Hospitals working to avoid non-emergency ED care

forget hospitals, doctors are avoiding seeing Medicare patients or doing any elective procedures if at all possible. . I still see critically ill patients in the hospital and take care of all the emergencies. I have restricted elective procedures to 10 Medicare and Medicaid patients per week. We also routinely toss out requests for change of mediations from PBMs. It is really not possible to stay in business if a non-federally funded practice sees more than 30% Medicare and Medicaid patients. I wish the government gave us private practitioners the same tax breaks they give federally funded clinics and hospitals. That might mitigate our distress and maintain our solvency. Remember the patients are not irate at doctors but at the price gouging by the big pharma allowed by the government for Medicare and Medicaid recipients. The big pharma is by definition the largest welfare recipient in the medical business. They have been exempted from all anticompetitive and anti-kickback laws. They are allowed to fix their prices and not bid in the open market. To add insult to injury they have unleashed the PBMs on us they also want us to use e.prescribing to facilitate their trade. Either doctors are extremely generous or extremely stupid to go along with this arrangement!

To say I was angry when reading this article about ED Physicians suing CA is putting it mildly. I suffer from two very severe, chronic pain syndromes and I hate going to the ED because I am undermedicated, undertreated, and have been directed to go by my PCP, my Pain Management Physician or the ON Call RN after hours, sometimes all three. I am treated like a drug seeker when I already have my little pharmacy, it's my RSD is have a severe flare up due to Breakthrough Pain (BTP) a term, ED Physicians don't even know what it seems to mean. I hate going and will wait until a week after directed to go because I know I will be treated by a NP or PA instead of an MD. There is nothing wrong with either of those positions if a kid has a cold or someone on Medicaid knows it's faster to get seen by going to the ED than waiting for an appointment, makes my blood boil.

I have been through the wringer with the RSD/CRPS I suffer from, the severe spasms, severe pain, and may be given one or two injections of 1 ML of Dilaudid when I take an oral dose between 24 and 32 mgs. They won't even call my Pain Management Physician for advice as my case is severe, but well documented.

Someday their time will come, and I hope they are treated the way I and others like me have been treated.

to the person with chronic pain syndrome. the ED is for emergencies not chronic pain. i know you dont understand that. that is why you are treated like a drug seeker because if you have chronic pain then outpatient is the appropriate way to handle it, not via the ED. You know you will need narcotics for your chronic pain, so make sure you have your regular daily narcotics and then extra for breakthrough pain. This is done through your pcp and pain clinics,not through the ED. Whats wrong with being treated by NP or PA, you have chronic pain, its not an emergency that a MD need to deal with.