Quote:
>> A patient is in the hospital on a second admission with an infected
>> foot, but the problem is now under control. He has been non-compliant
>> with his follow-up care and with taking his antibiotics.
>> On discharge, the HMO case manager asks for a home nursing visit to
>> evaluate his resources and ability to care for himself, but the
>> hospital discharge planner says "no". She reported that the staff
>> nurses caring for the patient didn't feel it was necessary, so she was
>> not going to pursue or arrange it.
>> The case manager circumvents the hospital systems and makes the
>> arrangements, anyway. The home health nurse finds that the patient
>> lives in a house with no heat, running water, family, etc. He is
>> transferred to a SNF for the course of his treatment.
>So how does a guy who lives in a place with no heat, water, etc. afford an HMO?
>So how does a guy who lives in a place with no heat, water, etc. afford an HMO?
Evidently he has a job, if not these other amenities. From my
conversations with the case manager (a friend of mine), my sense is
that this is his choice and not because he can't afford them. This
was supported by my wife's cousin, who is a nurse on this man's unit
and knew him as a patient.
While I wasn't personally involved in his care, I had a unique
opportunity to hear both the HMO's and the hospital's perspectives
from people with first-hand knowledge and whom I trust.
I know it's hard to establish 'proof' of things operating the way they
should, as it's expected that they should do so. To offer the
suggestion that things may not have gone so well absent an HMO (or any
other entity) is virtually impossible to support.
It's easy to point out the planes that crash...
True HMO Stories