Sunday, December 6, 2009

Eliminate Home Health Care?!?

Today's San Francisco Chronicle headlines announce that Congress has figured out how to insure 30 million people -- eliminate Medicare home health care and reduce Medicare payments to physicians.  Brilliant!  Imagine what a cost savings that will be.  Then even fewer physicians will accept the pitiful payments that Medicare offers and all the seniors who are maintaining in their homes with the help of home health nurses can go to the hospital or to a nursing home. That should save lots of money.  The physicians who will be hurt the most by this policy, of course, are the geriatricians.  What apparently no one wants to address are the enormous wastes of dollars spent on lab tests and on end-of-life care that is relatively futile.  Today, I heard about a 105 year old man who was taken to the coronary cath lab.  Does that make sense?  Or my friend, whose orthopedic surgeon orders an MRI every three months just in case he finds something that he can surgically treat.  I have story after story of people who had hundreds of thousands of dollars of laboratory tests, but no one had ever taken a careful history.  I had a patient who received 2 MRIs, one CT, two ultrasounds, one HIDA scan, colonoscopy, and duodenoscopy, only to be put on narcotics, when the history revealed in 20 minutes that her symptoms worsened on birthdays and when she ate whole wheat bread.  The diagnosis was celiac disease and she was normal after three weeks of gluten.  Probably didn't need all those tests -- just a careful history.  Until we wake up and look at the state of medicine today, health care reform will not work.