Medical Story of the Week
This comes from a regular physician reader of the Authentic Medicine Blog:
Around Christmas time, a family member on Medicare went to her “Local Mega HMO Clinic” because she was still anemic from bleeding hemorrhoids which had been operated on successfully several months ago. They NEVER checked her B12 levels, just iron and hemoglobin levels. This does not surprise me because a B12 injection costs less than $2, but a blood transfusion is like red gold. But that isn’t the real outrage hereSo she goes to get yet another blood transfusion at the clinic and has an allergic reaction this time. Her provider deems it appropriate to transfer her to the hospital next door (of course, we can correctly assume this brand new hospital is attached directly to the clinic so the clinic can bill higher rates). Because this is a small town, the clinic/hospital is correspondingly small, too. To walk between the front doors of the clinic and hospital is maybe 500 feet on the outside, even less inside. They called the ambulance crew to put her in a gurney and take her over to the hospital. She just asked if she could walk over there herself or if her husband could wheel her over in a wheel chair via the indoor corridor. She was then informed that “due to HIPAA regulations she had to be transported via gurney in an ambulance.” She was loaded into the ambulance which ceremoniously drove all the way behind and around the complex and then ended up back at the front, but other door. She and her husband were so disgusted by this theatrical antic imposed on them that her husband sarcastically asked if it wouldn’t have been better to helicopter her next door. The head nurse in all seriousness replied, “Oh no we can’t. It is too foggy to fly today.”Does anyone need to ask why our healthcare costs are skyrocketing out of control?
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Bet the hospital had bought the practice!
Occasionally I see a patient with fecal impaction in my office. When I first went into practice, we arranged for a visiting nurse to go to the patient’s home to disimpact them — no muss, no fuss, no patient complaints. It was a fast, successful, and low cost solution.
All that ended when Medicare stopped paying for the visiting nurse. Now, the patient has to go to the E.R., incur new and additional charges, and even though we call in advance and send them with a note of what to do, they occasionally get a C.T. scan “just to be sure.”
You didn’t really just say “no muss” about a disimpaction, did you?
Touché! 😉
Oh no, there will be another tongue-in-cheek comment about this, too!
Ah, shades of ye olde Placebo Gazette.
Non-medical person here – at 70 got first kidney stone – real pain – called my small town ambulance for ride to local hospital – they were “out-of-service” so next town over had to get me – never mind what went on after – the town over charged BCBS $1638 for the ride whereas 23 months earlier for a ‘heart attack’ my own town to the SAME hospital billed BCBS $619, to be fair, this was at Noon and the latest was at midnight – perhaps After Midnight the fee doubles – the late great JJ Cale would be proud ………….
In the last hospital that I worked at there was an attached Veteran’s home with a hallway that leads to the ER. But, any patient being sent to the ER for evaluation (most often for nothing serious) would have to be transported not by wheelchair down the hall, but by ambulance. The poor patient would have to be swaddled in blankets and strapped to a gurney, rolled outside and into the rig, then driven through the parking lot to the ER ambulance door to be off loaded. EMTALA law supposedly applies because it’s considered a transfer.
Weird.
We have patients refuse ambulance transport to the hospital every day (and it’s several miles away).
We just warn them about how they could have a heart attack / pass out / die on the way, have them sign the release form and let them go.
You can’t force people to take the ambulance if their mental status is normal. It’s illegal.
Medicare requires an ABN for ordering a b12 level with the diagnosis code anemia. Maybe they wanted to order it before but couldn’t find an “appropriate” ICD code.