I recently had to care for my 89-year-old father when he was admitted to the hospital. He had fallen after feeling dizzy and having a bad headache. My belief is that he had a transient ischemic attack (TIA), or a ministroke. He was taken by ambulance to a major teaching institution. While in the hospital, he was poked and prodded for three days and underwent some rather expensive tests. He was given a CT scan to detect bleeding in the brain and a heart ultrasound to detect heart valve insufficiency.
The attending physician told me it was not a ministroke even though he exhibited classic symptoms of one. Her feeling was that even if he did suffer a ministroke, there was nothing they could have done anyway (and she was right based on the current standards of care).
After two days in the hospital (including an overnight stay), he was well enough to be discharged under my care. Due to Medicare rules on inpatient versus outpatient care, however, the hospital wanted him to stay an extra day—to equal two overnight stays—so the hospital would obtain the higher inpatient reimbursement.
Additionally, it was recommended that he receive physical and occupational therapy for a week at a skilled nursing facility. But in order for him to be eligible for coverage under Medicare for skilled nursing services, he would have been required to stay in the hospital for another night—for a full three days. If he had gone to the skilled nursing facility recommended by the hospital, he would have been transported by ambulance—another cost that would have been incurred by Medicare. An expensive one at that. Incidentally, my mother was also in another nursing facility recuperating from back surgery performed at the same institution, and this medical center was going to send my father to a different nursing facility.
In the end, I convinced the hospital to let me take him to the nursing facility my mother was at, which pleased my father.
Still, while my father could have been discharged a day early based on his feeling fine with no residual symptoms, he was required to stay an extra day in the hospital to be poked and prodded by physicians. This academic medical center did not have access to my father’s records, including details of his prior ministroke, as the records were kept at a competing hospital that was not part of his treating hospital system. The simple reasons that hospitals and providers can’t or don’t share records are twofold: Too many different software systems exist and to get them to talk to each other would cost billions; and hospitals are in competition with one another, promoting a distinct lack of coordination. Because of this, many of the same tests were repeated, including a heart ultrasound that revealed the same findings from his previous test—that he suffered from mitral valve regurgitation.
What a waste of resources! What a screwy health care policy by Medicare!
Medicare could have saved significant taxpayer dollars by covering my father for the skilled nursing facility based on an earlier discharge.
Despite all of the cost reduction and greater access required by the Patient Protection and Affordable Care Act, we have a long way to go to address fragmented and uncoordinated care, which is an important component of driving down costs. It does not help that hospitals and other providers know how to stretch Medicare policies to maximize their revenues.