Long-Term Care Hospitals Proliferate Without Much Scrutiny – NYTimes.com

Yet another detailed investigative report by the NY Times brings a series of real-life vignettes of bad care and human suffering to the forefront of public awareness.

Alex Berenson, a NY Times reporter for just over 10 years, reported yesterday on conditions in long term care facilities, fostered by minimal governmental oversight, Medicare reimbursement issues and lack of medical supervision.

The following is an excerpt from his article and tells the story of a 46 year old patient, Tina Bell-Jackman, and the tragic events that led to her death on June 26, 2007.

On the night of June 26, 2007, Ms. Bell-Jackman turned restlessly in her bed in Room 7 at Select Specialty Hospital of Kansas City, a small medical center that specializes in treating chronically ill patients. Ms. Bell-Jackman, a 46-year-old with diabetes, had been hospitalized at Select for five weeks, was increasingly agitated and could not speak because of a surgical hole in her throat. Her physicians had ordered the hospital to keep a sitter with her.

But at 8 p.m., the sitter left, according to a state court lawsuit and a Medicare inspection report. Left alone, Ms. Bell-Jackman tried to get up. Around 9:30 p.m., staff members tied her down with wrist restraints. Around 12:15 a.m., after the restraints had been removed, a nurse injected her with a sedative to calm her.

Berenson reports that in the last 25 years more than 400 long-term acute hospitals have opened in the United States.  He cites several key problems pervasive in many of these facilities.

• Serious and repeated violations of Medicare rules
• Rapid growth of these for-profit facilities – “Medicare rules that offer high payments for hospitals that treat patients for an average of 25 days or more.”
• Despite the rapid expansion of long-term care hospitals and the serious illnesses they treat, Medicare has never closely examined their care. Unlike traditional hospitals, Medicare does not penalize them financially if they fail to submit quality data, he says.
• Few of these facilities have doctors on staff yet treat many very ill patients who are often in need of urgent physician care.
• Under Medicare payment rules, traditional hospitals often lose money on patients who stay for long periods. So they have a financial incentive to discharge patients to long-term hospitals, which then receive new Medicare payments for admitting the patients. Both hospitals benefit financially.

These are to name a few of the inherent defects in such institutions.  Those of us who handle cases involving such lack of quality patient care have seen our own ‘Tina Bell-Jackman’ stories:  a patient discharged to a long term care facility for wound care and a staff that (as written in their own progress notes) waits for days to have a wound-vac representative come to ‘teach’ them how to use this critical piece of equipment; repeated stories of restraints and sedatives to replace ‘sitters’ for those in need of such personal supervision – the horror stories go on-and-on.

Berenson further reports on the financial incentives that have driven the proliferation of such facilities:

Long-term care hospitals now treat about 200,000 patients a year, including 130,000 Medicare patients — at a projected cost of $4.8 billion to the government this year, up from $400 million in 1993.

Whether it’s a report on 60 Minutes about outright fraudulent Medicare  claims or reports like those of Mr. Berenson – isn’t there a clear lesson to be learned?  If you are going to try to fix the healthcare system, maybe, just maybe, a good place to start is with the Medicare system.  After that gets fixed, maybe then a dialogue about things like ‘tort reform’ might be relevant – maybe.  Ever consider that if it weren’t for lawsuits and reporters, stories like this would just be buried – literally and figuratively?