After Obamas stunning victory Tuesday, I got an email from an old friend asking if we were concerned about the ramifications of socialized national healthcare on our business. I was asked how we would prepare. I was asked if I was happy about the election results. My friend Larry put it best in his response to the recent voting experience...I didn't see "none of the above" on the ballot. Amen brother, and ditto.
So in response to my other friends inquiry...how will we prepare?
I get it, believe me, but I have seen the worst in the business, and yes: healthcare is a business. I want to tell you a story that I think illustrates what I'm talking about here. A few months ago, we were pursuing a contract with a 42 bed rehab facility (physical, not substance). The facility was across the street from a major hospital, and seen many of the long term care patients after they were discharged from the neighboring acute care facility.
Patients that have been sedentary for an extended period of time can develop blood clots in their lower extremities, a potentially deadly condition called DVT (deep vein thrombosis). This condition is easily detected by MRI with contrast, but MRI is expensive and insurance companies won't pay for it simply to rule out a certain condition. DVT is also easily diagnosed with vascular ultrasound, a portable and much less expensive modality. Still, insurance won't cover the DVT ultrasound because in such cases it would be considered a screening, and therefore unnecessary.
Lets compound the problem...The rehab center is scared to death of DVT. If they admit a patient that has all of the classic warning signs of potential DVT...swelling, edema, sedentary for an extended period, trauma or surgery in the lower extremities... then they are assuming a huge liability. What if the clot breaks loose when they put the patient into physical therapy? The patient could die. Would the family sue the insurance company? The hospital? No, of course not...they sue the rehab center. So since the rehab center is not chartered to do diagnostic imaging, they would simply admit the patients, never take them off the gurney, then turn right around and send them back to the hospital for an ultrasound...on the rehab center's dime of course, because an ounce of prevention is worth a pound of cure, right?
This whole ordeal is like a six hour process for the patient. Oh, and how do they get them back to the hospital for the ultrasound? Ambulance of course. $400 dollars each way. So, here we come...we show up on our white horses offering to bring the ultrasound to the rehab center for a flat fee, everybody wins, right?
When talking to the administrator of the rehab center I discovered perhaps the most disturbing bit of insight that I had heard in years. While we were trying to negotiate a time frame that we could arrive and see his patients, he informs me quite casually that they never admit patients from the hospital across the street before 2pm. This presented a small challenge for me since I only had two morning slots available. If he wanted afternoons, I would have to rearrange a tech or go hire someone. Not a big issue, but big enough for me to pry a little deeper.
"So, why do you only admit in the afternoon?" I asked. "Simple", he says with a perplexed, "I can't believe I have to explain this" sort of look on his face... "The first shift nursing staff at the hospital across the street get off at three in the afternoon. If they release a patient before two, they have to prep the room for a new patient, set IV's, capture the new patients vitals, etc. You know, do some actual work. If they release their patients after 2pm, the second shift has to admit the new patients."
So there you have it. Now you know. Now you know why you have to wait forever. It is sad really, but very, very true. Fixing that is to fix our collective morality, and althouh Obama's good, I've seen no water-walking from the guy yet.
