Veroniche
Western Region, US
Female, 54
I’ve been an ER nurse manager since 2009. Previously, I spent 24 yrs as an ER nurse. My hospital, a Level III trauma center, sees 70,000+ ER patients/yr. My responsibilities include billing, federal/state regulation oversight, metrics reporting, software education of e-records, and hiring/termination/disciplinary actions. The ER is one of the key impacted areas of healthcare reform. It’s a scary and exciting time for us, not just in the care of patients, but what the future holds for healthcare.
That is a simple question that has a very complicated answer. If you get a chance to read Time Magazine's cover story from March 4, 2013, titled "A Bitter Pill," please do. It is a great article about a lot of things in healthcare, however, a great deal of the article is devoted to a hospital's "chargemaster", which is the spreadsheet document that shows what the patient/insurance company is charged for every thing from soup to nuts. What a person is charged for a certain service or procedure is not what you or the insurance company eventually pays. There is a tremendous mark-up for everything in the hospital because generally, the only income a hospital gets is from payment from the patient/insurer for the services it provides. Of course, a hospital can have investments and investment income, but that is not the main source of income for the hospital system I work for, which is non profit. So the money the hospital receives from the patient/insurance companies is what pays all of the bills, salaries for 1500 employees, utilities, work comp insurance, etc, whatever it takes to run the hospital. When our hospital is doing ok (making budget), we generally do so with a 2-3% operating margin at the most. However, in the first two months of 2013, our hospital lost over 1 million dollars. Most of that had to do with what is called the "payor mix." In January and February, a greater percentage of patients had no or minimal insurance, so there was no way to pay for the cost of providing care to patients. So to finally answer your question, you can probably get a ballpark answer of what the charges might be, but that is not what you or your insurance company will end up paying--it is usually a 40-60% discount on the actual charges. Plus there are a lot of charges that make up the bill--the facility charge (the ER room charge, basically), any doctor's charges, which are billed separately, lab charges, x ray charges, pharmacy charges for any medication you may receive, etc. So it is hard to estimate. I can tell you easily what the facility charge would be, but I can't speak to the other charges.
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You want to get on the phone with billing start talking to them right away. Generally if you are uninsured, the bill can be lowered to approximately the same contract rate insurer's pay, you can get from 40-60% off. Ask for the patient rep, ask to talk with financial services and don't wait. You can also ask for a payment plan for the negotiated balance. Don't forget to go over your bill for any errors, just that could save you some $. Don't ignore the bill though, start talking to them right away. It's when you ignore it that it starts down that collection road. good luck, and start looking for the insurance exchanges to get coverage for yourself.
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The Emergency physician is a board certified specialist who enters a 3-4 year program after medical school. They are specifically trained in Emergency Medicine--they need to know how to treat any kind of health issue, including trauma, and medical emergencies for adults and children. They are unlike primary care or family physicians, who treat and have established relationships with their patients. ER physicians generally do not have private practices, they only work in ERs or Urgent care centers. In 2011, about 7% of graduating medical school seniors entered an Emergency Medicine residency program in the US--there are about 100 programs in the US. It is a fairly new specialty, just over 20 years, so it is very popular and can be difficult to enter. A physician who is not board certified in Emergency Medicine can still work in an ER, however, I would want a board certified physician treating me if I had an emergency. In the hospital where I work, all of the physicians are board certified, and you will see that in most ERs. ER physicians are not generally on call--they work their shift and go home, so it can be an attractive area for that reason. The malpractice insurance is higher than some other specialties, but not the highest. You can't really compare ER docs to other specialists, whether one is "better" than the other, it is like comparing apples to oranges. I would want an ER doc to treat me if I had an emergency, and I would want an OB/Gyn doc to take care of me if I was having a baby.
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I would not go to the ED for a rapid HIV test, although you could. This type of testing should be done through your PCP or clinic to ensure adequate followup. If a person has concerns they have been exposed, one negative test only tells you that you are negative right then. The conversion to a positive result may take months, so you may need further testing. An ED is not the place to create an ongoing doctor-patient relationship. As far as treating with the medication, the physician would talk to you about the risks of immediate treatment with these medications. The meds are not without risks or significant side effects, so that would have to be balanced with the chance of developing a positive HIV test. If you know for certain that the other party was HIV positive, that could sway the decision. It also depends on how much exposure you had--long term continuous exposure vs. a one time thing. There are a lot of factors.
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Call Center Employee (Retail)
What's the meanest thing someone's said to you on the phone?
Parcel Delivery Mailman
Does labeling a package "fragile" actually lead to you handling it with more care?
Oral and Maxillofacial Surgeon
Do you ever operate on guys who get their jaws busted in a fight?
Wow! I don't have any expertise in that at all! I think that is a question for a police officer or security company.
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The nursing leader is called the director, and then under that are managers, and then under that are the charge nurses for each shift. These are all RN positions. So the top nurse is the nursing director.
The physician who is in charge of all of the physicians is called the medical director.
The ED uses both physician assistants and nurse practioners. They are directly supervised by the physicians who are on duty, and practice under the physician's direction. Generally, they provide care to the less seriously ill or injured. Depending on the experience of the PA or NP, the physician may do their own independent examination, or may just "sign off" on the patient without seeing the patient themselves.
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I have not seen that particular series. When I was younger I was hooked on St Elsewhere (shows you how old I am!), and then began watching ER a couple of seasons in, then quit watching. I will watch old reruns of "Trauma--Life in the ER",--which I have found to be the most accurate, however after a while I have said--I do this everyday, why do I want to watch it in my free time. I get frustrated watching medical shows on TV, especially shows such as ER, Chicago Hope, Grey's Anatomy, House, etc. They are all just soap operas set in hospitals. I wonder if law enforcement employees get tired of all of the cop shows on TV?
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