Jay Owen Beyond GDP


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Avoiding the healthcare “tow truck trap” lowers costs, improves health. 



Imagine your car broke and towed to the shop. The mechanics listened, poked, and prodded, and explained what your choices were, and the costs.   You choose one, and agree to leave the car for repair.  In a day or so, you go get the car, and are assured everything is fine now. After handing over your credit card (Ouch – that much?), you get the keys and drive off.


Several days later the car breaks again – in roughly the same place under the hood. Call the tow truck, and wind up back in the shop again. “Sorry”, they say, “these things happen”. “Wasn’t exactly the same problem, just close to the one we fixed – can we have your credit card please?” How does that feel?


Now let us mentally get out of your car, and get into an ambulance as you hold the hand of your son or daughter or parent whose health is broken.   Your loved one is about to become a member of a new club, made up of the thirty million Americans (one out of every ten citizens) treated by Americas’ hospitals every year. [1]  


As the Emergency Medical Technicians bustle about connecting tubes and wires, remember that our current healthcare system costs about $8,600 per American per year – just about twice as much per capita as the other developed nations – and most of those nations get higher scores for healthcare quality. [2],[3]   


In the world of hospitals, one out of every eight hospital patients have to be towed back (“readmitted”, in healthcare speak), for lack of fixing the original problem, or to fix something accidentally broken while fixing the original problem.[4] For Medicare alone this costs around 17 billion dollars annually. [5]  


Unplanned readmissions are one of the reasons our healthcare system is so expensive. They are also an indicator of quality of the healthcare non-system.


Back in the day, the family doctor took care of you in the hospital. They knew what drugs you were on, your medical history, and your personal circumstance.   Those days are gone – because of the invention of hospital based new tools and medicines, hospitals now have full time doctors to care for you , and your family doctor often does not know a lot about your hospital care.   The non-system has changed.


Information sharing has broken down in many cases.


Research shows that many re-admission can be avoided. The three leading causes are a) hospital issued drug that fight with other drugs the patient is already on, b) failure of the family to follow instructions for patient home care and c) lack of a visit by the patient to the family doctor after discharge from the hospital to keep an eye on the patients overall condition. [6]  


The bottom line is that once the patient leaves the hospital, it falls to the family to keep all the various parts of the “system” working together. This includes the pharmacy, nursing home, primary care doctor, school nurse, other specialists, the VA, and on and on.   This often overwhelms the patient’s family. The patient’s health declines, and the tow truck is called, and off to the hospital they are carted again. And out comes the credit card.

It does not need to be this way.


Cox Medical Center Branson in Missouri put in place an information sharing system designed to notify all members of the patient’s family and healthcare treatment team of what was being done to the patient in the hospital, and what needed to be done after discharge.   Readmission rates dropped almost one third![7]  


Other hospitals started what they call Transition Planning. The hospital care team identifies the possible risks to the patient and assigns specially trained people to shore up the system. They make sure the family doctor is fully informed.   Prescriptions are cross checked. House calls are made by specially trained caregivers.   These steps alone can eliminate about one quarter of all admissions![8]  


We can help control healthcare costs, prolong life, and lower taxes, as these hospitals have done. When people you know enter the hospital, you can make a big difference by being present to offer support, log temperatures, and generally keep a loving eye on stressed patients and family members. Make a list of all their medications, and enter them into a website that checks for harmful interactions likehttp://reference.medscape.com/drug-interactionchecker. If their health seems to be getting worse, head off that ambulance run by a timely trip to the family doctor.


Your efforts to help a loved one will also make America healthier, and healthcare cheaper, by local action.


[3] U.S. Health in International Perspective – Shorter Lives, Poorer Health