Field ambulances can have 3 people. I rarely see a patient in the ER post arrest with an ambulance team of fewer than 3. As far as equipment, ALS ambulances can have advanced equipment. Paramedics often can measure end-tidal CO2 and have glidescopes for intubation that are not immediately available in the ER so "far more advanced equipment" is not quite true. BLS ambulances can be staffed by 19 year old EMT's with a few weeks of training, ALS ambulances usually have more experienced paramedics. I suspect many of what the ALS units are calling as cardiac arrest are not. Patients with weak pulses are not always picked up in the field and without a monitor to show a rhythm, they probably aren't searched for as well. This study is flawed.
-I have over a decade of experience as an ER physician.
The Coast Guard and marine police are legally able to board your vessel at any time. Any of these boats with nuclear devices crossing into the US territorial waters would be seen by US radar and most likely intercepted.
I like the Zebra 301 and 402. The 701 is more expensive with the same ink cartridge. For documenting charts all day, its the only pen I use. It doesn't bleed, no blobs, pretty consistent line. Its not expensive either.
Let's examine that..
- Unions are even stronger - Obama bailed out the UAW with the "auto bailout." Now unions get our tax dollars directly; this is hardly what was first imagined when unions were created.
- Even bigger government spending - like on healthcare. Now they actually steal from Medicare which we have paid into to funnel into this new abomination
- No one paid 90%, there were massive deductions that high earners were able to take that are not available now. Sheltering income was also much easier. The top bracket paid closer to 40% back then. And then there's the fact that the tax brackets are not indexed to inflation...
- We give out more foreign aid every year than any other country.
- and the UN has grown
The leaders in our government have hardly swung to the right - I mean, you have to be kidding, right?
Bush was constantly demonized by the media. The Dems did everything they could to win the presidency except put forth an interesting alternative (Kerry?) How about the Dems passing Obamacare without any Republicans and against popular opinion? Even Clinton admitted that he passed on the tech bubble- it was a crisis that was created during the Clinton years. That's the point.
of course they can create incentives to hire when they have loads of our tax money to spend. If you want to look at inefficiencies, look at government jobs whether in healthcare, law enforcement, shipping etc and get back to me.
As far as fooling human perception, the calculations seemingly ignore 3 other senses. To be an immersive experience, you would probably have to fulfill those as well. Sensory is the big one obviously. Holding a gaming controller is a pretty big block to me as far as "realism." Hopefully something like this - http://www.virtusphere.ca/ will come down in price. Might get me off the couch too.
I find I can use it for email, surfing the web, watching movies- then I can hand it to my 3-year-old and she can watch movies and play games on it. It is easy to use, durable, and makes a lot of sense for trips. I'll bring my laptop too if I need to do work, but that's really not what the ipad is for.
You are exactly right- my 2011 BMW 335is convertible weighs 4000 lbs which is about what my parents 1992 735i weighed. I wouldn't want to be in an accident in anything smaller nowadays. I was t-boned by an Ford Expedition while I was in a Mercedes ML - both vehicles totalled. I, and my daughter, were OK. I am not confident that would have been the case in a smaller, more fuel-efficient vehicle. Elsewhere is mentioned car seats- most people here have no idea that baby/toddler seats don't work in subcompact/compact cars and are tight in even large cars. Hence- mini-vans and SUVs being popular.
Yeah, totally understand dealing with the car insurance- tough to get KBB value, but usually pretty close-rarely enough to involve lawyer.
I know I don't recommend renting something expensive predicated on the possibility of using it. If there was still some discharge from a wound-maybe keep it available... really don't understand- again, not your treating MD. You are right about the dance between insurance and billing. Insurance companies will try to weasel out of paying, or, offer to pay a low percentage of the bill, all the while you pay a deductible based on the hospital bill price. Many times patients won't pay, even a copay, and then the bill won't get paid at all- collections agencies are not that efficient with med bills. A hospital will often get an aggressive billing dept to deal with lower collections, but this is not a direct reflection on the doctors. I know this might sound funny, but doctors don't run hospitals, suits do. I doubt you will be denied care secondary to fear of legal matters, unfamiliar with such cases - there are other doctors if such case should arise. I'm not in a position to deny care for emergencies and I have to take care of them despite threats they may make at the time. Give me sovereign immunity and we can talk more about cost cutting. And poorer cities are not necessarily less wasteful with health care expenses - Miami Dade actually has the highest Medicare fraud in the country. The poor are more likely to sue; do you think a doctor would be more conservative with working up that patient?
"Has it occurred to you that some people go for the lawsuits because of medical expenses? Just because some people sue is no reason to charge everyone such extreme prices."
This quote seems to imply suing for medical malpractice. Otherwise, yes, people without health insurance and/or mounting debt are more likely to seek legal recourse- and not just against doctors.
"Enthusiastically play along, of course!"
Don't know any doctors collaborating with lawyers to drum up expenses- they do exist - definitely a few bad apples- but definitely the exception.
To try to get "Just a few hundred more" from an insurance company for your car through the legal system seems like a waste since time and legal fees seem to mount quickly. If you were able to win a large amount from the insurance company (or what you believe is reasonable) - than I guess congrats. As far as "cheeky," you were the one who described your lawyer in a less than flattering way- and continued to use him. As far as blaming - lots of finger pointing- just saying...
I fail to see where doctors are to blame for any of this. This isn't some grand plan to bankrupt you. Not all of us have "zero financial sense":) The costs of health care are too high - that is not even debatable. I have never told a patient not to worry about the cost of a work-up. Most of my experience is with emergency care- which I deal with first-hand. Yes, I try to write for less expensive outpatient medication, but ER doctors are usually pretty removed from billing/costs issues. I can't give you a deal on an X-ray, ER med, lab test as I am unable to. As far as medicine/supplies costing 10x more- picking up package of advil at walmart is different than a doctor determining if you need a medication, ordering it, having a nurse obtain the single dose from a Pyxis machine, and dispense it. Not to mention the overhead of the machines, programs etc.. used for that dose of medication. Supplies are expensive, and they are often stolen from ER's. That and medical equipment walk off frequently. Margins are getting thinner for hospitals, and the patients paying for the people who show up at the ER saying they are there because they have no insurance is becoming more commonplace. Oh, and collections on the uninsured is almost nil in South Florida. Also, Medicaid doesn't apply to a significant amt of patients as they are undocumented illegals. I know what you think is reasonable is reasonable to you - but there are a lot of variables that you may not be aware of. The fear of medical malpractice is difficult to convey to the layman. You seem to be pretty sure of your expectations and you don't appear to have much faith in doctors. If you felt wronged, I wouldn't find it difficult to imagine you seeking "legal recourse" against a doctor. Now imagine seeing thousands of people like you a year who are suspect of everything you do who might have an ailment that could kill immediately or slowly (days, weeks, months.) As a health care professional, how conservative would you be working a patient up? As far as lack of competition, the rise of urgent care centers partly addresses this - and you can pay cash and lower fees for most work-ups secondary to significantly lower overhead. In getting non-emergent care, I suggest you find a physician you trust and stick with him. You said you did argue over the medical bills, but I guess you said you paid your part or whatever percentage. As far as "sleazy," the vast majority of people in healthcare aren't. Ranking below car sales, wow! Usually doctors rank pretty highly as far as respectability.
Hospitals do go under with the ER's. Classically, ER's were the loss leaders for the hospital- but that has changed for many over the past several years. ER's are typically not funded by the state unless you are referring to Medicare/Medicaid which is billed as it is elsewhere in the hospital. A few ER's are subsidized by the county, but they are the exception.
Wow! So first, you don't have insurance - auto? health? But you ran to the legal system and are somehow blaming doctors for the ambulance chaser you employed. And just how is someone who is apt to run to lawyers who run up the costs of healthcare damning doctors? You stuck with this lawyer who appears to have no problem misrepresenting the facts? Guess what, you pay higher prices for plane tickets because of blown up airplanes. You pay more in healthcare bills for frivolous lawsuits. You pay for the healthcare of the homeless guy in the next room. This is the cost of doing business. Even Medicare pays a certain amount for malpractice with their RVUs. People expect to be treated like "filet mignon," not pieces of meat. If you think I am enthralled by patients coming in saying their lawyer told them to, well..., I have more important things to attend to in the ER. ER doctors don't want that kind of business - there are enough "real" patients. As far as blame, you managed to blame the other driver, the intersection, the insurance company, the lawyers, doctors, costs of medical products and costs of nursing visits. And to answer the first question, yes, considered, not correct. Most people who sue doctors are not in it to just recoup medical expenses.
When as much money is spent on the last 3 months of people's lives in the ICU because people want "everything" done, there is a need to address patient and family expectations (and healthcare's obligations.) When med mal insurance is over $100,000 a year for some specialties, then yeah, it is a factor despite what some nuts try to debate to further their agenda. My med-mal was $80,000/year before a single suit (emergency medicine.) When an ER doc sees 5000 patients a year and knows most of his tests are nowhere near 100% accurate - numbers dictate more extensive work-ups than you would find in other countries when the next patient could be a career-ender. Somehow a country with the best educated physicians has the largest number and size of settlements in medical malpractice...hmmmm. I understand the costs are sometimes ridiculous - but the insurance companies will pay only a small percentage of the bill- hence, inflated prices. This game has been going on a long time. Going after these insurance companies to dispute the percentage they pay is also costly for the practice- which ultimately the patient pays for also. Many times the bill doesn't get paid at all - and you are also charged more because of that. I've worked in hospitals where literally less than 13% of patients paid for private insurance. Margins are getting thinner in some places - I think some of your frustration is a bit misplaced.
You can get "turned away" from an emergency room. EMTALA states that you are entitled to a screening exam to determine if you have an actual emergency. If you don't, the hospital does not have to provide uncompensated care and patients are typically given directions to local clinics/urgent care centers. Headaches are not typically screened out. I have never - never heard of a doctor not working a patient with a significant condition because of insurance status. Usually the ER doctor doesn't even know insurance status. The amount of people with sore throats and leg pain for months that show up at emergency rooms would surprise most. Negotiating price of services in emergent situations is probably not a good idea BTW. If the fear of lawsuits was taken away and certain patient expectations were more realistic, costs would probably go down...
Not to belittle the achievement- but a height of 1 meter means he never got out of ground effect. It would take a lot more power to really fly. I mean, if a vehicle never goes out of ground effect while flying over water, it can be registered as a boat.
Has everyone failed to notice that the United States has the largest number of immigrants both legal and illegal coming into the country? We still are a melting pot. With most countries, vacationers don't become residents. Here in South Florida, they often don't make plans to go home. Maybe some legitimate border security would help....
Pretty much nailed it. Many ER's now have a screening room for just that. If you have an emergency, our responsibility is to identify and treat it. If you "think" you have an emergency (back pain for months, doctor didn't refill narcotic prescription,) you may get triaged out. Urgent care centers and clinics often are more appropriate for other medical complaints. An ER doc friend of mine thinks they should name it the "You might die today room" as opposed to the "Emergency Room" considering what shows up.
I earn top 5% income and have worked hard my entire life. This is such an asinine blanket statement, I don't even know where to start. Do you resent the kids who got into better universities, grad schools than you? Most people who succeed financially in the US do so from hard work. Maybe you have moved more sod or shoveled more snow than me, but I somehow suspect your liberal leanings are more a defense of your own ineptitude at being a provider.
As the top 5% pay over 60% of the federal income tax burden in our country, maybe we should stick it to them a little more. If you want the top performers in our country to look for work elsewhere, I couldn't think of a better way than to tax them really heavily. It is not a sound fiscal move: Reagan brought down the highest tax bracket for federal income tax from 70% to 35% and revenue shot up. Most people that made over $250,000 last year were not responsible for this recession and are eating it. The GOP has this right and their is reasoning that we are being taxed too heavily.
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Field ambulances can have 3 people. I rarely see a patient in the ER post arrest with an ambulance team of fewer than 3. As far as equipment, ALS ambulances can have advanced equipment. Paramedics often can measure end-tidal CO2 and have glidescopes for intubation that are not immediately available in the ER so "far more advanced equipment" is not quite true. BLS ambulances can be staffed by 19 year old EMT's with a few weeks of training, ALS ambulances usually have more experienced paramedics. I suspect many of what the ALS units are calling as cardiac arrest are not. Patients with weak pulses are not always picked up in the field and without a monitor to show a rhythm, they probably aren't searched for as well. This study is flawed. -I have over a decade of experience as an ER physician.
The Coast Guard and marine police are legally able to board your vessel at any time. Any of these boats with nuclear devices crossing into the US territorial waters would be seen by US radar and most likely intercepted.
I like the Zebra 301 and 402. The 701 is more expensive with the same ink cartridge. For documenting charts all day, its the only pen I use. It doesn't bleed, no blobs, pretty consistent line. Its not expensive either.
Let's examine that.. - Unions are even stronger - Obama bailed out the UAW with the "auto bailout." Now unions get our tax dollars directly; this is hardly what was first imagined when unions were created. - Even bigger government spending - like on healthcare. Now they actually steal from Medicare which we have paid into to funnel into this new abomination - No one paid 90%, there were massive deductions that high earners were able to take that are not available now. Sheltering income was also much easier. The top bracket paid closer to 40% back then. And then there's the fact that the tax brackets are not indexed to inflation... - We give out more foreign aid every year than any other country. - and the UN has grown The leaders in our government have hardly swung to the right - I mean, you have to be kidding, right?
And, pray tell, how would that be tracked if identification isn't used? Better we all just looked the other way, eh?
love the fear-mongering. Interesting who the Dems want voting for them....
obligatory http://www.youtube.com/watch?v=THNPmhBl-8I
Bush was constantly demonized by the media. The Dems did everything they could to win the presidency except put forth an interesting alternative (Kerry?) How about the Dems passing Obamacare without any Republicans and against popular opinion? Even Clinton admitted that he passed on the tech bubble- it was a crisis that was created during the Clinton years. That's the point.
of course they can create incentives to hire when they have loads of our tax money to spend. If you want to look at inefficiencies, look at government jobs whether in healthcare, law enforcement, shipping etc and get back to me.
I just downloaded the 17 files from the article- they are all listed as SOCOM files- pretty cool- feels like I finished a game level:)
As far as fooling human perception, the calculations seemingly ignore 3 other senses. To be an immersive experience, you would probably have to fulfill those as well. Sensory is the big one obviously. Holding a gaming controller is a pretty big block to me as far as "realism." Hopefully something like this - http://www.virtusphere.ca/ will come down in price. Might get me off the couch too.
I find I can use it for email, surfing the web, watching movies- then I can hand it to my 3-year-old and she can watch movies and play games on it. It is easy to use, durable, and makes a lot of sense for trips. I'll bring my laptop too if I need to do work, but that's really not what the ipad is for.
You are exactly right- my 2011 BMW 335is convertible weighs 4000 lbs which is about what my parents 1992 735i weighed. I wouldn't want to be in an accident in anything smaller nowadays. I was t-boned by an Ford Expedition while I was in a Mercedes ML - both vehicles totalled. I, and my daughter, were OK. I am not confident that would have been the case in a smaller, more fuel-efficient vehicle. Elsewhere is mentioned car seats- most people here have no idea that baby/toddler seats don't work in subcompact/compact cars and are tight in even large cars. Hence- mini-vans and SUVs being popular.
Yeah, totally understand dealing with the car insurance- tough to get KBB value, but usually pretty close-rarely enough to involve lawyer. I know I don't recommend renting something expensive predicated on the possibility of using it. If there was still some discharge from a wound-maybe keep it available... really don't understand- again, not your treating MD. You are right about the dance between insurance and billing. Insurance companies will try to weasel out of paying, or, offer to pay a low percentage of the bill, all the while you pay a deductible based on the hospital bill price. Many times patients won't pay, even a copay, and then the bill won't get paid at all- collections agencies are not that efficient with med bills. A hospital will often get an aggressive billing dept to deal with lower collections, but this is not a direct reflection on the doctors. I know this might sound funny, but doctors don't run hospitals, suits do. I doubt you will be denied care secondary to fear of legal matters, unfamiliar with such cases - there are other doctors if such case should arise. I'm not in a position to deny care for emergencies and I have to take care of them despite threats they may make at the time. Give me sovereign immunity and we can talk more about cost cutting. And poorer cities are not necessarily less wasteful with health care expenses - Miami Dade actually has the highest Medicare fraud in the country. The poor are more likely to sue; do you think a doctor would be more conservative with working up that patient?
"Has it occurred to you that some people go for the lawsuits because of medical expenses? Just because some people sue is no reason to charge everyone such extreme prices." This quote seems to imply suing for medical malpractice. Otherwise, yes, people without health insurance and/or mounting debt are more likely to seek legal recourse- and not just against doctors. "Enthusiastically play along, of course!" Don't know any doctors collaborating with lawyers to drum up expenses- they do exist - definitely a few bad apples- but definitely the exception. To try to get "Just a few hundred more" from an insurance company for your car through the legal system seems like a waste since time and legal fees seem to mount quickly. If you were able to win a large amount from the insurance company (or what you believe is reasonable) - than I guess congrats. As far as "cheeky," you were the one who described your lawyer in a less than flattering way- and continued to use him. As far as blaming - lots of finger pointing- just saying... I fail to see where doctors are to blame for any of this. This isn't some grand plan to bankrupt you. Not all of us have "zero financial sense" :) The costs of health care are too high - that is not even debatable. I have never told a patient not to worry about the cost of a work-up. Most of my experience is with emergency care- which I deal with first-hand. Yes, I try to write for less expensive outpatient medication, but ER doctors are usually pretty removed from billing/costs issues. I can't give you a deal on an X-ray, ER med, lab test as I am unable to. As far as medicine/supplies costing 10x more- picking up package of advil at walmart is different than a doctor determining if you need a medication, ordering it, having a nurse obtain the single dose from a Pyxis machine, and dispense it. Not to mention the overhead of the machines, programs etc.. used for that dose of medication. Supplies are expensive, and they are often stolen from ER's. That and medical equipment walk off frequently. Margins are getting thinner for hospitals, and the patients paying for the people who show up at the ER saying they are there because they have no insurance is becoming more commonplace. Oh, and collections on the uninsured is almost nil in South Florida. Also, Medicaid doesn't apply to a significant amt of patients as they are undocumented illegals. I know what you think is reasonable is reasonable to you - but there are a lot of variables that you may not be aware of. The fear of medical malpractice is difficult to convey to the layman. You seem to be pretty sure of your expectations and you don't appear to have much faith in doctors. If you felt wronged, I wouldn't find it difficult to imagine you seeking "legal recourse" against a doctor. Now imagine seeing thousands of people like you a year who are suspect of everything you do who might have an ailment that could kill immediately or slowly (days, weeks, months.) As a health care professional, how conservative would you be working a patient up? As far as lack of competition, the rise of urgent care centers partly addresses this - and you can pay cash and lower fees for most work-ups secondary to significantly lower overhead. In getting non-emergent care, I suggest you find a physician you trust and stick with him. You said you did argue over the medical bills, but I guess you said you paid your part or whatever percentage. As far as "sleazy," the vast majority of people in healthcare aren't. Ranking below car sales, wow! Usually doctors rank pretty highly as far as respectability.
Hospitals do go under with the ER's. Classically, ER's were the loss leaders for the hospital- but that has changed for many over the past several years. ER's are typically not funded by the state unless you are referring to Medicare/Medicaid which is billed as it is elsewhere in the hospital. A few ER's are subsidized by the county, but they are the exception.
Wow! So first, you don't have insurance - auto? health? But you ran to the legal system and are somehow blaming doctors for the ambulance chaser you employed. And just how is someone who is apt to run to lawyers who run up the costs of healthcare damning doctors? You stuck with this lawyer who appears to have no problem misrepresenting the facts? Guess what, you pay higher prices for plane tickets because of blown up airplanes. You pay more in healthcare bills for frivolous lawsuits. You pay for the healthcare of the homeless guy in the next room. This is the cost of doing business. Even Medicare pays a certain amount for malpractice with their RVUs. People expect to be treated like "filet mignon," not pieces of meat. If you think I am enthralled by patients coming in saying their lawyer told them to, well..., I have more important things to attend to in the ER. ER doctors don't want that kind of business - there are enough "real" patients. As far as blame, you managed to blame the other driver, the intersection, the insurance company, the lawyers, doctors, costs of medical products and costs of nursing visits. And to answer the first question, yes, considered, not correct. Most people who sue doctors are not in it to just recoup medical expenses.
When as much money is spent on the last 3 months of people's lives in the ICU because people want "everything" done, there is a need to address patient and family expectations (and healthcare's obligations.) When med mal insurance is over $100,000 a year for some specialties, then yeah, it is a factor despite what some nuts try to debate to further their agenda. My med-mal was $80,000/year before a single suit (emergency medicine.) When an ER doc sees 5000 patients a year and knows most of his tests are nowhere near 100% accurate - numbers dictate more extensive work-ups than you would find in other countries when the next patient could be a career-ender. Somehow a country with the best educated physicians has the largest number and size of settlements in medical malpractice...hmmmm. I understand the costs are sometimes ridiculous - but the insurance companies will pay only a small percentage of the bill- hence, inflated prices. This game has been going on a long time. Going after these insurance companies to dispute the percentage they pay is also costly for the practice- which ultimately the patient pays for also. Many times the bill doesn't get paid at all - and you are also charged more because of that. I've worked in hospitals where literally less than 13% of patients paid for private insurance. Margins are getting thinner in some places - I think some of your frustration is a bit misplaced.
You can get "turned away" from an emergency room. EMTALA states that you are entitled to a screening exam to determine if you have an actual emergency. If you don't, the hospital does not have to provide uncompensated care and patients are typically given directions to local clinics/urgent care centers. Headaches are not typically screened out. I have never - never heard of a doctor not working a patient with a significant condition because of insurance status. Usually the ER doctor doesn't even know insurance status. The amount of people with sore throats and leg pain for months that show up at emergency rooms would surprise most. Negotiating price of services in emergent situations is probably not a good idea BTW. If the fear of lawsuits was taken away and certain patient expectations were more realistic, costs would probably go down...
Not to belittle the achievement- but a height of 1 meter means he never got out of ground effect. It would take a lot more power to really fly. I mean, if a vehicle never goes out of ground effect while flying over water, it can be registered as a boat.
its considered news to college students and young liberals
Has everyone failed to notice that the United States has the largest number of immigrants both legal and illegal coming into the country? We still are a melting pot. With most countries, vacationers don't become residents. Here in South Florida, they often don't make plans to go home. Maybe some legitimate border security would help....
Pretty much nailed it. Many ER's now have a screening room for just that. If you have an emergency, our responsibility is to identify and treat it. If you "think" you have an emergency (back pain for months, doctor didn't refill narcotic prescription,) you may get triaged out. Urgent care centers and clinics often are more appropriate for other medical complaints. An ER doc friend of mine thinks they should name it the "You might die today room" as opposed to the "Emergency Room" considering what shows up.
I earn top 5% income and have worked hard my entire life. This is such an asinine blanket statement, I don't even know where to start. Do you resent the kids who got into better universities, grad schools than you? Most people who succeed financially in the US do so from hard work. Maybe you have moved more sod or shoveled more snow than me, but I somehow suspect your liberal leanings are more a defense of your own ineptitude at being a provider.
As the top 5% pay over 60% of the federal income tax burden in our country, maybe we should stick it to them a little more. If you want the top performers in our country to look for work elsewhere, I couldn't think of a better way than to tax them really heavily. It is not a sound fiscal move: Reagan brought down the highest tax bracket for federal income tax from 70% to 35% and revenue shot up. Most people that made over $250,000 last year were not responsible for this recession and are eating it. The GOP has this right and their is reasoning that we are being taxed too heavily.