An elderly patient arrives at the Electrophysiology Lab to evacuate post-operative hematoma that started draining that morning. The patient without fever, chills and otherwise felt well. Surgery is arranged the same day to re-explore the wound and drain the hematoma, but because of the uncertainty of the presence of clinical infection, the decision was made to extract the defibrillator. IV antibiotics are initiated prior to surgery, intraoperative gram stain and cultures are sent, a drain is placed, and the wound closed with plans to continue IV antibiotics until cultures return.Act One, Scene Two
The patient appears relieved the next morning, glad to know that the draining hematoma will not cause his ICD to become infected and is generally understanding of the circumstances. He as been on antibiotics and has is draining little from his wound. He'd like to convalesce at home. An attempt is made to contact social work to arrange home antibiotics, since he was otherwise stable and could follow up as an outpatient.Act Two, Scene One
"Hello, Ms. Social Work?"
"I have a patient who would like to continue his treatment at home, rather than just sit here in the hospital getting daily antibiotics. Clinically, he is very stable and I see no containdication to him receiving care at home."
(I hear typing on a computer in the background...)
"Oh, I'm sorry Dr. Fisher, we can't do that?"
"Well, I see your patient is over 65 and home IV antibiotics in these circumstances are not covered by Medicare."
"Why is that? Isn't it more expensive (not to mention inconvenient) for my patient to remain hospitalized?"
"I'm not sure. But those are the rules."
"So my patient stays, get vital every shift, three hots and a cot, and festers at great expense to our system."
"Unless he wants to pay for it out of pocket..."
"Doctor, I think I have supplemental insurance for home health care. Maybe they could pay for my home antibioitics?"So much for a real "medical home" this weekend, eh?
"Really? Let me check with Ms. Social Work..."
(A call made ...)
"Well, I'm not sure if his particular policy convers this, I'm just not familiar with this coverage, but we'll check on it. It's hard to get things handled on the weekend, you know."
What a waste.
PS: The end.