “Report on Frequent Users of Hospital Emergency Departments in South Carolina” is inaccurate when it says the proportion of non-urgent visits has increased nationwide. The percentage of nonurgent patients actually has declined for 3 years to less than 8 percent in 2007, according to the CDC.

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

This blog post is a deliberate misreading of both ...

2011-04-20T15:35:43.744-05:00

This blog post is a deliberate misreading of both the TIME article and ACEP's position. ACEP never attacked urgent care centers or said anything about them in fact. Further, as this blog post's author even acknowledges, the TIME article does not talk about urgent care centers. How then can it be construed as an attack? The press release that triggered the TIME article can be found here. We say nothing about urgent care centers.

http://www.acep.org/Content.aspx?id=77433

One significant difference between urgent care centers and emergency departments must be mentioned: emergency departments are federally mandated to take everyone who walks through the door, regardless of their ability to pay. As much as 50% of all care delivered in emergency departments is uncompensated, which is part of the reason individual bills are high. The same cannot be said of urgent care centers.

The American College of Emergency Physicians

After eight years of consulting to clients seeking...

2011-04-14T15:34:30.687-05:00

After eight years of consulting to clients seeking to open new urgent care centers- many of which are former emergency room physicians, Drs. Pines and Meisle's comments seem to be "out of touch" with the general feelings of many of these practitioners who are in the "trenches" daily. Without fail, nearly everyone of these doctors have expressed to me the overwhelming need for a resource- other than the local E.D. for patients with non-emergent complaints, generally considered inappropriate for care within the E.D. setting. They are tired of the misuse and abuse of the system, tired of long waits, tired of poor quality and lack of resources being spent "urgent" instead of "emergent" cases. In fact, that's why they are exploring the feasibility of opening their own urgent care center. It's not that they aspire to become the next Donald Trump, it is generally that they are seeking to provide quality medical care in an appropriate enviroment to patients who want and need the services but might not have other access. And sure, they want to make some money too. But if it was all about the money- they'd likely remain working in the E.D. Urgent Care is and will continue to be a viable solution to the healthcare mess this country continues to face. Dr. Stern and others in the UC industry like him, have the vision and determination it will take to help stop misguided rhetoric such as this TIME article.

I think Drs Meisel and Pines are smoking and inhal...

2011-04-14T11:45:10.930-05:00

I think Drs Meisel and Pines are smoking and inhaling something bad.

Aren't charges one of the major complaints fro...

2011-04-14T09:49:34.985-05:00

Aren't charges one of the major complaints from patients going to the ER for non-emergency conditions? I have been an urgent care supervisor in Las Vegas for about 7 years now. We are located across the street from a very busy ER where the wait time almost always exceeds 6 hours. (I've even heard of times when it was 16 hours.) It's funny that this article was published when this particular hospital's ER triage staff will direct patients to our facility instead of having them wait those extensive times. One of our physicians wrote a paper back in the 1970s on the concept of urgent care facilities. His model was almost dead-on with the current structure. Urgent care is the perfect place for those patients who are in the "acute" phase of a non-life threatening condition. ERs are the perfect locations for MIs, CVAs, multi-trauma scenarios, etc., but let's not forget about the "basics" that we all learned when we first started in health care. Why is it that a patient came to our urgent care after being discharged from the ER for a complaint of chest pain & SOB? Why did this particular patient have a VQ scan performed but no chest x-ray? How is it possible that the higher leveled facility (the one ACEP is pushing for) missed a huge pneumonia but the urgent care caught it? It's called the "basics." Let's focus more on good "quality" and less on good "quantity." That's what saves lives and brings people back.

I am a board certified emergency medicine physicia...

2011-04-14T08:20:03.948-05:00

I am a board certified emergency medicine physician in a democratic practice and our group also has two urgent care centers. One of the centers we built directly across from our hospital ED which has proven to be a great asset to the patients and our practice. It has helped decompress our ED tremendously. In addition, it drastically reduced cost to the insurance payors and self pay. I can give many examples of this but here is a recent; a 38 year old carpenter (self pay) dislocated his shoulder playing on a trampoline with his son. He arrived, was given an IV with pain medication, xray, had his shoulder reduced/immobilized, given a filled prescription for pain medication, sent home within 45 minutes and charged $265. He informed us that with his last dislocation he went to an ED and had his shoulder reduced but spent approximately 4 hours in the ED and received bills from the hospital, radiology group and ED group totaling close to $3,000.

As a 27 year Emergency Physician, I applaud Dr. St...

2011-04-14T01:02:43.618-05:00

As a 27 year Emergency Physician, I applaud Dr. Stern's cogent comments. I in fact used to try to get the nurses to bring back patients who were less emergent and they wouldn't do it. The systems are too rigid, and the chancefor a flood of new critical patients always held them back. Now I operate an Urgent care in the same town(and continue to practice EM in a neighboring community). It has been so rewarding.

A perfect example of why I discontinued membership...

2011-04-14T00:13:04.804-05:00

A perfect example of why I discontinued membership in ACEP. I refuse to belong to any organization that demeans my existence.

Fortunately, the reason the ACEP is taking on this...

2011-04-13T22:58:29.290-05:00

Fortunately, the reason the ACEP is taking on this issue now is that they are about to lose out big time to the far more efficient, appropriate and cost effective care offered by the nations urgent care providers. The ACEP must be running scared. Every day hundreds of thousands of patients vote with their feet and their pocket books. Insurance companies have been slow to follow because of little incentive to control costs. Can you imagine how much our health care system would save if the 80% or so of emergency room patients who could be treated as well or better in Urgent care centers actually were encouraged to use them?

Certainly, the underlying rationale for an article...

2011-04-13T22:26:30.434-05:00

Certainly, the underlying rationale for an article like Drs. Pines and Meisle's should be questioned. More so, the Time & CNN rationale for publishing it with no apparent regard for accuracy or logic. This is a classic example of the "brokeness" of the health care system. But, as most logical people will realize, isn't the expectation of achieving improved results (i.e. lowering the cost of quality care) while employing the same old methodology, the definition of insanity? Time and CNN may have an established excuse: long established "insanity" in the mainstream media. The doctors can't claim that line of defense.
Maybe the docs, Time and CNN were just checking to see if we are paying attention!

Why would you expect otherwise? It's always a...

2011-04-13T19:44:29.479-05:00

Why would you expect otherwise? It's always about the money. Why should the uninsured or insured with high deductibles go to the ER when they can get the SAME service at an urgent care for a TENTH of the price? Because the hospitals and ER physician's groups like to gouge the hapless public. I have owned and operated an urgent care for over twenty years. 98% of people coming to me do not need an ER. It's hypocritical to have the ER docs grumble about nuisance ER patients, yet the ACEP says otherwise.

I am an urgent care MD, and the ED doctors in the ...

2011-04-13T18:42:19.832-05:00

I am an urgent care MD, and the ED doctors in the town I work in are actually even annoyed if I refer a patient to them with a tonsillar abscess or someone presenting with ACS, when they should be jumping for joy per this TIME editorial. I could just imagine my town's ED doctors rolling their eyes up if a patient goes to the ER with just a Lyme rash alone; or a minor abrasion that just need an updating of their Td vaccine; or a small laceration needing just a glue and not stitches. I can hear them saying to these patients under their breath that they should have gone to the urgent care center down the road and not have waited 4-6 hours.

An urgent care center's best friend is any hos...

2011-04-13T17:43:07.112-05:00

An urgent care center's best friend is any hospital emergency department. This is because the average citizen with only minor medical problems has been so mistreated by ER's for so long that they've grown to hate them (ERs). Hospital emergency departments got away with treating people with minor problems as secondary citizens while scolding them for wasting an ER doctors time up until just lately when an alternative arrived, the urgent care center. The Urgent care center has dedicated itself to treating the minor problems. Now, suddenly the hospital ER's are losing those average citizens with minor problems and the hospitals and the ACEP are crying "foul-play." And, the reason the hospitals are actually missing these patients with minor medical problems is that the lion's share of these patients were well-insured. While it's true that hospital ERs have been unfairly burdened with caring for the uninsured, NO PAY patients, the answer isn't to make the average citizen pay for it and the answer certainly isn't to remove the most innovative, responsive form of medical care to ever be used by people: being seen on their schedule when they want, for a price usually one quarter that of hospitals. The public has tasted this unmatched convenience and won't go back so hospitals and the ACEP should get more creative; instead of disparaging urgent care centers, they should embrace them and understand they aren't going to go away.

Absolutely unbelievable that the American College ...

2011-04-13T16:57:18.532-05:00

Absolutely unbelievable that the American College of Emergency Physicians are attacking the quality and a cost effective means of delivering care to patients in the Urgent Care setting. I certainly hope that others see the nonsense in this allegation. Dr. Stern's rebuttal is right on the money.
Deanna Dickey, RN
Marble Falls TX