A “New Math” for Healthcare in America

Ian Morrison hits the nail on the head with his newest commentary on Hospitals and Health Networks online site. In “The New Math” Ian explains why business as usual in the healthcare industry just isn’t sustainable anymore. While this has been obvious to many of us for some time, nobody so succinctly makes the case, or does it with such wry humor, as Ian. If he hadn’t been born in Scotland, I would suggest that he should run for President. He might not be able to solve our economic woes, but he certainly could make us laugh.

imageA while back I wrote a piece here on HealthBlog railing against the idea of putting “affordable” and “health insurance” in the same sentence. My reasoning was the the rules of insurance (paying premiums to protect yourself against unlikely events) just don’t apply to cover something really, really expensive that each and every one of us will need a lot of in our lifetime. It must have made some sense because it was picked up by ABC News and published widely on the web. Ian and I have been saying the same thing, he just makes it more fun to read.

I suspect Ian’s “The New Math” particularly hit a home run for me today because of what happened in my own family last week. My elderly, but otherwise healthy mother called me on the phone because she was having some unusual left-sided arm and shoulder pain. It immediately raised my concern about possible angina. Heart problems and heart attacks often present more subtly in women than men, and although not everything she told me raised a red flag, it was enough that I recommended she go to an urgent care center or call her own doctor. She later phoned her doctor and talked to the physician on call. He too suggested a visit to urgent care. The doctor at urgent care was likewise rightfully concerned and sent my mom by ambulance to a nearby hospital. I hopped in the car and met up with her late that evening in the ER. Her ECG was just slightly abnormal, and it was recommended that she stay the night for further tests and observation. I agreed.

imageThe next morning when my wife and I went to the hospital to visit my mother, we were told that she had been transferred to ICU during the night. Her troponin (an enzyme associated with possible heart attack) had come back elevated. Over the course of the day, several more blood samples were taken. A physician’s assistant who worked for the consulting cardiologist came by to see my mother. After examining her, he phoned in his report to his boss. A short time later, I was asked to come to the phone to speak with the cardiologist. He told me that based on the information they had, my mom had had a heart attack and was at significant risk of having another big one in the future. As he put it, “your mother is a heart attack waiting to happen”. So, we put in place plans to transfer her to another hospital where she could have a cardiac catheterization and possible stent angioplasty depending on what was found.

But wait, there’s more. Much later in the day, we were called back to the hospital by the cardiologist’s physician assistant. He told us that late in the afternoon he began to suspect that something just wasn’t right about the troponin levels. Instead of the enzyme levels rising at a predictable rate, blood samples taken later in the sequence had come back negative. The PA asked the lab to run all the samples again. Guess what? The machine in the lab had malfunctioned, and Mom’s enzymes were completely normal--zip, zero, nothing. It was later determined that her ECG was also pretty much normal, and one final test (a radionucleotide stress scan of her heart) showed no evidence of blockage or heart damage. Mom could go home. It was all most likely a false alarm.

imageMind you, this took place in a very new, modern hospital with architectural elegance and patient-centered care. The staff was marvelous, and yes, they had electronic medical records. Despite all of this, an error happened. An extra sharp PA picked it up, and Mom was saved the risk, discomfort and inconvenience of a cardiac cath. None-the-less, when the bills start rolling in a few weeks from now I’ll bet this little misadventure will cost Medicare $25,000 dollars or more. And Mom? Well, she wasn’t even sick!

This is but a small and personal example of what is wrong with healthcare. Don’t blame the docs. They’re just practicing good (and defensive) medicine. Don’t blame the hospital. They had the technology and by golly they were going to use it. And what might have happened if the patient was clueless and her son hadn’t been a physician? I’ll bet the cardiac cath might have been done anyway, just to be “safe”. But then, so long as Medicare is picking up the bill, does anybody really care?

And so it goes, and so it is……why “The New Math” is the order of the day in healthcare. Thank you, Ian.

Bill Crounse, MD Senior Director, Worldwide Health Microsoft

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