The New England Journal of Medicine recently ran an article by Clay Ackerly, MD, and David Grabowski, PhD, calling for “Post-Acute Care Reform.”
They use a (presumably) fictional patient to illustrate the problems with the current payment system:
Mrs. T. is an 88-year-old woman who lives alone, has a history of congestive heart failure and osteoarthritis, and has traditional fee-for-service Medicare coverage. One day, she was found lethargic and sent to the emergency department, where she was discovered to be in renal failure and was admitted to the hospital for fluids and monitoring. Her hospitalist concluded that she had accidentally overdosed on Lasix (furosemide). On hospital day 2, Mrs. T. was having difficulty ambulating, although her cognition and renal function had improved and she felt “back to her old self” and was eager to go home.
What to do?