Friday, September 12, 2008

Broken Healthcare

The Blog that Ate Manhattan made an interesting post today discussing the broken healthcare system when a scenario was related in which an insurance company would not pay for home nursing services for weekend wound checks. They instructed the patient to go to the ER for this follow up while the physician's office was closed.

I had a similar situation a few months ago. I was collaborating with a urologist on a mutual patient which was an elderly lady with recurrent urinary tract infections. This time, she had developed a UTI which was resistant to all oral antibiotics and the only antibiotic the bacteria was sensitive to was Amikacin. The urologist recommended we admit her for IV antibiotics. However, the patient was stable and afebrile as well. So when I asked him if we could treat her with IV antibiotics as an outpatient with home health he agreed.

Sounds like a good plan, right? Keeps the patient out of the hospital which prevents her from potentially aquiring a hospital-aquired infection, saves the system money, etc. Nope. Medicare would not pay for this service. Additionally, the hospital owns a home health agency and I spoke with the social workers, discharge planners and even one of the administrators. They refused to do it. In essence for the DRG, they are willing to risk further infection and potential "never events."

The unfortunate patient had to come into the hospital and fortunately did not have an adverse event. She did end up growing a second bacteria on re-culture and had to have 20 total days of IV antibiotics before she was sent home.

The system is definitely broken.

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