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Posted: 4/17/2024 11:13:10 AM EDT
[#1]
Quote HistoryOriginally Posted By N1150x: This is bad. Expect all Healthcare to be government run soon... And then it will get even worse. |
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Posted: 4/17/2024 11:19:35 AM EDT
[#2]
Quote HistoryOriginally Posted By SARS: Kemmerer mentioned in the story is at least 2 hours by ground from a significant hospital. And that is in decent weather. While you're onto something with the small hospitals closer to major hospitals, there are large chunks of the country that depend on rural hospitals to provide much of the care, or at least stabilize the patients while transport is arranged (and weather windows open). Flying everyone around (even if there were magical birds that aren't on hold much of the time like around here) would be extraordinarily expensive vs. taking them to the local ER where labs, imaging, etc. can often rule out the conditions for which patients would need to go to a major hospital. For example, an initial stroke workup, or chest pain workup, often can lead to discharge of the patient following appropriate diagnostics. It is more common for patients to be transferred straight from the emergency department of the rural hospitals than for patients to get admitted and then transferred, though it does happen, especially when initially no hospital agrees to receive the patient or transport is unavailable. Rural hospitals are a critical lifeline for much of the country. Could reforms be made to be more cost effective and promote better care? Sure, but outright elimination of them is a horrible idea. I agree. I'll point out that those aviation assets are going to get more scarce as we delve into DEI being the driver of who goes to flight school. |
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Posted: 4/17/2024 11:27:55 AM EDT
[#3]
Quote HistoryOriginally Posted By killstick_engaged: You need staff to bill for services. They don't have staff. Couple things mentioned already CEO and admin probably make tons of cash still Providers who provide actual services (physicians, PAs, and since it's Wyoming, nurse practitioners) are not incentivize to work there because the pay for them is shit. Even though they and the taxpayer are the primary ones whose work keeps the lights on. Donald Trump and his cabinet figured this out and tried to get NPs and PAs better reimbursement. It's always the same song and dance with these 'failing' places. They want money but don't want to incentivize people to work there because it involves paying money to make money. Note how the article touts medicaid expansion at the end , once more putting the burden on the taxpayer while not actually solving any problems. Pay actual providers more and they will come. God forbid admin take a pay cut tho Quote HistoryOriginally Posted By killstick_engaged: Originally Posted By bayouhazard: Can't make enough money if there are too many healthy people or not enough sick people? You need staff to bill for services. They don't have staff. Couple things mentioned already CEO and admin probably make tons of cash still Providers who provide actual services (physicians, PAs, and since it's Wyoming, nurse practitioners) are not incentivize to work there because the pay for them is shit. Even though they and the taxpayer are the primary ones whose work keeps the lights on. Donald Trump and his cabinet figured this out and tried to get NPs and PAs better reimbursement. It's always the same song and dance with these 'failing' places. They want money but don't want to incentivize people to work there because it involves paying money to make money. Note how the article touts medicaid expansion at the end , once more putting the burden on the taxpayer while not actually solving any problems. Pay actual providers more and they will come. God forbid admin take a pay cut tho @killstick_engaged +1 It doesn’t matter how rural you are, hospitals always have no problem finding more administrators. It’s amazing how many layers of administrators they have, one supervising the other, and wonder why they don’t have money to hire doctors and nurses who actually bring in the money. |
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Posted: 4/17/2024 11:35:09 AM EDT
[#4]
It’s going to get worse. Before it gets worse.
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AZ, USA
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Posted: 4/17/2024 11:47:22 AM EDT
[#5]
Quote HistoryOriginally Posted By exponentialpi: It’s going to get worse. Before it gets worse. 
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Posted: 4/17/2024 11:48:33 AM EDT
[#6]
Quote HistoryOriginally Posted By exponentialpi: It’s going to get worse. Before it gets worse. then to only get really worse, a temporary respite before we are back on track on our way to way more worse... |
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MN, USA
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Posted: 4/17/2024 12:52:13 PM EDT
[#7]
It will get worse and worse as we take in more illegals and others that shouldn't be here.
If we keep supporting the trash sucking off of what's left of our economy, all businesses will eventually fail. |
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Posted: 4/17/2024 1:00:39 PM EDT
[#8]
Quote HistoryOriginally Posted By C-4: @killstick_engaged +1 It doesn't matter how rural you are, hospitals always have no problem finding more administrators. It's amazing how many layers of administrators they have, one supervising the other, and wonder why they don't have money to hire doctors and nurses who actually bring in the money. Quote HistoryOriginally Posted By C-4: Originally Posted By killstick_engaged: Originally Posted By bayouhazard: Can't make enough money if there are too many healthy people or not enough sick people? You need staff to bill for services. They don't have staff. Couple things mentioned already CEO and admin probably make tons of cash still Providers who provide actual services (physicians, PAs, and since it's Wyoming, nurse practitioners) are not incentivize to work there because the pay for them is shit. Even though they and the taxpayer are the primary ones whose work keeps the lights on. Donald Trump and his cabinet figured this out and tried to get NPs and PAs better reimbursement. It's always the same song and dance with these 'failing' places. They want money but don't want to incentivize people to work there because it involves paying money to make money. Note how the article touts medicaid expansion at the end , once more putting the burden on the taxpayer while not actually solving any problems. Pay actual providers more and they will come. God forbid admin take a pay cut tho @killstick_engaged +1 It doesn't matter how rural you are, hospitals always have no problem finding more administrators. It's amazing how many layers of administrators they have, one supervising the other, and wonder why they don't have money to hire doctors and nurses who actually bring in the money. |
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Posted: 4/17/2024 1:01:52 PM EDT
[#9]
Originally Posted By wienerman1961: Stop draining the system by letting morons go to ER for a yellow booger. ER is for EMERGENCY, not lazy ass farks. Originally Posted By Missilegeek: Of all the corrupt and incompetent bullshit happening in clown world... Nothing is more broken, needs and deserves a collapse and reset more than the health industry. I hope I live to see a day when hospital admins, doctors and medical billers are begging for my spare change in the street. I will tell them to mask up, get vaccinated and we are all in this together. Then roll up my window and drive off. Fuck that entire corrupt and useless industry. Originally Posted By Ryan_Scott: PAs and NPs are great for hospital systems because they refer and test at 4-5x the rate of physicians, which drives sales. If you actually want to go to the clinic and get the issue settled with finality, get a doc. Oh, you did a 400 hour capstone project? That's nice. I did 10-12,000 hours in residency. After 4 years of med school. And that's the shortest residency. Yeah, they order and refer a lot of things that a primary care doc can handle just fine. |
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Posted: 4/17/2024 1:02:46 PM EDT
[#10]
Quote HistoryOriginally Posted By HIMARS13A: Let me get this straight, you think when a woman has a baby she should be flown to a hospital somewhere else in the state? If there is a cloud in the sky Life Flight won't fly. These organizations are pathetic. |
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Posted: 4/17/2024 1:03:08 PM EDT
[#11]
Quote HistoryOriginally Posted By rob78: We're looking at a long-term lease for ours. A single hospital has no leverage during negotiations with insurance providers. The large providers have a huge pool of patients. Yes, I think the push is to drive expanded medicaid adoption, but I believe thst ship has sailed in TN. Our OB clinic is closed. A regular birth is reimbursed at ~$400 by TennCare/BcBs. A NICU birth is reimbursed at ~$1,300 by same. Private insurance reimbursements are fine, but any subsidized insurance is pretty poor. So we're entertaining offers for a long-term lease from a large Healthcare provider. Competition for market share is pretty fierce, the "big guys" can get fair reimbursement, and we've had significant interest. Our hospital is county owned. It's never been managed well in 60 years. The "good ol boys" had negotiated family members jobs and high pay. Watching them squirm has been fun. HCMC- I am familiar with the whole process. The employees from what I hear, want WTH to lease and not be unemployed. |
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USA
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Posted: 4/17/2024 1:03:15 PM EDT
[#12]
New designation of "rural emergency hospital" is coming to a small town near you.
Lots of federal subsidies, cut staff to the bare minimum, can't have patients admitted (running average, so exceptions can be made, as long as the average stay is < the set time by the designation). I read an article several years ago that noted that once a rural hospital loses OB, the remaining life of that hospital is well under a decade. Our local hospital here has been hanging on by a thread for years. It recently sold, was redesignated as a "rural emergency hospital" and time will tell on whether it is sustainable with that model. One thing people are missing, most companies will not operate a plant of any kind without some sort of local ER. The new designation that's keeping the doors open here is the only thing keeping what little bit of industry we have left here. https://www.beckershospitalreview.com/hospital-transactions-and-valuation/arkansas-hospital-sold-renamed.html |
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Posted: 4/17/2024 1:08:12 PM EDT
[#13]
I thought that one of the reasons people to choose to live rural is to live away from people. Commensurate with that decision, you’re going to have less services available to you.
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Posted: 4/17/2024 1:08:16 PM EDT
[#14]
Quote HistoryOriginally Posted By flightmed: Tell me you know nothing about prehospital care and air ambulances without telling me… Quote HistoryOriginally Posted By flightmed: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Tell me you know nothing about prehospital care and air ambulances without telling me… "I dont know anything about pre-hospital care" There feel better? 
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Posted: 4/17/2024 1:09:43 PM EDT
[#15]
Quote HistoryOriginally Posted By skid2041: My example is missed. Nevermind. Yes, it would be great if your rural hospital has surgical sal uites for appy's and lap chole's et al. My local rural hospital does not. And the the next closest has them but still transfers out most. I apologize, I understand there is a need. But they aren't going to get the funds or the staff. It's not profitable for anyone. Critical Access hospital reimbursement is higher than urban... My rural hospital has a full time OR, all the specialties and we are a level 2 trauma provider, We do many CABGs a month. I believe we have about 320 in patient beds right now. GD posters paint with a broad brush and they don't even realize there's no paint on it.  |
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AZ, USA
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Posted: 4/17/2024 1:09:55 PM EDT
[#16]
Quote HistoryOriginally Posted By wm69: One thing people are missing, most companies will not operate a plant of any kind without some sort of local ER. The new designation that's keeping the doors open here is the only thing keeping what little bit of industry we have left here. That occurred to me but I wasn't sure if it was true. |
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Posted: 4/17/2024 1:11:42 PM EDT
[#17]
Quote HistoryOriginally Posted By OKnativeson: i work in fetal maternal medicine as a part of my profession. trust me, you don't want that. when things go south, it goes south very, very quickly for the mother and or baby. Quote HistoryOriginally Posted By OKnativeson: Originally Posted By ChuckD05: I mean, she could have it in a bathtub, or bring back midwives? Like we didn't have children before hospitals. i work in fetal maternal medicine as a part of my profession. trust me, you don't want that. when things go south, it goes south very, very quickly for the mother and or baby. Everyone wants to have this idyllic childbirth, with scented candles and soft music in the background, with a caring midwife (not a callous doctor) and probably a doula to do visualization techniques and deliver a perfect child at home. And that's a lovely goal. But people (like ChuckD05) forget that childbirth has been a huge cause of maternal and infant mortality since the day Adam and Eve got kicked out of the garden. Women and babies died. A lot. And there are few things in medicine that can go from normal and controlled to absolute dogshit faster than childbirth. She's in labor and doing fine and her water breaks. And instead of the baby's head engaging, a loop of umbilical cord drops out. Guess what? That midwife and doula aren't gonna be helpful here. They're gonna be on the phone, screaming for an ambulance and hoping there's a doctor at the hospital with a knife in his pocket and qualified to do a crash C/section. Or the baby dies. Like how we had children before hospitals. You want to have a bathtub birth. Be my guest. But when shit happens, who you gonna call? |
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Posted: 4/17/2024 1:11:58 PM EDT
[#18]
Quote HistoryOriginally Posted By dirtyboy: $100,000 helicopter flights are the answer? Quote HistoryOriginally Posted By dirtyboy: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. $100,000 helicopter flights are the answer? @dirtyboy. They are $30,000 actually. And you can get subscriptions to them. Everyone should. I pay $60 a year for one of the local services, & $50 a year for the other. Covers my own family. They save my Lat/longs for landing. They cover transfers and one of them is a world-wide conglomerate so I can use them throughout the US and some European countries. Some of my neighbors have had to use them. If it doesn't need a copter, you can wait for an ambulance or drive yourself. |
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Posted: 4/17/2024 1:13:12 PM EDT
[#19]
Quote HistoryOriginally Posted By skid2041: Same. We paid about $4-$5 k per kid. But again, plenty of uninsured have home births. What is "plenty"? Approximately 0.9% per year occur in the home in the United States. |
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Posted: 4/17/2024 1:14:32 PM EDT
[#20]
Quote HistoryOriginally Posted By Ryan_Scott: PAs and NPs are great for hospital systems because they refer and test at 4-5x the rate of physicians, which drives sales. If you actually want to go to the clinic and get the issue settled with finality, get a doc. Absolutely not true..... |
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Posted: 4/17/2024 1:14:32 PM EDT
[#21]
Quote HistoryOriginally Posted By JackelopeMed: Seriously. He's so full of shit it's not funny. Air medical will not fly if there is any chance of hazardous flight conditions. Most rural areas don't have high levels of ALS/paramedic providers. Transporting a chest pain multiple hours by ground to a tertiary is so far beyond stupid I have to think he's trolling. Quote HistoryOriginally Posted By JackelopeMed: Originally Posted By AKoch31: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. You have no idea what you're talking about. Seriously. He's so full of shit it's not funny. Air medical will not fly if there is any chance of hazardous flight conditions. Most rural areas don't have high levels of ALS/paramedic providers. Transporting a chest pain multiple hours by ground to a tertiary is so far beyond stupid I have to think he's trolling. Lol, what's a tertiary going to do? Start heparin? TpA? That can be done on an ambulance. Making a stop when you can save an hour or 2 "stabilizing" before Cath is stupid. |
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Posted: 4/17/2024 1:15:21 PM EDT
[#22]
Quote HistoryOriginally Posted By SARS: Unless it's fallen through they're building a nuke plant there. I find it interesting that despite so many of these critical access hospitals struggling more continue to be built. Pinedale is building one, and Saratoga recently opened one. Their reimbursement is very good. |
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Posted: 4/17/2024 1:15:29 PM EDT
[#23]
Quote HistoryOriginally Posted By N1150x: Actually if you knew how Medicare and Medicaid billed you would be livid. This is bad. Expect all Healthcare to be government run soon... Quote HistoryOriginally Posted By N1150x: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. This is bad. Expect all Healthcare to be government run soon... I know how they bill. Those with insurance or cash pay, pay the losses from Medicare & Medicaid. |
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Posted: 4/17/2024 1:16:11 PM EDT
[#24]
Quote HistoryOriginally Posted By flightmed: Tell me you know nothing about prehospital care and air ambulances without telling me… He will not let that stop him from posting.
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Posted: 4/17/2024 1:16:44 PM EDT
[#25]
Quote HistoryOriginally Posted By jsnappa: I know for a fact they transport dissecting aortic aneurysms by ground. Chest pain it’s routine. Quote HistoryOriginally Posted By jsnappa: Originally Posted By JackelopeMed: Seriously. He's so full of shit it's not funny. Air medical will not fly if there is any chance of hazardous flight conditions. Most rural areas don't have high levels of ALS/paramedic providers. Transporting a chest pain multiple hours by ground to a tertiary is so far beyond stupid I have to think he's trolling. I know for a fact they transport dissecting aortic aneurysms by ground. Chest pain it’s routine. If they are dissecting, depending on how soon or what kind, they are probably dead anyways. Even on a surg table. |
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AZ, USA
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Posted: 4/17/2024 1:17:07 PM EDT
[#26]
Quote HistoryOriginally Posted By HELOBRAVO: Absolutely not true..... There aren't a lot of studies out there but there is one from an ACO in MS that was paying $43 PM/PM more for NP care than physicians. To put that in perspective, my wife offers unlimited care and hour long appointments and she's $80 PM/PM. |
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Posted: 4/17/2024 1:18:07 PM EDT
[#27]
Quote HistoryOriginally Posted By Smokey0844: Burned my mother back in September. She fell and hit her head. Developed a brain bleed that proved fatal. Local hospital closed three years ago and the nearest one is close to an hour away so you can imagine how long it took for an ambulance to arrive and get her there for treatment even though the call was made when it happened. Very little a tertiary hospital can do for a fatal head bleed. Unless they can do burr holes or have ICP relief. |
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Posted: 4/17/2024 1:18:32 PM EDT
[#28]
Quote HistoryOriginally Posted By OregonShooter: If there is a cloud in the sky Life Flight won't fly. These organizations are pathetic. You're free to take risks with your own life. I'm not going to judge those people for not wanting to fly in bad weather. And at best, helicopters are a barely contained mass of rotating parts that is continually trying to disassemble itself. |
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Posted: 4/17/2024 1:22:28 PM EDT
[#29]
Quote HistoryOriginally Posted By C-4: @skid2041 You’d be surprised how much smaller hospitals can theoretically take care of locally. It’s a complicated topic because you have to discuss the hospitalist system which has been a disaster to medicine. Quote HistoryOriginally Posted By C-4: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. @skid2041 You’d be surprised how much smaller hospitals can theoretically take care of locally. It’s a complicated topic because you have to discuss the hospitalist system which has been a disaster to medicine. @C-4 I agree, truly. Local hospitals USED to be able to do great things.... now most Doctors have turned to cookbook medicine and won't take risks because of legal liability and how their Management won't allow. It's really sad. I realize they still can handle much. But they aren't more than a urgent care or stand alone ER at this point. Medicare & medicaid require volume, not quality, to make money. Heck, a major trauma to trauma center nets them $100k + per pt from the government. Otherwise there wouldn't be trauma centers. It's all about $ |
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USA
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Posted: 4/17/2024 1:22:31 PM EDT
[#30]
Never forget running my little nephew to my rural county hospital after he crashed his quad and broke his arm in two places. It was around 5pm and they did not have a doctor on duty who could set his arm. It had to be done at a children's hospital the next day that was 200 miles away.
No money to have a Doctor on duty but my governor is able to find all of this money to provide every need for the illegals flooding our state. |
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AZ, USA
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Posted: 4/17/2024 1:24:27 PM EDT
[#31]
Quote HistoryOriginally Posted By CTM1: Never forget running my little nephew to my rural county hospital after he crashed his quad and broke his arm in two places. It was around 5pm and they did not have a doctor on duty who could set his arm. It had to be done at a children's hospital the next day that was 200 miles away. No money to have a Doctor on duty but my governor is able to find all of this money to provide every need for the illegals flooding our state. What's happening in rural areas is primary care is expanding to cover things that might otherwise be done in a hospital. I've met two FMs that have treated minor GSWs in an outpatient setting. |
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Posted: 4/17/2024 1:25:03 PM EDT
[#32]
Quote HistoryOriginally Posted By JackelopeMed: I do too. I've done it. But to transport from residence to a tertiary hours away for CP of unknown etiology? Vs having a local hospital to perform an EKG, run serials trops and monitor? It's just...dumb. Quote HistoryOriginally Posted By JackelopeMed: Originally Posted By jsnappa: I know for a fact they transport dissecting aortic aneurysms by ground. Chest pain it’s routine. I do too. I've done it. But to transport from residence to a tertiary hours away for CP of unknown etiology? Vs having a local hospital to perform an EKG, run serials trops and monitor? It's just...dumb. 12-leads and trops can now be done onscene with an ambulance. If they need a Cath, going to a tertiary can be a death sentence. |
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AZ, USA
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Posted: 4/17/2024 1:25:14 PM EDT
[#33]
Quote HistoryOriginally Posted By skid2041: Very little a tertiary hospital can do for a fatal head bleed. Unless they can do burr holes or have ICP relief. You mean secondary care, tertiary is the regional medical center level. |
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AZ, USA
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Posted: 4/17/2024 1:26:29 PM EDT
[#34]
Quote HistoryOriginally Posted By skid2041: 12-leads and trops can now be done onscene with an ambulance. If they need a Cath, going to a tertiary can be a death sentence. EKGs are pretty easy to do now, you can even get a read remotely if you need one. |
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Posted: 4/17/2024 1:28:07 PM EDT
[#35]
Quote HistoryOriginally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Ignorance is biss, and you are very happy. What you propose is beyond unaffordable and would reduce medical care dramatically for most rural residents. |
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Posted: 4/17/2024 1:32:36 PM EDT
[#36]
Quote HistoryOriginally Posted By HIMARS13A: There aren't a lot of studies out there but there is one from an ACO in MS that was paying $43 PM/PM more for NP care than physicians. To put that in perspective, my wife offers unlimited care and hour long appointments and she's $80 PM/PM. Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By HELOBRAVO: Absolutely not true..... There aren't a lot of studies out there but there is one from an ACO in MS that was paying $43 PM/PM more for NP care than physicians. To put that in perspective, my wife offers unlimited care and hour long appointments and she's $80 PM/PM. Overall, our acute care NPs do a very good job without ordering excess diagnostics. A couple of the dummies may need to order a few more test.
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Posted: 4/17/2024 1:34:24 PM EDT
[#37]
Quote HistoryOriginally Posted By HIMARS13A: EKGs are pretty easy to do now, you can even get a read remotely if you need one. We've had people send the EKG from their smart watch for an accurate diagnosis. Doesn't get easier than that. |
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WY, USA
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Posted: 4/17/2024 1:38:46 PM EDT
[#38]
Quote HistoryOriginally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. That’s all fine and good until the road closes and rotor AND fixed wing can’t fly due to the weather. |
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Posted: 4/17/2024 1:38:53 PM EDT
[#39]
Quote HistoryOriginally Posted By skid2041: @dirtyboy. They are $30,000 actually. And you can get subscriptions to them. Everyone should. I pay $60 a year for one of the local services, & $50 a year for the other. Covers my own family. They save my Lat/longs for landing. They cover transfers and one of them is a world-wide conglomerate so I can use them throughout the US and some European countries. Some of my neighbors have had to use them. If it doesn't need a copter, you can wait for an ambulance or drive yourself. Quote HistoryOriginally Posted By skid2041: Originally Posted By dirtyboy: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. $100,000 helicopter flights are the answer? @dirtyboy. They are $30,000 actually. And you can get subscriptions to them. Everyone should. I pay $60 a year for one of the local services, & $50 a year for the other. Covers my own family. They save my Lat/longs for landing. They cover transfers and one of them is a world-wide conglomerate so I can use them throughout the US and some European countries. Some of my neighbors have had to use them. If it doesn't need a copter, you can wait for an ambulance or drive yourself. Noice! |
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AZ, USA
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Posted: 4/17/2024 1:39:16 PM EDT
[#40]
Quote HistoryOriginally Posted By HELOBRAVO: We've had people send the EKG from their smart watch for an accurate diagnosis. Doesn't get easier than that. Are they as good as a 12 lead? We have a SmartHeart for the clinic, it's pretty cool, my wife says it's harder to read than a 12 lead but it's a lot easier and more portable. |
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Posted: 4/17/2024 1:41:29 PM EDT
[#41]
Quote HistoryOriginally Posted By skid2041: Very little a tertiary hospital can do for a fatal head bleed. Unless they can do burr holes or have ICP relief. The capability used to be there. It wasn’t a first aid center until the last few years after they closed the ER and stopped doing any procedures. The ICP that was done gave her a chance but the brain was too far compressed by the time they had her there to do it. |
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AZ, USA
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Posted: 4/17/2024 1:41:37 PM EDT
[#42]
Quote HistoryOriginally Posted By HELOBRAVO: Overall, our acute care NPs do a very good job without ordering excess diagnostics. A couple of the dummies may need to order a few more test. The last time anyone in my family saw an NP she ordered the wrong labs and prescribed the wrong prescription. It cost over $400 and it was completely unusable. |
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WY, USA
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Posted: 4/17/2024 1:42:20 PM EDT
[#43]
Quote HistoryOriginally Posted By HIMARS13A: OB wards are closing all over because reimbursements are too low. Part of this conversation, that is always left out, is the “self pay” pts that are too lazy to even bother to get Medicaid. |
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WY, USA
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Posted: 4/17/2024 1:43:59 PM EDT
[#44]
Quote HistoryOriginally Posted By skid2041: Actually, I do. And they aren't releasing shit. For major hospitals. Except for maybe rehab spots. Rural are shipping daily all critical care or acute care to cities. No, you really don’t have any idea |
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AZ, USA
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Posted: 4/17/2024 1:44:19 PM EDT
[#45]
Quote HistoryOriginally Posted By JoinDatePostCount: Part of this conversation, that is always left out, is the “self pay” pts that are too lazy to even bother to get Medicaid. Hospitals have social workers on site that will get someone signed up for MC if they qualify. They aren't going to eat that without a fight. Most of the self pay people that aren't on MC probably make too much to qualify, but not enough that writing a $10k check is easy. |
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Posted: 4/17/2024 1:46:55 PM EDT
[#46]
Quote HistoryOriginally Posted By HELOBRAVO: You literally how no idea what you are talking about. (Posting from a rural hospital.) Quote HistoryOriginally Posted By HELOBRAVO: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. You literally how no idea what you are talking about. (Posting from a rural hospital.)
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IL, USA
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Posted: 4/17/2024 1:53:42 PM EDT
[#47]
Quote HistoryOriginally Posted By Sartorius: This is spot on. I did rural medicine for 5.5 years before moving back to the big city. This included delivering babies and doing C/sections. 100 miles to the nearest tertiary care hospital. 8 family doctors in a county bigger than Rhode Island. That's it. Zero specialists. I did procedures and took care of cases there that family docs in the city would never touch. Because you either did it or they were going 100 miles away. And we still transferred a lot. Everyone wants to have this idyllic childbirth, with scented candles and soft music in the background, with a caring midwife (not a callous doctor) and probably a doula to do visualization techniques and deliver a perfect child at home. And that's a lovely goal. But people (like ChuckD05) forget that childbirth has been a huge cause of maternal and infant mortality since the day Adam and Eve got kicked out of the garden. Women and babies died. A lot. And there are few things in medicine that can go from normal and controlled to absolute dogshit faster than childbirth. She's in labor and doing fine and her water breaks. And instead of the baby's head engaging, a loop of umbilical cord drops out. Guess what? That midwife and doula aren't gonna be helpful here. They're gonna be on the phone, screaming for an ambulance and hoping there's a doctor at the hospital with a knife in his pocket and qualified to do a crash C/section. Or the baby dies. Like how we had children before hospitals. You want to have a bathtub birth. Be my guest. But when shit happens, who you gonna call? Yup, as I mentioned earlier, for our first born, it got real hectic REAL FAST with that tangled up umbilical cord. Luckily, a surgical team and facilities were 20 yards down the hall. Second kid was a breeze (all things considered). |
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Posted: 4/17/2024 1:54:44 PM EDT
[#48]
Quote HistoryOriginally Posted By HELOBRAVO: Critical Access hospital reimbursement is higher than urban... My rural hospital has a full time OR, all the specialties and we are a level 2 trauma provider, We do many CABGs a month. I believe we have about 320 in patient beds right now. GD posters paint with a broad brush and they don't even realize there's no paint on it. Quote HistoryOriginally Posted By HELOBRAVO: Originally Posted By skid2041: My example is missed. Nevermind. Yes, it would be great if your rural hospital has surgical sal uites for appy's and lap chole's et al. My local rural hospital does not. And the the next closest has them but still transfers out most. I apologize, I understand there is a need. But they aren't going to get the funds or the staff. It's not profitable for anyone. Critical Access hospital reimbursement is higher than urban... My rural hospital has a full time OR, all the specialties and we are a level 2 trauma provider, We do many CABGs a month. I believe we have about 320 in patient beds right now. GD posters paint with a broad brush and they don't even realize there's no paint on it. Great! You are a Level 2! You get a ton of money from the Federal government. That's a HUGE difference between my 2 "local" ones (20mins) 6-medsurg, 6 ER beds, & the one 1hr away, slightly more. Everything gets flown or driven to the bigger city hospitals. I realize I'm broad brushing. But it's a conversation needed to be had. Everyone is using ER's and hospitals as primary care. Point of service (at their homes) can be a thing again (and is starting to be in some areas because of cost). Everything is mobile now. Even surg suites. It can be done & at lower cost with good reimbursement. |
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FL, USA
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Posted: 4/17/2024 1:55:38 PM EDT
[#49]
Quote HistoryOriginally Posted By skid2041: If they are dissecting, depending on how soon or what kind, they are probably dead anyways. Even on a surg table. Mortality isn’t nearly that high, besides, no one (of course very few do) dies on the surgical table. Especially if you can get them to someone like Dr. Tomas Martin or the surgeons he’s trained. A robust transport network is key. |
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Posted: 4/17/2024 1:57:41 PM EDT
[#50]
Quote HistoryOriginally Posted By Sartorius: This is spot on. I did rural medicine for 5.5 years before moving back to the big city. This included delivering babies and doing C/sections. 100 miles to the nearest tertiary care hospital. 8 family doctors in a county bigger than Rhode Island. That's it. Zero specialists. I did procedures and took care of cases there that family docs in the city would never touch. Because you either did it or they were going 100 miles away. And we still transferred a lot. Everyone wants to have this idyllic childbirth, with scented candles and soft music in the background, with a caring midwife (not a callous doctor) and probably a doula to do visualization techniques and deliver a perfect child at home. And that's a lovely goal. But people (like ChuckD05) forget that childbirth has been a huge cause of maternal and infant mortality since the day Adam and Eve got kicked out of the garden. Women and babies died. A lot. And there are few things in medicine that can go from normal and controlled to absolute dogshit faster than childbirth. She's in labor and doing fine and her water breaks. And instead of the baby's head engaging, a loop of umbilical cord drops out. Guess what? That midwife and doula aren't gonna be helpful here. They're gonna be on the phone, screaming for an ambulance and hoping there's a doctor at the hospital with a knife in his pocket and qualified to do a crash C/section. Or the baby dies. Like how we had children before hospitals. You want to have a bathtub birth. Be my guest. But when shit happens, who you gonna call? Quote HistoryOriginally Posted By Sartorius: Originally Posted By OKnativeson: Originally Posted By ChuckD05: I mean, she could have it in a bathtub, or bring back midwives? Like we didn't have children before hospitals. i work in fetal maternal medicine as a part of my profession. trust me, you don't want that. when things go south, it goes south very, very quickly for the mother and or baby. Everyone wants to have this idyllic childbirth, with scented candles and soft music in the background, with a caring midwife (not a callous doctor) and probably a doula to do visualization techniques and deliver a perfect child at home. And that's a lovely goal. But people (like ChuckD05) forget that childbirth has been a huge cause of maternal and infant mortality since the day Adam and Eve got kicked out of the garden. Women and babies died. A lot. And there are few things in medicine that can go from normal and controlled to absolute dogshit faster than childbirth. She's in labor and doing fine and her water breaks. And instead of the baby's head engaging, a loop of umbilical cord drops out. Guess what? That midwife and doula aren't gonna be helpful here. They're gonna be on the phone, screaming for an ambulance and hoping there's a doctor at the hospital with a knife in his pocket and qualified to do a crash C/section. Or the baby dies. Like how we had children before hospitals. You want to have a bathtub birth. Be my guest. But when shit happens, who you gonna call? Field c-sections (occur but not optimul, yet) and traveling suites are being talked about. Great post though.  |
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