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Health Insurance Coverage And Leaving The Hospital Against Medical Advice

There is a huge myth being unknowingly  perpetrated against the general public when it comes to their rights and responsibilities as a patient.  It’s a myth that I can remember hearing as far back as my first few weeks of clinicals during medical school.  It was a constant presence during my residency training and even now, as a private practice hospitalist I hear misinformation being handed down day after day, month after month.

This myth is perpetrated by doctors, nurses, and therapists of all kinds.  What is this myth?  That their health insurance company will not pay for the care provided if they want to leave against the medical advice of their physician.

Will my insurance company pay if I leave against medical advice (AMA)? Yes.  They will pay.  Medicare and Medicaid pay for services that are medically necessary.  For example, if you go to the ER and the doctor recommends a CT scan of your chest and you decline, this does not mean the insurance company will deny payment for your visit to the emergency room.  This is what  the informed consent process is for.  If you have been admitted for a medical condition that requires hospitalization and your care plan meets Medicare medical necessity muster, your care will be paid for whether you leave the hospital when your physician believes it is safe or not.   Read more »

*This blog post was originally published at The Happy Hospitalist*

More Medical Waste: Does A $6000 Flashlight Improve Patient Outcomes?

So I’m rounding in the ICU the other day when I came upon this new hospital medical device.  It’s called a pupillometer.  What does this pupillometer do?  It  measures subtle changes in the light reflex of the pupil to help take the physical exam to the next level of precision.

Or eliminate it, depending on how you look at it.  What used to be a basic physical exam skill is now being replaced by a $6000 piece of medical technology that can distinguish tiny changes in pupil size. Now the real questions remain.  Has this pupillometer device gone through the rigors of randomized trials in the ICU to define whether a  $6000 flashlight changes outcomes or mortality?   And if not, how do we allow medications to require such testing but not the technology that often changes nothing and simply makes health care more expensive.

The way I see things, if I’m trying to decide whether someone’s pupils constrict 1% vs 3% vs 10%, I’m getting a palliative care consult instead and putting the pupillometer back in my holster.

First the vein light.  Now the pupillomter.   And I thought the super bright LED pen light was all the rage.

*This blog post was originally published at The Happy Hospitalist*

Bariatric Bathrooms: Toilets Built For 500 Pound Patrons?

America’s handicap bathroom definition has officially left the train depot for the next station. In America, we are entitled to life, liberty and the pursuit of happiness.

Oh yeah, and bariatric rated bathrooms. I snapped this picture of a bariatric rated “handicap bathroom” at the hospital Mrs Happy delivered Zachary

A part of me feels for folks who struggle through life outside their home in search of a toilet adequate enough to do their thing. Bathrooms and toilets simply aren’t made to hold the weight or size of 300, 400 or 500 pound people and neither are the hospital toilets.

Part of me wants to believe these bariatric rated bathrooms are for the oversized pregnant women on the floor. But the rational side in me knows otherwise. America is fat. And we have the bariatric rated handicap bathrooms to prove it.

*This blog post was originally published at The Happy Hospitalist*

Quiz: What Is The Most Frequently Shoplifted Item At Walgreens?

I’m not sure if this is true or not, or if it’s a local phenomenon, but I heard a discussion the other day from a previous Walgreens employee describing the most shoplifted item in their store.  Are you ready for this…..

Hemorrhoid creams and suppositories.

There are apparently a lot of a**holes in this world that get rubbed the wrong way.

*This blog post was originally published at The Happy Hospitalist*

How A Patient Who Asks For Salt For His Eggs Could Cost A Hospital $2.5 Million

This was a classic moment of comical clarity that only comes along once a week.  As you may or may not know, starting in 2013, The Medicare National Bank has promised to take back 1% of all  of a hospital’s total Medicare revenue (to increase in future years) if the hospital has a higher 30 day readmission rate for  congestive heart failure, acute myocardial infarction or pneumonia than an as yet undefined acceptable 30 day rate of readmission.

What does this mean?  It means if the government decides that 20% is an acceptable rate for congestive heart failure 30 day readmission, and the hospital has a readmission rate of 25%, the hospital will be told to return 1% of all Medicare revenue for the year, not just their heart failure revenue.

Let’s use some hypothetical numbers, shall we?  If a hospital generates $250 million dollars in a year on 25,000 Medicare discharge diagnosis related groups (DRGs)  but only 100 of those discharge DRGs (or $1,000,000) were heart failure in 2013, what would happen if 21 CHF patients returned for readmission  (a 21% thirty day readmission rate) within 30 days for heart failure instead of allowable 20%? The hospital would have to return 2.5 million dollars (1% of their total revenue on all Medicare admissions).
That one patient that took them from 20% to 21% will cost them 2.5 million dollars.  The hospital would generate one million dollars in CHF  revenue for the year and pay back 2.5 million dollars in penalty.  That’s a pretty hefty price to pay considering that hospital profit margins from Medicare have been negative, on average, for most of the last decade. Read more »

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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