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.
