Lack of Coordinated Care Costs Time, Money and Sometimes a Good Outcome
The concept of coordinated care is considered a best practice, but in light of a recent survey and story by NPR, the Robert Wood Johnson Foundation and Harvard School of Public Health, it’s hardly a widespread one.
A few years ago, we wrote about what happens to hospital patients when the facility’s right hand doesn’t know what the left hand is doing. The story told how the lack of coordinated care resulted in 1 in 5 Medicare patients being readmitted to the hospital within 30 days.
Earlier this year, we reported that some health insurers are beginning to appreciate the wisdom of coordinating patient care in terms of both health outcomes and cost savings.
Coordinated care involves a therapeutic plan that integrates the efforts of all of the patient’s medical and social service providers. It might designate a single person to manage all of the collaborators or simply might be an understanding they share to ensure efficiency and communication. The point is to maximize resources, minimize duplicate procedures, reduce costs and, ideally, prevent harm.
That didn’t happen for Andrew Dasenbrock, one of the subjects detailed in the NPR story.
A 32-year-old a self-employed IT consultant, Dasenbrock says he can't afford health insurance. When he woke one night with intense stomach pain — "like shards of glass traveling through me," he said—he went to an urgent care center nearby. Doctors ran several tests, couldn’t settle on a diagnosis and sent him to the hospital.
The hospital was part of the same system, but its staff was not alerted to Dasenbrock’s arrival, nor were his records transferred. He was forced to fill out the same questionnaires and repeat all the same diagnostic tests. He remained in excruciating pain.
The hospital diagnosed an ailment that, while painful, wasn’t serious and required only that Dasenbrock ingest a lot of fluid. He went home. Two days later he received two bills totaling thousands of dollars.
"I laid the two bills next to each other and it was literally word for word, letter for letter and line item by line item the same charges ... for all the tests I had gone through," Dasenbrock said. He had to pay double what he should have for his care.
Another tale was told by Jacki Bronicki, whose father was 80. He had Parkinson’s disease, but the retired engineer and physics teacher was mentally acute and responding well to his treatment.
Last year he fell, broke three ribs and was admitted to the hospital. His mental state began to deteriorate by the second day. "He wasn't even coherent by the third day," Bronicki said.
Bronicki said that the parade of doctors who saw him seemed to assume that his confusion was, for him, normal, and reflected his age and condition. Bronicki said she had to explain to each new doctor that he had Parkinson's, that his mental deterioration was not his normal, that he usually was coherent.
Finally, a neurologist finally figured out that all the different doctors had prescribed different pain medications, and the drugs were interfering with Brown's Parkinson's medication. That caused his mental deterioration and made his limbs rigid.
His prescriptions were realigned, and he improved. But Bronicki and her sisters felt they had to remain at his hospital bedside 24 hours a day to prevent another medication error. And, she reported, "He has a lot more dementia than he had a year before. He can't walk anymore. And I'm not sure if it would have normally progressed like this, or if we really sped it up."
It wasn’t they who sped it up; more likely, it was the lack of communication and coordination among all of his caregivers.
Certainly, many of the survey respondents were pleased with their care. But of people hospitalized in the last 12 months:
- 30 percent said doctors, nurses and other health-care professionals communicated poorly with each other;
- 24 percent said doctors, nurses and other health-care professionals didn’t communicate information about their condition or treatment.
To prevent mistakes and unnecessary costs that result from uncoordinated care, ensure that in advance of your need for care by multiple parties, you and your loved ones have a patient advocate (read our article “Bring an Ally with You to the Doctor's Office”). Get and maintain a complete patient history, and make sure all of your care providers have it.
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