Of course the problem extends beyond the ER doesn’t it. Every part of the system seems to be still under pressure. Notice I said seems to be. 9 months for a neurology appointment. If you need to see an electrophysiologist in the Dartmouth system it is months to see a PA no MD appointment before defibrillator placement. Ha I may need to come out of retirement.
I've been to the ER once each year since 2021 🫠 and each time it has been different. August 2021, the waiting room had spilled out into a temporary area in the main hospital lobby and I waited 6 hours before being boarded in ED overflow (not the ideal place to be told a bad diagnosis). October 2022, virtually no wait and back to regular waiting area, and again boarded in ED overflow (and again not the ideal place to learn the results of a surveillance scan). December 2023, waited 4 hours and boarded overnight in an ED hallway.
Tough call if hallway boarding was worse than when I was in the hottest part of ED overflow right next to the HVAC duct, while I was in with a fever...
Of course the doctors were all great each time--but the ED experience has definitely made me unwilling to go back unless my oncologist tells me I have to.
Fantastic data! I am now curious how the urgent care data looks post-pandemic. Coming from public health and school nursing, I can honestly say the children coming into our health offices post-pandemic are much sicker. They can come in not feeling well and we will test them with a rapid antigen covid-19 test and it always comes back positive! Yes, today’s health offices are pretty busy. Like a mini ER. :) And that is because today’s kids are just sicker with more medical issues. However, the pandemic, covid-19 has not helped the situation. It definitely increased the numbers coming thru the health office. As expected.
I run a very tight ship in my health offices. Meaning, all triage goes thru me because I don’t want any student being sent back to class if they are sick. If the school is sending a kid to the urgent care or ER, it’s always due to my recommendation and I always follow up with the families to see how it all went.
Sometimes we do need to call 911. But those times are not too often. Thank goodness! Not all districts and or schools run that way and not all school nurses are as diligent as I am. I can cover up to 4 elementary schools’ at one time. My phone and texts never stop ringing / going off because I can’t be everywhere at once. The big 3, covid-19, RSV and the flu has been beyond huge.
Could it be that our population is growing older on average as well, which likely leads to more health issues? That might be interesting to take a look at as well.
This may be a simultaneously dumb *and* crass question, but is this trend better or worse for the economics of the ED’s? Does the higher acuity result in higher reimbursements or is that outweighed by the number of uninsured patients with higher acuity? I’m sure this varies from hospital to hospital, but I wondered if there was a general trend.
Interesting question. It probably depends on the place. We certainly chart in ways that increase the reimbursement when the care is more complex. But I think there's also a juice vs squeeze issue. When volumes are high, we tend to cut corners on charting in ways that would increase revenue. So the hospital makes more money on complicated care, but it might be that they make less than they "want" because when we are so busy, we don't chart quite as assiduously as we might when volumes are low. Another caveat is that it really depends on the business model for the doctors. Where I work, a tiny percent of my annual incentive compensation (bonus) is how much I bill per patient. The percent bonus I get from that is so small, and the difference between whether I am below average, average, or above average on it makes it meaningless for us. But I'm in an academic setting. Some doctors' entire financial picture could hinge on that stuff.
Of course the problem extends beyond the ER doesn’t it. Every part of the system seems to be still under pressure. Notice I said seems to be. 9 months for a neurology appointment. If you need to see an electrophysiologist in the Dartmouth system it is months to see a PA no MD appointment before defibrillator placement. Ha I may need to come out of retirement.
Great review of the issue….thanks
Yes the fact that wait times for outpatient appointments has gotten out of control is definitely a part of this. Come on back!
I've been to the ER once each year since 2021 🫠 and each time it has been different. August 2021, the waiting room had spilled out into a temporary area in the main hospital lobby and I waited 6 hours before being boarded in ED overflow (not the ideal place to be told a bad diagnosis). October 2022, virtually no wait and back to regular waiting area, and again boarded in ED overflow (and again not the ideal place to learn the results of a surveillance scan). December 2023, waited 4 hours and boarded overnight in an ED hallway.
The variance and uncertainty can be so frustrating. And sometimes things LOOK quiet but are busy---or the opposite.
Hallway boarding is just the worst!!!!
Tough call if hallway boarding was worse than when I was in the hottest part of ED overflow right next to the HVAC duct, while I was in with a fever...
Of course the doctors were all great each time--but the ED experience has definitely made me unwilling to go back unless my oncologist tells me I have to.
Fantastic data! I am now curious how the urgent care data looks post-pandemic. Coming from public health and school nursing, I can honestly say the children coming into our health offices post-pandemic are much sicker. They can come in not feeling well and we will test them with a rapid antigen covid-19 test and it always comes back positive! Yes, today’s health offices are pretty busy. Like a mini ER. :) And that is because today’s kids are just sicker with more medical issues. However, the pandemic, covid-19 has not helped the situation. It definitely increased the numbers coming thru the health office. As expected.
I run a very tight ship in my health offices. Meaning, all triage goes thru me because I don’t want any student being sent back to class if they are sick. If the school is sending a kid to the urgent care or ER, it’s always due to my recommendation and I always follow up with the families to see how it all went.
Sometimes we do need to call 911. But those times are not too often. Thank goodness! Not all districts and or schools run that way and not all school nurses are as diligent as I am. I can cover up to 4 elementary schools’ at one time. My phone and texts never stop ringing / going off because I can’t be everywhere at once. The big 3, covid-19, RSV and the flu has been beyond huge.
Just wanted to note that when I say I can cover up to 4 elementary schools at one time, that means I have been assigned 4 elementary schools to cover.
Could it be that our population is growing older on average as well, which likely leads to more health issues? That might be interesting to take a look at as well.
This may be a simultaneously dumb *and* crass question, but is this trend better or worse for the economics of the ED’s? Does the higher acuity result in higher reimbursements or is that outweighed by the number of uninsured patients with higher acuity? I’m sure this varies from hospital to hospital, but I wondered if there was a general trend.
Interesting question. It probably depends on the place. We certainly chart in ways that increase the reimbursement when the care is more complex. But I think there's also a juice vs squeeze issue. When volumes are high, we tend to cut corners on charting in ways that would increase revenue. So the hospital makes more money on complicated care, but it might be that they make less than they "want" because when we are so busy, we don't chart quite as assiduously as we might when volumes are low. Another caveat is that it really depends on the business model for the doctors. Where I work, a tiny percent of my annual incentive compensation (bonus) is how much I bill per patient. The percent bonus I get from that is so small, and the difference between whether I am below average, average, or above average on it makes it meaningless for us. But I'm in an academic setting. Some doctors' entire financial picture could hinge on that stuff.
I'm surprised they don't give all the attendings "Jonathans" - it would seem like they could more than pay for themselves if they had coding training.