Down the rabbit hole

I do health systems research for a living. For the last 8 years, I've gained a lot of knowledge about health care delivery. The system is broken, we know this. But it's the only system we've got. Now, as I prepare to start my journey through a complicated gauntlet of information, questions, standards, and billing, I reflect on what I know about how care is managed and delivered.

In my family, I've always seen myself as the last line of defense in health care. When my father had to have open-heart surgery, I prided myself on the fact that nobody got to him during the four days I was there without going through me. I questioned every person who showed up in his room, confirmed every procedure, and validated everything they did to him. Now I'm going to have to turn that duty over to my husband. I won't be competent enough to do it. At least for a while. How long, I don't know. Certainly in the few hours after my surgery, he'll have to stand watch over me and make sure that I don't become the latest casualty in a health care system that injures 1,000,000 people a year and kills another 90,000. I'm not trying to freak you out. But those are the facts and when you're in my line of work, you can't just ignore the facts.

So, ask questions and check everything. Follow the doctor's directions to the letter. Another hot topic in health care quality research is hospital readmissions. I don't want to be in the hospital in the first place. I certainly don't want to end up BACK in the hospital. Yet about 10% of patients do (higher for Medicare patients, who are older than I am). Keeping myself from getting an infection in the surgical site will be the best way to make sure I get out and stay out. I can do that. Oh, and not falling down the stairs.

Finally, I know that after all this is over, I get to deal with the medical bills. Medical facilities have a variety of numbers that they put on bills, many of which are meaningless. First there is the "charge" for the stay. That's meaningless. That's just a number that the CFO of the hospital has decided will be assigned to this particular DRG (diagnosis related group). I'd have to start another blog to explain medical billing in any detail, I kid you not. Based on the charge, and my insurance, there will be an "allowable charge" (a lower number) that my insurance company and the hospital have worked out ahead of time will be the amount that they will actually get charged (as opposed to the "charges" which nobody gets charged unless they are uninsured. The irony) Then there will be co-insurance and a bunch of other complicated crap that I'll have to wade through. I'm already theoretically $500 into this journey ($250 deductible toward the MRI that I paid, plus my co-insurance which they have billed me at $322 but which I have not yet paid).

My plan is to ask the hospital for an itemized bill, preferably before I even leave. Then I'll go over that in great detail and question every single line item. It's entirely common for hospital patients to be billed for stuff that was never done or to be billed more days than they actually stayed. This is because hospital set rates for all the "stuff" that you'll need for whatever they are going to do for (to) you and it gets billed automatically. If you deviate from the expected course, there isn't necessarily going to be somebody who will catch that. You'd think the insurance companies would, but they don't. It typically falls to patients.

Being down the rabbit hole is an interesting place to be for somebody who does what I do. Knowing as much I as I do from my vantage point up here in the data, I'm curious as to what the view from down there will be like.