In Real Life Review Doesn’t Work
Daily Observer
Public Law 92-603
established the Professional Standards Review Organizations other wise known as
PSROs. Purportedly created to raise the standards of medical care (and
obviously standardize medical care, which is not really a good idea) the real
purpose of PRO is to develop basic guidelines of care as standards against
which medical and hospital care can be measured in order to cut hospital costs.
Although the blurb
that
The thrust of the
message is that PSRO will assure the patient that not only the length of stay
is necessary, but that the doctor is doing a good job. Aside from impugning the
professional integrity and ability of the doctor on the case, it also might unsettle
the patient by implying that his hospitalization is not necessary, that his
doctor is not rendering medical care according to standards of acceptability.
Worse however, is that there is no way that the PSRO doctor can assure each
patient that he is receiving the “recognized standard of care” because the PSRO
does not see either the patient or the chart, but sends a subordinate in the
health hierarchy to peruse some of the charts.
Let’s see how it
works in real life. David is 90 years old and has severe back pain that is the
result of crumbling bones, collapsed vertebrae and possibly protruding
inter-vertebral disks that impinge on nerves. He is in the hospital in
traction. After about two weeks during which David improved enough to get out
of traction for about an hour a day, his chart was reviewed by PSRO minions.
They didn’t concern themselves about the level of care because the minions do
not have the competency to judge it, nor the authority to see (or examine) the
patient. All they could determine was that according to the “guidelines” the
patient had overstayed his welcome in the hospital at government expense.
David’s back went
into increased spasm when he received his letter from PSRO telling him he would
have to pay his own hospital bill from that time forward. He didn’t know what
to do. He couldn’t leave the hospital. He couldn’t walk. He couldn’t afford the
bill. So far, PSRO has done the country a great service. It bullied a sick man.
When I explained to
the PSOR physician advisor that the patient had no alternative other than
hospitalization, he said, in effect “He’ll never heal." What do you expect
from a 90 year old?” He then told me that he gets$40,000 a year for the job and
his back feels fine...
Finally a letter
arrived cutting off payments from Medicare and suggesting that a lower level of
care would suffice. Unfortunately nursing homes or extended care facilities are
loathe to accept a patient who is in traction; in the first place many don’t
have hospital beds, and secondly Medicare does not reimburse patients for
hospital type care in a nursing home.
Now I don’t
necessarily disagree with
Could David have
been cared for at home? Yes had he a family. But he lived alone and had no
relatives. A man living alone in traction cannot take care of his basic needs.
A homemaker would have been mandatory. The only catch is that Medicare will not
subsidize a homemaker unless the medical condition requires some modality that
only a nurse can perform. But alas David’s blood pressure was normal. There was
no need for a nurse. Ergo, no homemaker.
David is a prime
example of a defenseless man caught at the epicenter of laws in collision.
When cutbacks are
needed, cutbacks in health care should be last on the list. For starters, the
bureaucracy seems a better place to start.
.