The Trouble with Cost Containment

by Tom aka Rusty

The Trouble with Cost Containment

Long-term care facilities face multiple pressures thwarting cost containment attempts.

The nursing homes have three types of patients:

rehab: typically younger post orthopedic surgery or cardiac care, short stay
joint hospice patients: who are to be provided comfort care while dying
true long-term care residents: typically an 84 year-old with multiple chronic conditions, unable to live in a residence and who will likely die in the facility

Patients #1 and #2 are pretty clear cut as to costs and treatments. #3 is a problem.

The facility is in a vise created by regulators, physicians, families, residents and malpractice lawyers. Too much aggressive care is a waste of money and often violates patient wishes. But some family members want aggressive care.

Some family members hound physicians to provide more care, and the physicians may cave in. Nurses are often put in the middle of family battles (Mrs. Rustbelt once had a distraught daughter call 911 and had paramedics arrive to resuscitate a dead cancer patient, while family members screamed at each other in the hall).

Too little care is declared neglect by regulators and malpractice lawyers. And who wants a parent or grandparent to die? How much do you want to put someone through who is on the threshold of death?

The pressure on nurses is insane, partially accounting for high burnout and high turnover rates.

So what do harried nurses and physicians do? Transfer the patient to the hospital ER, for a stay that may last 2 hours to several days. The easiest course for a physician is to approve the transfer. This drives huge Medicare costs for little value. This drives Medicare administrators batty.

Some of the transfers make sense, rehydrating a flu patient who is nowhere near dying.

Other transfers create severe discomfort for the resident, with little to show for it.

How do we solve this?
Tom aka Rusty Rustbelt