My wife had a hospitalization for four days and five nights. No exotic surgery, no expensive medications, mostly nursing care and cardiology interventions for shortness of breath and coughing, no change in prognosis. She was given more medications and referred to her own Cardiologist who has just replaced her battery in her pacemaker and was contemplating the repair of a congenital mitro-value prolapse.
Total bill $39,378, Medicare paid $$8,180 provider hospital wrote off $30,198 and the patient copay was $1,000. The hospital claims that they lost $30,198 blaming Medicare for their high prices that private insurance is having to pay. Giving the Medicare program a $30,198 discount. Inflation in health care is in the provider pricing that isn't based on episodic costs but algorhythms for a particular diagnosis know as a RUG's payment for a grouping of similar input codes. Nothing to do with actual procedures and cost of labor, supplies and overhead so Medicare or Private insurance carrier knows what the actual cost are plus a reasonable profit margin.
Over a period of twenty-five years, the diagnosis went from shortness of breath to sinus infection to atrial fibrillation to Congestive Heart Failure to Pace Maker to Mitrovalve repair of the prolapse in blood flow caused by an enlarged heart to a faulty mid point of the mitro-valve. A congenital problem she had since a child, that her father had and her daughter currently has was never properly diagnosed and caused her near death with the nasal surgery, a disastrous insertion of a deliberator to prevent a stroke that went off the night she had it inserted despite no indication of need. It was wired wrong and one of the leads had penetrated her heart sack. After 18 years of billing for anyone of these diagnosis we finally got to the cause of the symptoms. By now thousands upon hundreds of thousands were misspent and we still have to have a clip inserted to fix the prolapse. At the age 81 she will finally get it fixed. Prior to this, the fix required invasive heart surgery. Now it is a simple catheter repair of the valve without surgery. Where she can return home same day.
The point here is the lack of analytical tools for making a valid diagnosis over just reviewing and testing symptoms. Currently, I found I could get a better diagnosis on Google then the inductive process that modern medicine uses to detect and treat Pandemics with more deductive problem solving. An artist uses inductive methods to create the unknown outcome. While health care should be using analytical deductive processes to deduce the health care problem that requires treatment and prevention. Sounds simple but why is it made more complicated. First of all the government makes the rules for payment that drives cash flow for the providers. If the protocol is to pay by the day, procedure, diagnosis, prognosis, income or outcome ... regardless it all comes back to a problem with a body system. There are eleven. Skeletal, muscular, heart, pulmonary, urinary, bowel, skin, brain, sex organs, digestive, mental. Within these main systems are sub to sub systems that are creating problems requiring analysis and diagnostics for solving the 120 problems that can develop one by one or among all eleven .
My company Caregiver Management Systems developed, over a period of twenty-five years, care plan AI models of medical and nursing diagnosis, problem, interventions by staff type, possible outcomes, including cost accounting for the detailed work assignments. So, each patient encounter within an episode of care could be linked from physician, to hospital, to nursing home, to assisted living to home or hospice. With use of computer intelligence it is possible to track costs by a myriad of problems.
