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The Waste-Land

I recently ran into a case of Medicare waste. No, not the kind we read about in OIG reports or DOJ actions. The kind of waste I saw is much more insidious, and it's built into our health care system.

I recently ran into a case of Medicare waste. No, not the kind
we read about in OIG reports or DOJ actions. The kind of waste I
saw is much more insidious, and it's built into our health care
system.

When my 80+ mother became ill, we started off at the office of
her primary care physician, who put her straight into a small
geriatric hospital nearby. After only eight hours, she was
transferred to a larger hospital with additional resources. After
another nine hours in that ER, she was admitted to the ICU. After
several days, she cycled to a regular room, then eventually was
discharged to a rehab facility. We didn't like it, so we
transferred her to another rehab.

On admission to each institution — a total of four —
she received an “admission kit,” one of those plastic
bins that includes things like toothpaste and a comb. I realize
Medicare doesn't cover plastic bins, and getting four separate kits
seems a miniscule waste in the world of the gigantic institutional
spending numbers we are used to seeing. But that turned out to be
only an indicator of how those numbers might get to be so big.

No one ever asked if we needed or wanted one of those kits. No
one ever suggested that we take them with us to the next place, or
inquired whether we wanted to donate them. I admit I might have
considered it a nuisance if anyone had mentioned saving a plastic
cup or a vial of deodorant (also part of the kits) when, at the
time, I was more concerned about my mom's condition than whether
she had a toothbrush. But shouldn't someone have brought it up?

I'm also sure there must be some kind of clinical rule that once
a kit makes it into a patient space, it can't be sent back to the
storage room. I will note, however, that it seems pretty wasteful
for an untouched plastic tub where everything is inside cellophane
packages to get tossed. Either that or whoever ended up with those
first few kits has a lifetime supply of travel-size shampoos and
lotions.

The same thing happened with my mom's normal daily medications.
At each place, those meds — about a two-page printout's worth
— had to be ordered from that individual institution's
pharmacy. When I asked if they could transfer with her, or if I
could have the unused part of the order to take home, I was told
that was a no-no, too.

That meant four separate pharmacy orders for the exact same
meds. I know what those meds cost, and it is by no means an
insignificant expense.

Neither is blood work. Within the first 24 hours, my mother had
blood drawn and sent to the lab for some of the same tests at the
doctor's office, the geriatric hospital, the larger hospital ER and
then the ICU where she ended up. After I regained my wits that is
something I was able to stop — but only after my mother had
had more than 30 vials of blood drawn within a day, and only after
a number of duplicate tests had been run. The tests were requested
by doctors and processed by labs within the same system, which
shares records and data across facilities. That was not only
wasteful but painful for my mom.

So, let's count up. For this one episode for this one patient,
we ended up with four admission kits, four separate pharmacy orders
for the same meds, I'm not sure how many duplicate lab tests and, a
number I haven't mentioned yet, eight different doctors. If you
multiply all that by the countless other patients, Medicare or
otherwise, who probably experience some of the same things, you can
see how the costs climb up there.

I have to point out that I'm incredibly grateful for the
excellent care my mother received. It could not have been better.
But crossing care settings was an eye-opener when it comes to
details about how waste in the system happens and why health care
costs are skyrocketing.

The only bill I've gotten so far is for the eight-hour geriatric
hospital stay, and it totals almost $4,000. My mother remains in
rehab (she is thankfully on the mend), so I'm not sure what the
final tab will be.

This is not fraud or abuse. It is simply system waste that we
need to get a handle on. And it doesn't have a thing to do with
DME.



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