PCP with hospital admission rights: does it matter?

[Accidental Retiree]

In my current bout with a debilitating back issue, I recently took a trip to the ER in the very early morning.

With the weekend now approaching, I talked to my doctor’s office about next steps; for example, how I’d go about being admitted to the hospital over the weekend, if things don’t improve, so that I don’t have to call 911 again.

The office told me the doctor doesn’t have “rights,” so if I need to go back to the hospital, I’d still have to take the 911 route.

Reading up a bit on this, I see that hospitalists are the doctors that take care of us in hospital although some PCPs do have admitting rights.

I’m wondering whether I need to find another doctor who has those rights.

How much does it matter?

I’m not even sure what questions I should be asking, so I’ll appreciate your feedback.

 

[Rianne]

Yep, it's my understanding you always have to call 911. Our ER is awful. They don't triage incoming patients. Everyone is treated equally unless you come in by ambulance. I was told if I'm sitting in a Dr office, and have some time of emergency health event, they call 911 and I go to the ER.

I think they have to evaluate what the real problem is in the ER. For instance, you have a terrible headache and it's really a stroke. Sending you to the wrong department is a liability. Not that the ER can figure it out either. I had a small bowel obstruction and they sent me home twice with a flu diagnosis. Could have died. Oh well.

 

[harllee]

There are some hospitals with much better ERs and doctors than others. In our area everyone tries to avoid the huge hospital ER and everyone tries to go to a smaller ER with much less wait time and better ER docs.

But my first question is whether you really want to go to an ER about back pain. I too have had debilitating back pain and eventually had back surgery but I avoided the ER. Are you seeing a back pain specialist? orthopedic or neurologist?

 

[Aerides]

For your back issues I'd go beyond your PCP for care, regardless of ER. You should find a good ortho/back doctor first. And someone who specialized in pain management (two different docs). And when you interview them, sure, they are more likely to have hospital admission rights as they often are surgeons as well - PCP's are not.

In any case, should you end up at your hospital, their MD's will coordinate with your PCP as needed. And it's most likely an ER situation would stabilize your pain, and send you on your way to a specialist vs. full admission. The deal with the acute, and send you back home to deal with the chronic.

 

[Accidental Retiree]

Thanks for your replies. You’ve given me some excellent direction for this afternoon’s talk with my NP.

While I had been diagnosed with arthritis and stenosis back in 2005, I haven’t experienced any back issues since about 2006, and never before to this extent, so I am just unaware of how these things work.

 

[MarieIG]

It's important that you stress to your NP how severe your pain is.

You may need referrals to the appropriate specialists - and you may need additional diagnostic testing.

Frequently (although not always) the treatment of back pain goes in stages, such as muscle relaxers, pain relief medications, physical therapy, maybe home exercises and/or chiropractic, (diagnostics such as MRIs), pain management specialist (injections), and surgery. And - there is a very broad spectrum as to the type/ extent of potential surgeries.

My son as a teenager had horrific back pain (and three badly herniated dics with nerve root compression). After five years of conservative treatment DH found a top surgeon at the Hosptial for Special Surgery in NYC, and due to my son's young age, the surgeon performed micro discectomies to spare as much of my son's spine as possible. The PC cleared him for surgery, but did not have privileges at that hospital.

 

[marko]

I've never heard of needing to call 911 to get into the ER. Two months ago I just walked in on four different occasions. Most everyone there had walked in with some minor injury.

Heck, the place was half full with homeless people who just needed a place to sleep.

 

[Aerides]

I've never heard of needing to call 911 to get into the ER. Two months ago I just walked in on four different occasions. Most everyone there had walked in with some minor injury.

You don't need to call 911, but if you need immediate care, then 911 gets your an EMT and ambulance and they will start stabilizing you in your driveway. You'll then get more immediate action arriving on a gurney vs. walking in.

Trust me, if you are ever having a heart attack or stroke or any life-threatening emergency, you call 911. You do not simply have someone drive you to the hospital.

Walking in is for injuries. 911 is for potential life-sustaining assistance en route.

 

[RetMD21]

Even if your doctor has the ability to admit the hospital wants you to go through the ER. It's about $

 

[foxfirev5]

It depends. What is your insurance? Medicare, Medigap, ACA, employer coverage or Medicare. DW broke her foot in Key West and I took her to the ER. Promptly treated and we were on our way. No cost. However I couldn't help but notice the old man with chest pains who got the slow ride. DW suspected he was a frequent flyer. We have some serious healthcare issues.

 

[badatmath]

My insurance has a $200 ER penalty if you go to the ER and are not admitted. This is over and above what any cost actually is.

It doesn't matter to them if it is a good reason or not as far as I know. It just you went, you pay.

To be sure I have not had a lot of practice.

 

[Accidental Retiree]

You don't need to call 911, but if you need immediate care, then 911 gets your an EMT and ambulance and they will start stabilizing you in your driveway. You'll then get more immediate action arriving on a gurney vs. walking in.

Trust me, if you are ever having a heart attack or stroke or any life-threatening emergency, you call 911. You do not simply have someone drive you to the hospital.

Walking in is for injuries. 911 is for potential life-sustaining assistance en route.

I called 911 because it was the middle of the night Sunday/Monday, I had been in increasingly bad pain since Saturday morning, I could not walk or stand or sit so could not get transported other than flat on my back—and even that was pretty excruciating—and I was shaking so hard I thought I was starting to have seizures or something. My blood pressure also apparently shot way up in the ambulance and stayed high until that nice nurse finally gave me morphine about 4 hours later.

I’m a medical issues rookie and had called our local PD’s non-emergency line and explained the situation. The dispatcher immediately sent the guys right over to assess me and they decided to transport me to ER.

I was and am very grateful for the care I received from start to finish, but I’m thinking that ride—indeed, that whole 4-hour experience—will end up in the “Blow That Dough” thread.

 

[Dash man]

I have chronic lower back issues and cervical spine issues. Last year I had severe back pain like someone was touching bare electrical wires to an exposed nerve. I fell to the ground and could only find relief by laying on my left side. My wife called an insurance nurse 24hr hotline since it wasn’t a life threatening emergency, but the pain wouldn’t subside. They said to call 911, so she did. I rode on the gurney on my left side. They offered some Demerol, but it didn’t do any good. At the hospital I received two more doses of Demerol and they sent me home, still in pain. I was screaming when they put me in a wheelchair to take me out. I will never ever go back to that hospital.
My pain is mostly managed by my Interventional Pain Management doctor who is great. He keeps me going with nerve blocks, facet injections and ablations. Unfortunately Medicare only allows one ablation per location per year, so primarily nerve blocks get me through the rest of each year. I also take 3,000 mg of Tylenol per day, and use muscle relaxers and hydrocodone when needed.
Life goes on.

 

[disneysteve]

The office told me the doctor doesn’t have “rights,” so if I need to go back to the hospital, I’d still have to take the 911 route.

Reading up a bit on this, I see that hospitalists are the doctors that take care of us in hospital although some PCPs do have admitting rights.

I’m wondering whether I need to find another doctor who has those rights.

The days of family doctors taking care of their own patients in the hospital are long gone for the most part. It's a very outdated and inefficient system that has thankfully been replaced by hospitalists. Rather than your care being managed by your PCP who is also swamped running their office and squeezing in brief hospital rounds early in the morning or late in the evening after hours, you're now cared for by someone whose full time job is doing nothing but caring for hospitalized patients. A member of the hospitalist team is on site 24/7, able to respond to everything in a timely manner, follow up on test results, place orders, make specialist referrals, whatever is needed.


Don't go searching for a PCP who does hospital work. You don't actually want that.

 

[disneysteve]

Yep, it's my understanding you always have to call 911.

You should only call 911 for a true emergency that can't wait until you get to the hospital, or if you have no other means of getting there. Think you're having a heart attack? Call 911. Think you broke your arm but your spouse is there to drive you to the ER. Don't call 911.

 

[disneysteve]

You don't need to call 911, but if you need immediate care, then 911 gets your an EMT and ambulance and they will start stabilizing you in your driveway. You'll then get more immediate action arriving on a gurney vs. walking in.

Trust me, if you are ever having a heart attack or stroke or any life-threatening emergency, you call 911. You do not simply have someone drive you to the hospital.

Walking in is for injuries. 911 is for potential life-sustaining assistance en route.

I agree with all of this with the possible exception of the bolded part. ER patients are treated based on severity, not how they arrived. If you call 911 for something not life-threatening, being brought in by ambulance isn't going to get you seen any faster.

 

[disneysteve]

Even if your doctor has the ability to admit the hospital wants you to go through the ER. It's about $

It's actually about getting you prompt care. If a doctor does a direct admission, it could be quite some time before you're seen by a doctor. Heck, it could be hours before they even have a room available for you. If you go through the ER, you get triaged and any urgent care is started right away. Labs, x-rays, CT scans can all be done relatively quickly. On the floor, all of that stuff can take hours.


That's not to say that direct admissions aren't okay sometimes. My wife was a direct admit back in March when outpatient labs identified a problem that required hospitalization but it wasn't an emergency situation. Her orthopedic surgeon made the arrangements and the hospital called when they were ready for her and we headed over.


So for emergencies, use the ER. For non-emergencies, direct admission might be an option.

 

[badatmath]

You should only call 911 for a true emergency that can't wait until you get to the hospital, or if you have no other means of getting there. Think you're having a heart attack? Call 911. Think you broke your arm but your spouse is there to drive you to the ER. Don't call 911.

I thought you were supposed to go to urgent care for broken arms unless you had bones sticking out. . . as they would not be life threatening. Doesn't the ER just xray you and send you home or do they actually set it?

 

[Aerides]

I agree with all of this with the possible exception of the bolded part. ER patients are treated based on severity, not how they arrived. If you call 911 for something not life-threatening, being brought in by ambulance isn't going to get you seen any faster.

Right, I mean, you stub your toe and call 911 you aren't going to the front of the line. Broken bones (profuse bleeding aside), anything where you are ambulatory and not in danger of dying in the next 8 hours, get in line and wait your turn.

But you do NOT want to walk into the ER if you think you had a heart attack. Or can't breathe. (sorry OP, yes you go to the ER, and if you are single or otherwise unable to get yourself there then sure).

Like for like: The person on the Ambulance gurney with a probable heart attack, validated by the EMT's, is going ahead of the walk-in in the probable heart attack, validated by nothing but his own description of symptoms.

 

[RetMD21]

It's actually about getting you prompt care. If a doctor does a direct admission, it could be quite some time before you're seen by a doctor. Heck, it could be hours before they even have a room available for you. If you go through the ER, you get triaged and any urgent care is started right away. Labs, x-rays, CT scans can all be done relatively quickly. On the floor, all of that stuff can take hours.


That's not to say that direct admissions aren't okay sometimes. My wife was a direct admit back in March when outpatient labs identified a problem that required hospitalization but it wasn't an emergency situation. Her orthopedic surgeon made the arrangements and the hospital called when they were ready for her and we headed over.


So for emergencies, use the ER. For non-emergencies, direct admission might be an option.

That's nice. The local hospital got rid of direct admits. ER charges go on the outpatient bill whereas diagnostics done on the inpatient side may get bundled into the inpatient charge depending on payer. So we would see them in the office across the street, know what the problem was, be willing to take care of it but be required to run them through the ER process. It was a revenue issue.

Sometimes it is worth taking a chance on getting an insurance penalty for using the ER. Years ago a local HMO had 2 criteria for waiving the ER penalty, hospital admission or death

 

[Rianne]

I'm not sure if I understand this correctly. If you have original Medicare with part G (for instance) and you do need an ambulance, is that cost covered if you are admitted? I'm fuzzy on understanding all Medicare benefits requiring an ambulance including Medigap.

 

[aja8888]

I'm not sure if I understand this correctly. If you have original Medicare with part G (for instance) and you do need an ambulance, is that cost covered if you are admitted? I'm fuzzy on understanding all Medicare benefits requiring an ambulance including Medigap.

With Part G it's covered except for any of the $230 annual deductible you have not met already. You don't have to be admitted for coverage.

 

[Accidental Retiree]

With Part G it's covered except for any of the $230 annual deductible you have not met already. You don't have to be admitted for coverage.

That’s good to know. I have a G plan and I’d already met my deductible for the year.

 

[aja8888]

That’s good to know. I have a G plan and I’d already met my deductible for the year.

Before my DW passed last December we had many ER trips that ended with no admittance and some with, and each was covered.

Also, for Texas residents, be aware that a special DNR form is used for non-hospital use. It applies to ambulances, doctor's offices, Skilled care facilities, emergency rooms (not all are affiliated with the hospital even though they may be in the same building), and other establishments.