Shorter hospitals stays=more money for hospitals

Back in the day, hospitals received insurance payments for each day you were in the hospital. This method of billing created an incentive to keep you in the hospital for prolonged stays. The more days in the hospital, the more money the hospital made. Now, hospital stays are based on a code system called diagnoses-related group (DRG). Every diagnosis has a code attached to it. That code signifies the amount insurers will reimburse the hospital.  

Specialists in the hospital have a binder that lists the DRG codes, how much the hospital is reimbursed for each code, and the maximum number of days the payment covers. These specialists review your chart to create the highest billing code that will match a diagnosis. For example, you may have come to the hospital with non-threatening “angina pectoris” (chest pains), a diagnosis that brings the hospital $5,221 in revenue.  By upgrading the diagnosis to “acute myocardial infarction with cardiovascular compromise,” the hospital would receive $15,731. The hospital is reimbursed for this amount whether you stay two days or ten days. Thus, the shorter your hospital stay the more profitable your admission is for the hospital. Hospitals also have specialists whose job it is to get you out of the hospital as fast as possible, sometimes harassing your doctor or family members.

Of course, getting kicked out of the hospital quickly isn’t necessarily a bad thing. You are probably better off at home, away from bad bugs, bad food, and interrupted sleep. Plus, you’re helping your hospital make more money! 

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Get rid of the pain scale!

 Recently, I’ve been asked over and over again to rate my pain using that dumb 0-10 pain scale. I’m always at a loss as to what number to choose. One nurse told me that a 10 is surgery without an anesthetic.  I’ve no experience with that!

The pain scale is relatively new. In 1995, the American Pain Society (now defunct), began a campaign—heavily supported by Purdue Pharma and other drug companies—to promote pain as a fifth vital sign, along with temperature, pulse, blood pressure, and respiration rate. Purdue, the maker of OxyContin, started working with the Joint Commission on the Accreditation of Hospitals in a effort to pursue this objective with the result that, in 2001, the commission started judging hospitals based on patient satisfaction of pain treatment. Now we’re stuck with that scale.

Of course, there’s not much validity to these numbers. A pain I might rate a four, you might rate a six. Patients hoping for strong medications might choose a high number.  Doctors are faced with making tough prescription decisions based on the rating system. Dr. David Sherry, a pain specialist at Children’s Hospital in Philadelphia, thinks that recasting pain as a vital sign fundamentally changed the way both doctors and patients think about and respond to pain. It makes patients more conscious of pain and doctors more ready to treat it. Both attitudes, he believes are counter productive. He thinks it would be healthier for everyone to move toward the old way we saw pain—as a difficult but predictable and expected part of life.

I think they should get rid of the scale, but, from my vantage point at the moment, not the pain meds. 

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

My knee replacements

 On May 17th I had my right knee replaced. Four weeks later, on June 14th, I had my left knee replaced. I wanted to get it all over with.

I’m writing this on June 15th, lying on the couch and typing on my iPad with my left index finger. We’ll see how it goes. Normally I write these posts using Word on my desktop computer, then copy and paste them into the Blogger app. But my desktop computer is upstairs.

I’m doing well. The pain isn't too bad and I can bend it and straighten my leg pretty well. So far, I haven’t needed to take many pain meds. A physical therapist came here today. She said she was impressed with my progress.

My surgeon is Alexander Sah. Here’s his picture. When he calls, maybe I’ll ask him how old he is. I do know that he’s performed about 1500 of these surgeries and that his resume is 35 pages long. I chose him because of friends’ rave reviews.

Sah and his partner established The Center for Joint Restoration and Research at Washington Hospital in Fremont, about an hour’s drive north from our house. An entire wing of the hospital is devoted to this outfit. I found it interesting that not one of the many people dealing with me was white. They were a mix of Chinese, African, Indian, and I don’t know what else. All the patients I saw were white. I looked up the demographics of Fremont: 61 percent Asian, 22 percent white.

I hope all this lying around on the couch day after day doesn’t atrophy all my muscles. I’m looking forward to getting back to golf and gardening (house cleaning not so much).

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Our quirky bodies

 Even if I drink a lot, I never pee very much. I can go ten hours without emptying my bladder. I think my tissues just hang on to water, as they seem to be doing right now. I had my knee replaced on May 17^th and, as I write this ten days later, it’s still quite swollen. The swelling isn’t going down as fast as I’d like, but maybe that’s the case with everyone whose had this surgery.  

At the hospital, after surgery, they get you up to go to the bathroom. They place a little plastic pee-catcher under the toilet seat. You pee into that so the nurses can measure your output. Even though I’d been given fluids intravenously, I peed only a few tablespoonsful. Despite my protestations, the nurses assumed I was holding urine in my bladder. They wouldn’t let me go home until they were sure I’d emptied it—this, I guess, to ensure everything was working properly. They insisted on doing an ultrasound on my bladder to see what was in it, a procedure that delayed my discharge. The ultrasound showed that my bladder was empty. Told ya!

I’ve always gotten blisters exceptionally easily. A few years ago, I walked about 100 yards in Crocs shoes without putting socks on first, figuring I could make it from our room at Asilomar to the dining room. When I got back, I had huge blisters on both feet. My theory is that my blister-making capability is another example of my tissues hanging on to fluid. By the way, my blister problem was largely solved with the introduction of socks like SmartWool that cling smoothly to your feet with no wrinkles.

I don’t know if my theory holds any water, but I’m sticking with it.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Price gouging with combination drugs

 Doctors often prescribe drugs that are a combination of two drugs. This makes it convenient for the patient. But the cost of the combo drug is ridiculously higher than the cost of the two drugs sold separately. Here are examples: Zegerid, a drug for acid reflux, costs $86.29 per pill, while the generic components, omeprazole, which you can buy off the shelf, and sodium bicarbonate (baking soda) cost 47 cents. Vimovo, an arthritis drug, costs $2,482 for a 60-pill bottle. It is a combination of Aleve ($14.00) and Nexium ($24.00). Fosamax Plus D, has a list price of $39.05 per pill, while the generic components, Alendronate and vitamin D3 cost $1.25.

When prescribing such drugs, doctors often don’t know the high cost of such drugs. As one doctor notes, “As a physician, I often don’t know what the medications that I prescribe cost. And then when a patient goes to pick it up at the pharmacy, they only see what their copay is.” Another doctor, writing in The New England Journal of Medicine gets it. A family member asked him to pick up Onexton, an acne medicine, from the pharmacy. The pharmacy was going to charge him $800. Instead, he bought the ingredients separately for about $20. The same doctor helped an uninsured patient save money on blood pressure medicine. Instead of paying $90 for Hyzaar DS, he prescribed the drug’s components, bringing the price down to $6.00.  

While insured people usually dole out a small co-pay for such drugs, Medicare shells out $925 million more for these combination drugs than they would pay for their generic components (2016 figures). As one cost economist says of the drug companies, “Their business model essentially involves gouging insurers and health plans, which ultimately costs consumers.”

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.