The State of Medicine under Obamacare... A frail 82 year old women living alone falls and bruises a hip. She goes to the ER and the Xrayis fine... they send her home. She follows up with me 2 days later accompanied by family from out of town. She had fallen again at home this morning and must use a walker as a new support. She has no food in the house and has limited capacity to care for herself. I advise we admit her to a skilled facility for more intensive over site and rehab to optimization. Insurance denies it, and needs a physical therapy evaluation prior to considering her admission. I could directly admit her to the hospital (for a PT evaluation) but she would not meet criteria for admission. Nothing is broken. They would declare her observation and stick her with the hospital bill. She would be MANDATED to stay for 3 days to qualify for the nursing home placement. She cant afford that. We could send her back to the ER and admit her that way but still would be stuck with the hospital bill as she doesnt meet criteria for admission. So we opt to send her home. Home Health with Physical Therapy ordered but that can take up to 3 days for insurance to authorize. The physician is no longer empowered to care for the patient. We must sign everything and accept all liability but have no power. None. Eight years ago if a physician said the patient needed to be in the hospital, the patient was in the hospital. If a physician said the patient needed a nursing home, that was sufficient. Never again in my career. You voted for this.
Posted on: Tue, 16 Sep 2014 22:16:11 +0000