Grab Your Afghan

I an attempt to reign in the mushroom cloud of expense associated with providing health services to the aging, Medicare has established all sorts of hoops, chasms and cliffs to navigate in order to get reimbursed for services. Among them is readmission within 30 days. Currently we are moving to a standard which provides there will be no payment if a Medicare patient is readmitted, for any reason, to a hospital within 30 days of discharge.

On the surface that seems reasonable.  If you get someone better they should stay better. A thirty day warranty seems conservative enough. Right?

Not always. I replaced a man's hip last week. He's in his 70's. He lives at home with his wife. He has no other disabilities.  He had his surgery and 2 days later was up and at it, ready to go home.  He would qualify for an intermediate level of care but both he and his wife wanted him home. So, off he went with a smile.

One week later he and his wife are in my office. He looks pale, he hurts, his wife is ready to pull her hair out. While he goes to X-ray she pulls me aside, "I can't take this. He yells at me. He just sits in his recliner. He's using a urinal instead of the bathroom. He won't even try to do anything for himself. I can't take this. Can we put him back in the hospital?" (I'm sure for some readers that may sound like their man even when he's not sick!)

Back he went.  His internist, a super compassionate kind of doc, re-admitted him, and rightly so. He was a little dehydrated and just plain wiped out. In short, he made the wrong decision going home. Unfortunately, I don't know if Medicare will pay for that.  It won't be paid for in the near future.

People can't get in the hospital anymore just because they're worn out, tired, or, sometimes, even if they're sick.  And, once in, they don't necessarily get to stay. Some of these changes are certainly for the better and others definitely not.  This much is for certain: Your doctor's judgement, compassion, and desire to do the right thing has little weight in contemporary medical decision making.

These days, cost trumps compassion. It may be time to get your afghan, rocker, and urinal lined up. Such may be the future of home care.