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We have become maybe too familiar with words that end in ‘cide’. Genocide,
Homocide, Suicide are some that we see almost daily. There seems to be a new
one coming up, Chronocide. Chronos meaning ‘time’ and of course, ‘cide’--
Death. No, I don’t mean killing time, even though that would fit. I mean that as we approach a certain age we become candidates for dying. The ‘Baby Boomers’ are a large group of people who are coming into the age where health problems are more common. The “Health Care System” is becoming more and more complicated to traverse for any age group. We are the front runners who will hit the wall first.
If any of you are at all familiar with medical terminology you may recognize the words, ‘Divert’ or ‘Bypass’. Not the kind concerning changes in your cardiac plumbing also known as Bypass. The kind where when the ambulance is called for whatever reason, falls, pain, confusion, loss of consciousness, and when they get there and pick up whoever is in trouble they have to find a hospital that is able to treat you. When a hospital is on ‘Divert’ status they are saying “We are full to the rafters and have no place to put another patient even if we stack them like cordwood.” You may live next door to a fantastic hospital where you have always gone. Your parents and grandparents even went there. First off, even if your son can pick you up and carry you to the hospital door, when someone calls 911, the ambulance is dispatched. Now let’s say that the hospital next door is packed so full that they can’t fit you in to the doorway, they would have gone on divert. When the ambulance comes and loads you in the back they may have to drive you several towns away to a hospital you have never seen because that hospital has got room. Your doctor may not be on staff there. For whatever reason, he just doesn’t go there. Now you are going to be seen in a hospital where no one knows your name. If you are lucky enough to be conscious, you can tell them who you are, who your doctor is, what medications you are taking, what things you are allergic to and just possibly how many steps you fell down. At some point, early in the game, someone is going to ask for your insurance company, probably in the ambulance. If you have one---Good for YOU! Maybe… Contrary to what some people think, YOU CAN NOT BE TURNED AWAY FROM A HOSPITAL FOR LACK OF INSURANCE!!!!!!!!! That’s illegal.
They may not have a welcoming champagne party for you but they can’t tell you to go away.
The difference between having insurance and not having insurance may be the difference in treatment. Say that you have slashed your hand while cutting the turkey---(which happens more than you will ever guess!) If you have ‘Good’ insurance, you might find that a plastic surgeon is going to take you to the Operating Room and sew you up and kiss the boo-boo and no one will ever see the scar. No insurance? The ER doc will look at it, and depending on how many layers you have cut through, either stitch it up right there or maybe he will use what they call ‘butterflies’ to hold the edges together, if it’s not too deep. You will have a small scar but then again, you weren’t going to be doing any hand modeling anyway. With insurance, you may spend the night in the hospital, but only if your insurance company doesn’t argue about it. The insurance company is the one who will be the deciding factor in how you are treated. If they will only pay for a band-aid for this type of injury, unless the doctor tells them that it is much more serious than it sounds.. “The cut is only 2 centimeters long but the knife is still in it!”, ask for the band[aid with Batman on it.
There are even some hospitals that your insurance company won’t pay. Let’s say that “JTR Insurance” (Jack the Ripper) has decided that Saint Facetious Hospital charges too much for gall bladder surgery. JTR tells St. F’s that unless they do gall bladder surgery for two thousand bucks less they won’t allow any of the policy holders to be treated there. St. F’s tells JTR, “It’s impossible for us to do gall bladder surgery any cheaper unless we leave the patient awake and tell him to bring his own supplies of dressings and tape.” JTR says, “ Kevorkian General is only 200 miles away from you and they don’t charge that much. We will notify our policy holders that they have to go to Kevorkian General in order for us to pay the bill.” This is not a science fiction sit com, this is real.
What’s that you say? You live next door to St. F’s? Your family contributed to their building fund and there is a plaque on the wall in the lobby with your name on it? You fell down the stairs and probably broke your leg and your gall bladder has been out for years? This is not a life threatening emergency as far as anyone can tell. Of course, unless you get it X-rayed you don’t know that. All sorts of interesting things can kill you from a broken bone. Sneeze and you can nick an artery and bleed out. Fatty embolism is another thing that can happen while you are in the ambulance speeding to Kevorkian General. Let’s say that the EMT’s who are with the ambulance and maybe even a paramedic or two insist that you have to be seen as soon as possible and they cannot take you any farther than the closest hospital. JTR Insurance company may send you a letter saying that they don’t cover your bill because you went to the wrong hospital. You may have to appeal their decision by saying that it was an emergency and that you were brought to the closest hospital for that reason. Maybe they will pay, maybe they won’t.
Here is where the ‘Divert’ thing gets important. If St. F’s is full to the brim and can’t take anyone else, you will go to the next closest hospital that isn’t on divert.
Some hospitals can go on a certain type of divert. If their Cardiac Care Unit is filled up they can ask for a divert for cardiac patients. If they have no ‘regular’ beds left but have a few in the Intensive Care unit, they can ask for a divert for anything that isn’t crucial. If you arrive in the ER, you must be treated regardless of what kind of divert is going on. Better yet, say you walked in on your broken leg….Divert or no divert, someone is going to have to do something.
One of the worst case scenarios is when the Level One Trauma center is so full they have to ask for a divert. If they are the closest to a multi vehicle car accident with severe injuries they have to take it. When they ‘Triage’ it means someone will have to make a decision that of the 12 people injured in the accident, two are hurt but not severely. They can be treated and if they need to be observed carefully and there is no room at the inn, they can be transferred to another hospital for observation. Or if push comes to shove, they will leave you on a stretcher in the ER hallway. These are not scenes from someone’s imagination, they are real and happen all the time. Is it because that there are more people now then there were a hundred years ago? Maybe….maybe not.
The Urge to Merge.
I’m in one of the most densely populated states on the map. There was a time where it seemed there were as many hospitals as there were gas stations. In one of the cities close to me there were three large hospitals. One they used to think of as the ‘City Hospital’ because it bore the name of the town. The other two were Catholic owned and the rumors ran that if you weren’t Catholic, they wouldn’t let you in. Way, way back in time that may have been true. It stopped being true when some of the doctors needed to use that facility for their patients who may not have been Catholic, or even religious at all. The doctors were the ones who determined a hospital’s financial health. If they had a good opinion of the way the place was run they would be more likely to admit their patients to it. This was before the insurance companies had the unlimited power they now enjoy. Your doctor determined the length of your stay, he told the insurance company how long you were supposed to be in the hospital. They couldn’t argue with the doctor. The same surgery that takes 30 minutes today could have taken a few hours then. You stayed in the hospital until the wound was healed. Nowadays, you leave as soon as you wake up from the anesthesia, because your insurance company says that’s what it expects. If you manage to get home intact and crawl into bed, you will have to go to your doctor’s office to get those stitches or staples taken out. If you develop a problem like fevers or severe pain, Whoopee! You now have COMPLICATIONS!!! That should earn you a little more hospital time. If you had stayed in the hospital for a few days where you could have had people checking on you, there might have not been any complications. If one hundred people have the same surgery done, regardless of the ages of those people, and 75 of them go home right away and manage to heal without complication, the insurance company just saved 75% of what they might have had to put out if they let everyone stay in for three days or so.
Those 25 people who got complicated may have very lengthy stays before they can go home and the total cost may exceed the 75% the insurance company would have saved. As far as the insurance company is concerned, they only see the good side of the numbers. I have seen the same statistics used for two completely different outcomes. The magic of numbers!
Say you have three hospitals in the same town all of them having 200 beds. That’s 600 available beds in an inner-city area. There were always some beds that remained empty. An empty bed means the hospital is losing money and that’s never good. Gradually the doctors lost the power to determine who goes in and how long they stay. That made for even more empty beds. If you only had 120 beds filled in your hospital most of the time and the other eighty sat gathering dust, you had to cut back on things like the number of nurses and aides and dietary people and even the housekeepers. People got overworked and things got sloppy. The doctors didn’t like that so they started sending their patients to the hospital they saw had good staffing and decent services.
And so came the merge………..
Let’s put all these hospitals under one name and we’ll make the good one bigger and better and we can close the ones that aren’t making it. We can make one of them a nursing home because the population is aging and there will be more and more elderly who have to have around the clock care. Maybe we can make another one for just specific services like dialysis and psychiatric.
Now we have one hospital with 450 beds. It has one Emergency Department, see we stopped calling it an emergency ‘room’ a while back. Sounds too small these days and now that area may have a lot of ‘rooms’. The insurance company is happier because it’s easier to track 450 beds in one place than 600 in three places. They are calling all the shots as to who can be admitted and who can probably go home and take 2 aspirin. If the doctor in the emergency department is convinced that the patient he is looking at needs to be admitted and the insurance company is looking at a list that gives them the amount of time and level of care for a certain diagnosis, that the patient might have, it can get to be a pissing contest. Too many times, it’s the patient they are pissing on.
Here’s where the baby boomers come in………..
More of us to get older and need health care, some of that group are living longer because of better medicines and more specific treatments. Don’t think that Medicare is not involved with insurance companies, they most certainly are!
Here we are! Less beds for more people? Well,,,,,,,,,Yeah! BUT! We have rules for how long you can be sick in the hospital and when you have to go home and be sick there. Is there an increase in what is known as ‘re-admissions’? Well,,,,,,,,,Yeah! You see people who were just sent home three days ago arriving at the Emergency Department and sometimes they are sicker than when they were there the first time. Now we are going to multiply that mess with our platoons of senior citizens, gaily marching into the valley of heart disease, cancers, diabetes, strokes, osteoporosis and many other age-related illnesses.
Remember when all the ‘old’ people in your family died of ‘natural causes’. That was what happened to you if you lived to be over 60. Who knows what they really died of? Besides, it was rarely that you were sent to the hospital if you got very sick. We can now diagnose diseases that didn’t even have names in Great-Grandpa’s day. It was told that one day, he said he didn’t feel good and was going to stay in bed. Great-Grandma was a bit concerned when he wouldn’t wake up so she sent someone to get the doctor. The doctor showed up and looked at Great-Grandpa. He might have listened for a heartbeat and maybe taken a temperature and pulse. He looked in his eyes to see if someone was still in there, and then he felt his belly to see if it was soft or hard. Hhhhmmm. He heard a heartbeat that wasn’t regular, but it was at least a heartbeat. He told Great-Grandma to brew up a pot of chicken soup and try to get him to take a little bit. He might have even left some medicine to give if he ever did wake up.
He didn’t. “Natural Causes” age 63.
These days, 63 is considered young. If this happens today, he would be 911’d and taken to an Emergency Department. There he would be tested, X-rayed, MRI’d, EKG’d, IV’d and a myriad of other things. If he dared to try to ‘Go gently into that good night’, he would be yanked back with all sorts of things and he would be maintained until they could either cure him or figure out what killed him. I’m willing to bet they don’t use ‘Natural Causes’ on death certificates anymore. We no longer consider death to be natural.
Gridlock Alert in the Emergency Department
If you have ever been unlucky enough to be in an Emergency Department recently, either as a patient or accompanying someone, have you noticed how long it seems to take to be seen? It’s not your imagination. The Boomers are marching in along with all the other ages. It’s not even that we are sicker, it just seems that we are. We get there and notice that some people are being seen right away and others just sit and wait. Is this favoritism? Nope. It is called ‘Triage’. If you came in and complain of a sore throat and cough that you’ve had for three days and you are told to sit and wait for a doctor to see you. Then in comes a guy who looks about 20 years younger than you and suddenly he is being put on a stretcher and wheeling down the hall with 3 people pushing him, are you a little put out? Could be that this guy is having a heart attack and they noticed his lips were a shade of blue and he was sweaty and maybe not breathing very well? That’s what rang the bell for him! No one said you weren’t sick, it’s just that he’s SICKER! This is not the beauty parlor where it’s first come, first served. And it’s going to get worse!
Here we are, Saturday night in the middle of a snowstorm,(For those of you who don’t have to deal with snow, make it a rip-roaring thunderstorm.) And let’s listen to the TV news while they predict a flu outbreak happening right now, right here. The local hospital, with 225 beds, has 224 of them filled. The one bed that is empty is for Maternity. That is why they have called in and put themselves on
‘Divert’ status.
Here comes an ambulance! Oh NO! Didn’t they know we are on divert? They roll in a man who appears to be fairly young, around 40. He has a lot of pain in his belly and can’t think of a reason why. The EMT’s tell the staff about his vital signs and what information they could get. They did know about the divert but the roads were so bad that they got here first. Oh well,,,,,,,. People are coming in walking and sneezing and coughing. If you didn’t have the flu when you came in, you will when you leave. If they are too sick to be sent home with a prescription, they will put them on a stretcher and park it out of the way. While they are doing what looks like air traffic control and sending this one to X-ray and that one to the bathroom. This is a juggling act and you just know that someone is going to drop the balls. Sometimes they do and most of the time they catch them in mid-air. What happens when they find out that someone is much worse than they thought? This person is in need of immediate and complicated surgery and there is no one here that can do it. They need to send him to the hospital that is set up for that kind of thing. That hospital is also on divert and it may not even be reachable in the storm. What is going to happen? Remember, this is not a TV program where everything comes out in the way you want it to. This is the stark reality of what we have allowed to evolve and have to depend on when it is, literally, Life or Death. OURS!
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