MANAGED CARE: Patients And Families Burdened By Cost-Cutting Efforts
HMOs are "shifting the burden of caring for the sick from their staff and provider networks to patients themselves and their often ill-prepared family members," writes author Suzanne Gordon in today's Los Angeles Times. Gordon, who recently completed a book in nurses at the frontline of medicine, notes that patients are now routinely discharged from hospitals more quickly than ever before, even after serious procedures like coronary bypass surgery. In their drive to reduce hospitalizations, she says that health plans are requiring patients to "undergo many complex medical treatments in clinics, outpatient surgery centers or at home." While HMOs argue that these efforts are designed to reduce exposure to hospital-borne germs and other problems with long inpatient stays, Gordon writes that "early discharge policies and expanded outpatient treatment leaves many patients at great risk in other ways." For example, families are often charged with administering as many as 12 medications or are left to monitor intravenous pumps, respirators and feeding tubes. Gordon contends that the trend could explain why "U.S. patient deaths due to medication errors in the outpatient setting increased more than eightfold between 1983 and 1993," according to a study in the Lancet.
Fewer Home Visits
Gordon writes that complications from early discharge could be averted if patients were allowed more visits by home health nurses. But HMOs have cut the allotted number of visits by half in some cases and Congress has just cut Medicare home visits by 30%, she writes. Thus, "visiting nurse agencies are cutting staff, some are closing and others are avoiding the sickest patients whose full costs will not be reimbursed." Gordon urges Congress to "restore its own cuts in Medicare home care services and require HMOs to pay for more of these services." She concludes, "Legislation must allow patients and their physicians to decide where treatments are performed and where patients can recover, without managed care guidelines that endanger lives" (7/20).