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Tuesday, September 21, 2010

Medicare Cost and Million Gazillion Dollars.

Recent new estimates from US government reported a 17.3% increase in health care spending as compared to the previous year. This is the largest jump in half a century. 2.5 trillion spent on healthcare was 134 billion more than last year. These are very huge numbers, beyond my comprehension. The way I see it they will continue to grow.

How we contribute to this cost, is best explained in the words of a patient I recently admitted.

ER called me regarding a patient who was unresponsive. She was in her late eighties. Patient had a comprehensive work up including labs, chest x-ray, EKG, cardiac enzymes and CT of the brain. These entire series of tests were predominantly negative.

When I saw her on the floor she struck me as all gray, her hair was all gray, skin ashen and face pale; like a flower dying slowly. She was still not responding to any commands, I saw that there was an order for a MRI of the brain and carotid ultrasound. After examining her I reviewed the records in the chart from the nursing home and among other things there was a DNR (Do Not Resuscitate) order in the chart.

I called the son and he asked me, what his mother was doing in the hospital. I told him about her grim status. He informed me that she was always good to him, he was her favorite.  She had started to deteriorate once dementia started to set it.   Now she had been non verbal for a year. She was like an empty shell. He decided to enroll her in hospice a year ago. I assured him that I will call hospice. Within few hours hospice saw the patient, I cancelled all pending labs and test and she was transferred to nursing home with hospice. 

Hospice patients just want to be comfortable, they do not want any heroic measures or any further diagnostic test. Even within twelve hours of her stay in the hospital, Medicare will be billed probably more then 15 grand, excluding bills from EMS etc. All of this could have been saved if someone had paid more attention to her code status at the nursing home, ER or on the floor.

The sad part is not just the cost of care but taking the opportunity away from some loved one to die in peace rather than dying with tubes coming in and out of you.

About the picture: I shot this at my backyard.

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