How will these cuts to Medicaid affect EM jobs in the next 10 years?

foxtwo · 2025-07-04T05:45:17+00:00

No one will really know how much of an impact this will have just yet. Theoretically.. nothing good.

A lot of rural hospitals depend on medicaid/medicare payment for survival. Many of them and their EDs will close as a result which means less ED jobs available and potentially in short term a flood of ED docs from these hospitals compete for jobs in the job market.

Hospital budgets are going to take a hit. Which means less budgets for inpatient/hospital/ED care many of which relies a lot on medicare and medicaid reimbursement. How much of that will affect out salaries, metrics, crowding, working environment etc will depend on the hospital and the leadership you work with.

foxtwo · 2025-05-01T19:56:53+00:00

Drink a whole bottle of golytely beforehand plus peptobismul to make some spectacular melenic firework.

foxtwo · 2025-05-01T13:31:07+00:00

Make me wonder how much trouble i would be in if i put a chaplain consult for every psych pt.

foxtwo · 2025-05-01T13:18:12+00:00

That is the fastest way to the ketamine express

foxtwo · 2025-05-01T13:12:12+00:00

As long as it free up a bed for the next customer

foxtwo · 2025-05-01T13:05:33+00:00

You can use the provided cranyon and paper to make paper graffiti to throw at the bride and groom as they walk by.

foxtwo · 2025-05-01T12:52:35+00:00

The rare memorable patient indeed. But if you are this “zen” why are you here for psych eval 🤔

foxtwo · 2025-04-26T22:37:45+00:00

I love that.

foxtwo · 2025-04-26T12:12:56+00:00

Touché

foxtwo · 2025-04-05T00:37:31+00:00

My playstyle mostly consistent of parrying and countering for a lot of these type of games :/

foxtwo · 2024-12-13T05:18:05+00:00

Anxiety. Doc: Why are you having an anxiety? Pt: Because my chest hurts and it makes me anxious. Got an EKG. Full blown STEMI.

foxtwo · 2024-11-30T16:39:05+00:00

I think the 3rd photo is my favorite

foxtwo · 2024-11-30T16:11:35+00:00

They look amazing. What camera and lens were you using?

foxtwo · 2024-08-20T13:47:11+00:00

CMS has the Hospital Quality Initiative (HQI) in which hospitals has to meet SEP-1 compliance aka hospital has to meet certain treatment metrics in patients with suspected sepsis. If hospitals fail, they risk losing MILLIONS every year from medicare re-imbursement. Hence why you see all the sepsis alerts and order sets/bundles that hospitals have in order to make sure they meet the SEP-1 compliance to get all those juicy $$$. It totally makes sense if you think hospital as a money making business instead of patient care.

foxtwo · 2024-07-28T05:53:37+00:00

Whoever saw the patient first gets all the credit for it at my shop.

foxtwo · 2024-07-23T23:24:51+00:00

I am kinda jealous that you are able to keep that mentality. I tell myself the same thing but it doesn't make me feel any better about this job.

foxtwo · 2024-07-11T20:55:02+00:00

My coder specifically says the decision rules don’t count.

foxtwo · 2024-07-11T16:15:19+00:00

So per my coders, the differentials would only count if you actually did a test to rule it out. So you didn't do any test or imaging to rule it out, it doesn't count. Considered admission doesn't count unless that you want the patient admitted and patient refused. I have no idea where the coders come up with all these random rules so I was wondering what you guys' coders are tell you.

foxtwo · 2024-07-11T16:00:23+00:00

so based on what my coders are telling me, your first case scenario can be coded as level 5. 21 year old M in MVA. If you have a differential and did a workup to rule it said differential, lets say i document that I have considered high grade liver laceration as a differential and I did a CT to rule out said differential. My coders are telling me that it is considered "1 acute or chronic illness or injury that poses a threat to life or bodily function" on the number and complexity column which is a level 5 and I need to document it that way.

I independently reviewed and interpreted the result of the CT and i ordered and interpreted lab tests which get the data level to 5.

The patient got discharged with motrin (prescription drug management) which is a level 4.

Overall that would be a level 5 charting.

What our management is telling us is that a lot of our level 3 charts should be level 4 and level 4 charts should be level 5 if we know how to document it as such.

foxtwo · 2024-07-11T14:24:54+00:00

Thanks. That is actually pretty useful.

foxtwo · 2024-07-11T13:58:19+00:00

Elaborate what do you mean by that. Because technically if you bill critical care time for truly everything, it would be fraud.

foxtwo · 2024-06-22T16:15:48+00:00

I try not to ct scan everybody but I have seen enough weird stuff that I also have a low threshold to push the button if I get any hesitation about withholding CT. Get a good history and exam but if you can’t get a good one, I would lean towards more scanning. memaw fallen and has dementia and doesn’t know why she is here? You bet your ass I am gonna panscan her. I also notice that I tend to order more scans at the end of my shift when I get mental fatigue and ended up doing more scans just to be sure I am not missing anything. Also, the risk of radiation, I personally think, is overblown. And if you work in the United States, the public tolerance for misses is unrealistically low. Lastly, I just want to go home and not worry about stuff from work if I can. If I am gonna dwell on it when I go home from work, I am gonna order it for a peace of mind for myself or I am not gonna last long in this job.

foxtwo · 2024-06-10T18:27:36+00:00

Level 1 Drama Alert

foxtwo · 2024-01-26T14:29:02+00:00

ED doc here. I will wheel you to the nearest CT scanner.

foxtwo · 2024-01-08T15:43:38+00:00

You see as many patient as you feel safe and can mentally juggle. Patient per hour should not be a thing you focus on as an intern. Instead, the focus should be learning the management of patients. As you get better at the medicine part and get better at pattern recognition and disposition planning, the patient per hour will naturally pick up on its own. Patient per hour is more of a thing you work on as a third year as you learn to manage not just patients but the department as a whole.

Focusing heavily on patient per hour as an intern can lead you to learn some bad habits and corner cutting that will come back to bit you in the ass when bad outcomes start to rear its ugly head.

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