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Comment by aluminussoma | Hacker News Reader

There is also another opinion: that many people go to the ER who don't really need to go there.

I had to visit the ER recently. I did not want to go but my doctor insisted. A family member who is also a doctor also insisted I go.

The ER was eerily empty. The ER doctor saw me immediately. There were only a couple of other patients that I could see. This contrasts to prior experiences in the ER where there is a long wait as I get triaged, with lots of people waiting to be seen.

Fortunately my situation was nothing serious. When I returned home and told my relative, he said his hospital's emergency department was also very light. In his opinion, there were a lot of people going to the ER who didn't need to go in the first place.

Edit: I am referring to non-trauma related admissions to the ER. E.g. I have a headache and I am going to the ER to be seen now.

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A lot of people don’t have insurance. You can’t go to a doctor for a $150 appointment without insurance. But you can go to the ER when it gets really bad for a $2000 appointment (which you don’t pay. May go to court against you but if you are poor, they won’t collect)

That's what walk-in clinics (Urgent Care) are for. You can visit those often without insurance.

What?

At every one I have been to (not a lot I admit, maybe 4 in my life), I had to both provide insurance card AND pay my copay before a doctor would see me. Without payment, they send you to go to the ER.

How do you know they would send you to the ER? Did you not have insurance? Did they actually send you to the ER for not having it? Honestly, sounds like you simply had insurance, filled out a form and just assumed it was required. I've been to multiple walk-ins, and you can visit without insurance. They will ask for insurance up front, but you can simply say you don't have any. Then you will offer payment options. The average Urgent Care visit is under $200. The point of Urgent Care is literally to handle things that don't need ER visits, and at a much lower rate. I don't know why I've been down voted above, you can simply Google/Bing/Duck "no insurance Urgent Care" and find tons. The CVS MinuteClinic, which is everywhere, doesn't require insurance for instance.

https://www.cvs.com/minuteclinic/insurance-and-billing

The OP said without payment they will send you to the ER, which is true. If you can pay, as you said, then they will see you.

The article addresses a decline in critical admissions such as strokes and heart attacks, so that would not explain it.

Countries where that isn't the case are seeing a big drop too.

The article addresses this. They expect fewer trauma patients as there are fewer people on the road, etc. but they expect the number of stroke, heart attack, etc. patients to remain constant, which hasn't been the case.

The article doesn't address the opinion that my doctor relative expressed: there were a lot of ER visits, not trauma related, that probably didn't need to happen.

Strokes and heart attacks don’t fall into they category.

Medically, they are different, but the risk factors are very similar, and I can't see why the quarantine would change the ratio of the two.

But, of the normal ER visits, one would expect to have the same scalar number of emergency (stroke, heart attack) visits to STILL be happening, and we would expect those people to still be going to the ER. These are not "no insurance" people, they're people having an emergency situation.

If we don't see them in the ER, it makes sense that they're staying home on purpose, or not handling symptoms until it's too late (?).

Great that's also not the point of the article, that heart attacks and strokes aren't being seen at the same rate.

Your point is orthogonal to the point of the article.

Exactly, I am not attempting to contradict the article, I'm just providing another opinion related to ER visits during this time.

My wife is a doctor. Not an ER doc, but had to do rotations through the ER and frequently interacts with the ER in other rotations.

The amount of non-emergencies the ER department sees is astounding.

24 hour urgent care would reduce the load on ERs.

We used to have 24 hour urgent care facilities in Indianapolis, but I don’t believe any are still open (or open 24 hours, anyway).

Not really. It's often "convenient" relative to all the places that aren't open, and they won't turn you away until they've assessed your situation.

What's wild is that we structure payment and regulatory models where a walk in at the ER costs more than a walk in at the urgent care located literally next door. Gotta self assess how serious the situation is if you don't wanna contribute to the high risk revenue pool.

The urgent care clinic can assess you. In fact, they could probably assess you over the phone before you even arrive.

Kaiser heavily pushes their nurse hotline to help minimize costs. I can hardly fathom going to either the Kaiser emergency or injury departments[1] without calling the nurse hotline. The nurse, in consultation with a staff physician in the call center, does an assessment, tells you what to do next, if anything, and schedules any appointments--phone physician, in-person primary physician, or calls ahead to the emergency or injury clinic to minimize wait times.

Our current healthcare system is so fractured that most people have no idea how to go about seeking healthcare in the most convenient and smoothest way possible. Smaller regional hospitals and even some regional systems don't have the scale to do what Kaiser does, at least not nearly as efficiently as Kaiser. High costs are baked into the system.

[1] Injury department is for broken bones, cuts, etc that happen during the day. At the SF Geary medical center they're conveniently located across the hall from the imaging department.

Right, my point is, why isn't the nurse line also standing at the door to the single walk in access point for the hospital? Because we are wild fools, that's why.

The hospital is liable for the costs in the ER, so fuck no are they going to tell you go home and get some rest if they can charge you $2000 to do that after taking your insurance.

Except with something like Kaiser, they are the insurance provider and the hospital system. You only pay a copay for the ER, and that’s it. There’s no incentive to push unnecessary medical services.

I expect they are subject to EMTALA and won't triage down in the event an outside customers strolls in.

I am a current Kaiser subscriber. (member?/customer?) Even despite the simplicity for which Kaiser is clearly striving, I had a tough time figuring out how it was supposed to work at first.

I was accustomed to urgent care without a phone call. I tried to apply that experience to Kaiser. I found a Kaiser facility, via their web site, that claimed to offer urgent care during certain hours. I even double checked the definition of "urgent care" on wikipedia. I arrived at listed opening hour. The security guard I found there didn't know anything about it, except that no one else would show up for another hour. Then I wandered around trying to figure out where "urgent care" was, but there was some confusion about it. Eventually, I got to a desk somewhere. I was told to call for an appointment, which I did from there. All in all I spent three or four hours waiting and shuffling around between different desks. It was a very frustrating experience.

Eventually, I found out that everything in Kaiser starts with a phone call. But I don't think I was ever told that. What you're supposed to do, as far as I can tell now, is just call the number on your card any time you want to do anything.

That would not explain the 40-70% reductions the article cites in actual emergency admissions (strokes etc).

Update: whoever downvoted this, I challenge you to state why.

I down voted it because you are arguing about down votes (meta rating) which is against the etiquette / rules.

Had a dozen visits to the ER. I was Constantly sent away because nothing serious. Tests generally clean. Told it was mental. Problems persisted.

Kept avoiding ER, I felt bad wasting time. Plus money.

Finally went in and they ran an extra test and found the issue. Probably had seen 30 doctors during all of this.

Some of the doctors were amazed I hadn’t dropped dead yet.

The realization that the median doctor is probably about as good at their job as the median techie makes me shudder at the thought of going to the ER. Yeah, I'll do it if I have to.

The old joke applies: what do you call the graduating student with the lowest grade? Doctor.

I unfortunately came to this realization as I was graduating college. A decent number of my less-than-stellar high school acquaintances were going to be attending medical school.

You not have overlooked these details when you read the article:

> One study collected data from nine hospitals across the country, focusing on a crucial procedure used to reopen a blocked cardiac artery after a heart attack. The hospitals performed 38% fewer of those procedures in March, compared with previous months.

> At Harborview Medical Center in Seattle, Dr. Malveeka Sharma has tracked a 60% decline in stroke admissions in the first half of April compared with the previous year

There's one obvious possibility... there's some evidence that flu triggers heart attacks in people already at risk for one, Covid-19 also seems to do the same, lockdowns have cut short the flu season but are less effective against Covid-19, and I've seen suggestions elsewhere that doctors are refusing to even consider doing this kind of procedure on people who test positive for Covid-19. It's possible the heart attack patients are right there in the hospitals dying untreated.

Except stroke admissions are way down too. No obvious link between the flu and strokes.

I saw an artical that corona causes strokes in young people.

Stroke patients are definitely just leaving it far too late to seek treatment. It's been happening in multiple countries. There was even an unfortunate New York Times article where a doctor talked about seeing strokes of a severity they wouldn't expect in people so young, which was spun as proof the coronavirus was causing the strokes - and it just happened to mention in passing that those patients had ignored their symptoms and taken far longer than usual to seek treatment. Of course, if coronavirus was causing strokes we'd expect an increase in stroke patients rather than a decrease.

From my link in this thread:

> MUSC, a major stroke center, averaged 550 calls per month over the past four months about possible stroke patients from the 45 to 50 emergency rooms that refer patients. But it has seen just 100 in the first half of April, said Alex Spiotta, director of neurovascular surgery.

This is not just happening at ERs, this is happening at the places ERs will refer you to, usually after checking whether you do in fact need immediate care.

This “opinion” has little bearing on the article. It specifically addresses the decline in heart attack (38%) and stroke (60%) admissions.

Similar happened to friend a week ago, he sailed right in instead of the hour or more wait he expected.

Not giving details, but he turned out to be just fine.

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