Meet the right-hand man for healthcare's ridiculous cost curve

"Look at this," my father-in-law implored. For the first time in more than a decade, he clenched and unclenched his right hand.

"And this," he added. He raised and lowered his right leg.

A massive stroke a dozen years ago had left him paralyzed on one side and by all rights should have killed him. It was shocking, if not miraculous, that he could perform such movements.

It's all thanks to the U.S. healthcare system--for every wrong reason imaginable.

My father-in-law regained such movement because he's receiving daily physical and occupational therapy. But that's only because he's spent the past six weeks in a rehab facility after a week in a Los Angeles-area hospital.

How did he wind up hospitalized? He decided he couldn't afford to spend the $100 a month for a prescription of colchicine to treat his gout. That left him in so much pain he was stuck in his wheelchair--for days on end.

The first time he went to the hospital, his speech aphasia must have confused the staff-- they thought he was complaining of chest pains. No heart attack, so they sent him home. My mother-in-law, depressed and beaten down after caring for him for the past dozen years, didn't make the trip with him. Three days later--after still not leaving his wheelchair--my wife intervened and made sure he returned to the hospital and stayed there. She found out about his skipping his colchicine in a tearful confession after he realized the root cause of all his trouble.

Okay. Fixable, I suppose. If only his physician had actually prescribed him gout medication. She has no record of that. She practices with the UCLA Health System, which widely touts its EHR system. As a matter of fact, there's even a live clock on the UCLA Health website announcing when the second version of its system will go live. If I wait another three days and 10 hours or so, perhaps the new software will tell me who prescribed the medication.

Did his podiatrist prescribe it? The only podiatrist I'm aware of sent him a bill for a "Home Visit Failed Appointment" that allegedly was made while he was in the hospital. He then dunned him and my mother-in-law repeatedly by phone. The email I sent him two days before Christmas suggesting I would report him to the podiatry board for "poor footside manner" was the highlight of my holiday season.

That was a lot more fun than changing my father-in-law's insurance back to his old policy on New Year's Eve so he wouldn't be kicked out of the rehab facility on New Year's Day because it wasn't in the network of his new policy. 

I haven't yet calculated the bill for this odyssey, but I'm guessing it's around $75,000 and climbing. That would have covered my father-in-law's gout medication co-pays until he was approximately 133 years of age. And this is the fourth or fifth time he's been in a hospital or rehab center over the past decade (I've lost count). I do remember that one time he was in rehab for about four months, mostly from contracting a debiliating hospital-acquired infection.

All that money--mostly from my fellow taxpayers--could have instead paid for the physical therapy he's finally receiving. That might have kept him on a cane instead of a motorized wheelchair (another pricey item Medicare pays to replace every few years). And it might have mitigated his gout, which might have prevented the need for gout medication in the know what I'm getting at.

"How does this happen?" my wife muttered mostly to herself as we concluded our most recent visit to the rehab facility.

"It happens 10,000 times a day," I replied. I'm probably wrong about that. In the United States, uncoordinated care, poor communication and the related cascade of unintended consequences probably occur closer to 1 million times a day.

And if any of these patients were treated more proactively with any consistency, imagine how many people would be put out of work overnight. The economy might grind to a halt.

But at least my father-in-law has regained use of a once-paralyzed body part. To paraphrase Winston Churchill, America's healthcare system got his right hand back-- after trying absolutely everything else. - Ron (@FierceHealth)

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