[ilovetv]

Originally Posted by blueash

Hopefully this will not be deleted as political, but you completely misunderstand the workings of the ACA. The ER's are in part overcrowded because people DON'T have insurance. ER's are required to provide evaluation without regard to the financial coverage of the patient. So the uninsured use the ER for primary care and minor illnesses. We still hear people say we don't need universal health insurance as poor people can get great free care in the ER, so everyone really already gets needed medical care. Once people have insurance, they will be able to go to primary care doctors and NP/PA's and not overcrowd the ER, and in fact get their care at much lower cost per incident. The ACA will hugely improve the ability of ER's to return to their mission of providing emergency care.

Wrong. An insurance card is of no use when there is no primary-care doctor to able to take on more patients, and they are quitting practice because Medicare reimbursements are already so low (and Medicaid payments are half of Medicare payments) they can't pay the bills and themselves and stay solvent.

When people with an insurance card can't get a primary doctor, or they cannot wait a week or two with the problem they have....or they do not WANT to wait a week to see the dr. they have....they go to the ER. And that is fact. And it's why the ER's are so full and will continue to be so, regardless of ACA coverage.

"A recent Senate report said the country is short about 16,000 primary care doctors – and that shortage is only expected to grow.

That's especially troubling for people in the public health and medical fields, since a soon-to-be-enacted provision of the Affordable Care Act will extend Medicaid to millions of Americans – begging the question of who, exactly, will treat them.

A recent study in the Annals of Family Medicine estimated there are nearly 209,000 primary care providers in the U.S.

That's a big number, but with population growth, aging and the changes brought on by the Affordable Care Act, experts say today's shortage of 16,000 primary care physicians will grow to about 52,000 by 2050.

That's also a big number – but it's a bigger problem.

Why the shortage of primary care doctors?

Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic in South Los Angeles, says the primary care physician is a "jack of all trades but master of none."

"The role of primary care is to provide comprehensive care that is affordable, prevention-based and that looks at all the faces of a human life – from babies to grandmas," he said.

Dr. Aguilar is a practitioner of family medicine – one form of primary care. He's worked in underserved South L.A. for about 10 years, and loves what he does.

But Aguilar says there are a few things about the job that keep a lot of young medical students away. For one, they have a heavy patient load.

"We have less support," he said. "We're not hospital-based and, of course, we get less money, so those are the drawbacks."

Primary care doctors typically earn less and and get less support than doctors who choose to go into specialized fields: cardiology, neurology, podiatry, oncology and other specialized fields. Specialists also tend to work with fewer patients.

Add to that an average medical school debt of more than $160,000, and it's easy not so hard to see why a more lucrative field – that is, one that isn't primary care – would be so attractive to medical students....."

Primary care doctor shortage creates critical void, leaving field's future uncertain | OnCentral | 89.3 KPCC

[tucson]

Originally Posted by Mack184

These stories enrage me and NOT for the people who are telling them about how badly they are treated and their poor, poor family member who is left to "rot" in the waiting room.

If you knew ANYTHING (which you don't) about how things work in an ER you might begin to understand. The ER staff at TVRH, and in fact most US hospital ERs are on roller skates from the minute they clock in until the minute they leave some 12 hours later. They often have not had a single meal break, or even a bathroom break.

ERs take people on a 1-5 triage scale. 1 being the most critcal, 5 being the least important. 1=you're dieing. They take people in order of their NEED. Since you have no idea what's happening behind the doors, you make the decision for yourself that the staff's in the back room playing cards and drinking beer while your poor, poor family member is left to rot. BS!

Actually these HARD WORKING people are handling heart attacks, strokes, gunshot victims and severe traumas. Those ALL go first. In every hospital everywhere in the USA.

TVRH has a problem that is only going to get much worse as time progresses. They have a chronic shortage of beds on the medical floors. If you can't get a patient OUT of the ER and onto a medical floor bed, they can't take another patient UNTIL that current paitent is moved out. TVRH is constantly short of med-floor beds.

Since TVRH draws fully 88% of it's entire revenue stream from Medicare, and Medicare reimbursements are continuing to decline, they have NO ADDITIONAL MONEY to build a larger facility, or hire better and more staff. However, they have a continually growing population that requires more and more services which they have to provide on less and less money. That's a losing deal all the way around.

Poster after poster has said "Something Had Better Be Done"! OK what? The staff pay is horrible and so they have trouble attracting more and good people. The revenue stream is dwindling daily. The answer is MONEY. Are you ready to come up with a few million bucks so that the hospital can afford to expand? Yeah. I thought not.

The problems that plague TVRH are financial. That isn't going to improve unless there's a BIG infusion of money.

And..when you finally get into an ER room..Zip Your Mouth and don't carp at your nurse, tech or doctor. They are busting their butts to help you out and they don't need your lousy whiny self-entitled attitude to make their hard day or night even harder. Also.. you are in the hosptial's ER..Not Denny's. The staff is there to give you MEDICAL care..Not run and get coffee & sandwiches for your family or fetch magazines or other personal wants.

If you are in need..you WILL get help at TVRH..but it will be on their need scale..not yours. And I would trust them ANYTIME to know what's important and what can wait.

Thank you for telling it like it is!! Like you said, It's only going to get worse...

[perrjojo]

Mack 184, I have no doubt that the ER employees are dedicated and work hard. Last night I did not see anyone whinning and asking for sandwiches and coffee. What I saw was a waiting room with at least 20 people, some who were frail and suffering. I saw patients helping one another to make the sitituation more tolerable. I understand that patients are treated based on order of severity but there just was NOT enough available help. i certainly never suggested that the help was inept. I also understand that the problem is financial and as our population grows and ages, it will only get worse. I know that this is a problem in all cities but just because it's that way everywhere, that doesn't make it ok. So how do we change this? I actually think most people DO know how emergency rooms work. They just feel the system is failing those in need....off my soap box know.

[Mack184]

TVRH has very little uncompensated care compared to the vast majority of US hospitals. They are not suffering from a "deluge of the uninsured".

One thing that gets almost no notice here on TOTV or within TV itself is the excellent Urgent Care facility on the East Campus. Compared to the TVRH-ER the Urgent Care handles very few patients often with staff waiting around with no one to help.

Far too many people call the Big Red Bus and that bus only stops at one location...TVRH-ER. Many, many of the people who find themselves waiting at TVRH could be easily handled at the Urgent Care but they choose not to. Then the gripe & carp about the terrible service and waiting time. Most of the people who wind up waiting & waiting & wating at the ER are triaged between a 3-5 which means they are non-critical (no matter what the patient thinks they are) and could be easily treated MUCH more quickly at the TVRH-Urgent Care on the East Campus. Give it a try.

[perrjojo]

Originally Posted by Mack184

TVRH has very little uncompensated care compared to the vast majority of US hospitals. They are not suffering from a "deluge of the uninsured".

One thing that gets almost no notice here on TOTV or within TV itself is the excellent Urgent Care facility on the East Campus. Compared to the TVRH-ER the Urgent Care handles very few patients often with staff waiting around with no one to help.

Far too many people call the Big Red Bus and that bus only stops at one location...TVRH-ER. Many, many of the people who find themselves waiting at TVRH could be easily handled at the Urgent Care but they choose not to. Then the gripe & carp about the terrible service and waiting time. Most of the people who wind up waiting & waiting & wating at the ER are triaged between a 3-5 which means they are non-critical (no matter what the patient thinks they are) and could be easily treated MUCH more quickly at the TVRH-Urgent Care on the East Campus. Give it a try.

I have used the Urgent care at LSL and have been very pleased but they close at 7:00. Is there any other urgent care that stays open 24/7?

[ilovetv]

Originally Posted by Mack184

These stories enrage me and NOT for the people who are telling them about how badly they are treated and their poor, poor family member who is left to "rot" in the waiting room.

If you knew ANYTHING (which you don't) about how things work in an ER you might begin to understand. The ER staff at TVRH, and in fact most US hospital ERs are on roller skates from the minute they clock in until the minute they leave some 12 hours later. They often have not had a single meal break, or even a bathroom break.

ERs take people on a 1-5 triage scale. 1 being the most critcal, 5 being the least important. 1=you're dieing. They take people in order of their NEED. Since you have no idea what's happening behind the doors, you make the decision for yourself that the staff's in the back room playing cards and drinking beer while your poor, poor family member is left to rot. BS!

Actually these HARD WORKING people are handling heart attacks, strokes, gunshot victims and severe traumas. Those ALL go first. In every hospital everywhere in the USA.

TVRH has a problem that is only going to get much worse as time progresses. They have a chronic shortage of beds on the medical floors. If you can't get a patient OUT of the ER and onto a medical floor bed, they can't take another patient UNTIL that current paitent is moved out. TVRH is constantly short of med-floor beds.

Since TVRH draws fully 88% of it's entire revenue stream from Medicare, and Medicare reimbursements are continuing to decline, they have NO ADDITIONAL MONEY to build a larger facility, or hire better and more staff. However, they have a continually growing population that requires more and more services which they have to provide on less and less money. That's a losing deal all the way around.

Poster after poster has said "Something Had Better Be Done"! OK what? The staff pay is horrible and so they have trouble attracting more and good people. The revenue stream is dwindling daily. The answer is MONEY. Are you ready to come up with a few million bucks so that the hospital can afford to expand? Yeah. I thought not.

The problems that plague TVRH are financial. That isn't going to improve unless there's a BIG infusion of money.

And..when you finally get into an ER room..Zip Your Mouth and don't carp at your nurse, tech or doctor. They are busting their butts to help you out and they don't need your lousy whiny self-entitled attitude to make their hard day or night even harder. Also.. you are in the hosptial's ER..Not Denny's. The staff is there to give you MEDICAL care..Not run and get coffee & sandwiches for your family or fetch magazines or other personal wants.

If you are in need..you WILL get help at TVRH..but it will be on their need scale..not yours. And I would trust them ANYTIME to know what's important and what can wait.

BRAVO, Mack184!!!!

[Mack184]

Originally Posted by perrjojo

Mack 184, I have no doubt that the ER employees are dedicated and work hard. Last night I did not see anyone whinning and asking for sandwiches and coffee. What I saw was a waiting room with at least 20 people, some who were frail and suffering. I saw patients helping one another to make the sitituation more tolerable. I understand that patients are treated based on order of severity but there just was NOT enough available help. i certainly never suggested that the help was inept. I also understand that the problem is financial and as our population grows and ages, it will only get worse. I know that this is a problem in all cities but just because it's that way everywhere, that doesn't make it ok. So how do we change this? I actually think most people DO know how emergency rooms work. They just feel the system is failing those in need....off my soap box know.

Actually you would be amazed about how many people once they are into an ER room treat their nurses and techs as though they were waitresses. I know all of this way too well. My wife is an ER-NP (not at TVRH) and I know what she goes through night after night after night. Plus the people in that fraternity all talk and share war stories, and you wouldn't believe a lot of it.

The answer as I said in my original post is...MONEY. With Medicare reimbursements falling faster than pants at an orgy those hospitals that rely heavily on Medicare for revenue are in a nasty bind. TVRH receives more per-capita Medicare dollars than any US hospital. Unfortunately they do not have access to the kinds of dollars that help other hosptials balance the books.

There are plenty of people of means within TV who could consider leaving part of their estate to the hospital. The hospital is a charitable organization, and while TVRH DOES get a lot of volunteer help, they could almost use donations far more than they need the bodies, although in all honesty..if TVRH didn't have the large number of volunteers they'd be in worse shape than they are because they can barely afford to pay the staff they currently have. It'll get worse.

A lot of this is NOT of TVRH's making. Decisions made the Federal & State level have handcuffed at lot of their choices. But again.. the answer is...MONEY.

[Mack184]

Originally Posted by perrjojo

I have used the Urgent care at LSL and have been very pleased but they close at 7:00. Is there any other urgent care that stays open 24/7?

I don't know..but here's a little secret. If more people who needed care during the day, went to the Urgent Care facilities then TVRH wouldn't stack up so badly during the day.

If you have lots of people coming into the ER during the day, the more the system clogs up and slows down. Then..if you need something at night when the Urgent Cares are closed..you enter a system that is running like a pig on stilts. Maybe..just maybe things will slow down about 2am and they'll start to catch up. Many nights that doesn't happen..So the cycle continues right into the next day.

Pretty much, if you're not dieing...(Use the hospital's scale here..not yours) the local Urgent Care facilities can take care of you. You will get in & out MUCH faster than if you use the ER.

[dillywho]

Originally Posted by Mack184

I don't know..but here's a little secret. If more people who needed care during the day, went to the Urgent Care facilities then TVRH wouldn't stack up so badly during the day.

If you have lots of people coming into the ER during the day, the more the system clogs up and slows down. Then..if you need something at night when the Urgent Cares are closed..you enter a system that is running like a pig on stilts. Maybe..just maybe things will slow down about 2am and they'll start to catch up. Many nights that doesn't happen..So the cycle continues right into the next day.

Pretty much, if you're not dieing...(Use the hospital's scale here..not yours) the local Urgent Care facilities can take care of you. You will get in & out MUCH faster than if you use the ER.

Mack, you are saying exactly what I have been trying to get across. As for most of the ER care being taken by Villagers with means, go in there and just take a look. You will see many more from surrounding areas than are from here. One young person actually had the audacity to ask if I had a lighter one night when I was on the way in to my husband's room in ICU. When I told her I did not and that even if I did she couldn't smoke on the grounds, she said that she knew that but wanted to have a cigarette first since the wait would probably be long. Emergency?? I think not. Like someone else noted, she could afford cigarettes and tats but then probably lets others pay for her medical care.

This most likely explains a lot and could also contribute to the explanation of why the ER was so non-busy over the Easter Weekend. Seems to be the same scenario on any other holiday weekend as well. Guess those "emergencies" can wait until after the festivities.

[Mack184]

Originally Posted by dillywho

Mack, you are saying exactly what I have been trying to get across. As for most of the ER care being taken by Villagers with means, go in there and just take a look. You will see many more from surrounding areas than are from here. One young person actually had the audacity to ask if I had a lighter one night when I was on the way in to my husband's room in ICU. When I told her I did not and that even if I did she couldn't smoke on the grounds, she said that she knew that but wanted to have a cigarette first since the wait would probably be long. Emergency?? I think not. Like someone else noted, she could afford cigarettes and tats but then probably lets others pay for her medical care.

This most likely explains a lot and could also contribute to the explanation of why the ER was so non-busy over the Easter Weekend. Seems to be the same scenario on any other holiday weekend as well. Guess those "emergencies" can wait until after the festivities.

Since you're ready to blame the "young & the poor" you might want to know that the average age of a TVRH patient is...78.

[perrjojo]

Originally Posted by Mack184

Since you're ready to blame the "young & the poor" you might want to know that the average age of a TVRH patient is...78.

Mack184, you are correct. The night I was there I saw about 20 people waiting. Only 2 or 3 looked like they were not from "around here" (whatever that means). I don't think Wildwood or Oxford have a hospital so of course there will be some young people there. :-). Anyway, the problem that I saw was far too many patients than could be accommodated.

[DEWRDW]

This is very scary - for those of us who just moved to TV this may be a awake up call - have a plan in place just in case a sudden illness occurs - thanks for the info

[TraceyMooreRN]

In Virginia I worked for a non-profit hospital that I loved- 5 miles down the road they built a stand-alone ER. This helped with the long waiting, etc. This facility would do EVERYTHING a hospital ER would do-with the exception of placing you in a bed to keep you. Tons of people liked the idea--maybe that would be a solution. However, it seems with the growth of our area 100,000 and increased ages- that there will be another hospital built. I am all for it!!! In Virginia I worked for a non-profit hospital that I loved- 5 miles down the road they built a stand-alone ER. This helped with the long waiting, etc. This facility would do EVERYTHING a hospital ER would do-with the exception of placing you in a bed to keep you. Tons of people liked the idea--maybe that would be a solution. However, it seems with the growth of our area 100,000 and increased ages- that there will be another hospital built. I am all for it!!! In Virginia I worked for a non-profit hospital that I loved- 5 miles down the road they built a stand-alone ER. This helped with the long waiting, etc. This facility would do EVERYTHING a hospital ER would do-with the exception of placing you in a bed to keep you. Tons of people liked the idea--maybe that would be a solution. However, it seems with the growth of our area 100,000 and increased ages- that there will be another hospital built. I am all for it!!!

[gerryann]

If you are not on Medicare or Medicaid, chances are you will get treated sooner. I posted this a few weeks ago



You are certainly correct that they NEED the beds, but going about releasing the beds is another matter. I was at urgent care recently. The Dr. wanted me to get a particular test that had to be done in the hospital. He told me to walk across the street to the hospital and he would send the orders over for the test. I walked over, they admitted me into a bed in the emergency room....walking past MANY sick and injured folks on gurneys in the hall way. I explained that I do NOT need a bed...only a test. they admitted me anyway. After blood work and a couple hours wait, they took me for the test....then back to the room that I didn't need. They kept me waiting in the room for another 4 hours while I waited for results, then a Dr to release me...all the while taking up a bed (really the room, I never got in the bed). On my way out I still saw many folks in the hall that needed a room. Two in particular had very bloody heads. Didnt have any idea why this incident happened this way....I was not sick, nor in an emergency situation...Is it possible that they saw that I had private insurance and not Medicare??? I hope thats not the case, but I did feel ridiculous taking the room away from those that needed it.

[tucson]

Something about all these stories is absolutely so totally sickening,(no pun intended)!