Stories of nightmarish encounters with what passes for the U.S. health system are, unfortunately, all too common. Often, the problems are the result of systemic failure at many levels, but every once in a while I read about something for which the solution is abundantly clear.
One such example appeared in FierceHealthcare last week. Poor Michael Stanzione, who has a rare lung condition called Pompe disease, has been trapped in a New Jersey hospital for three years because of various overlapping insurance plans.
Institutional Medicaid covers his inpatient care at Bergen Regional Medical Center, but won't cover services outside the hospital. Standard Medicaid coverage could pay for home care, but Stanzione has disability income that disqualfies him. Private insurer Aetna covers Stanzione's family via his wife's employer, but won't pay for hospitalization because of the institutional Medicaid coverage.
Pulmonologist Dr. Steven Jacoby says it would be much cheaper for all parties to send Stanzione home and put him on a ventilator with full-time nursing care to prevent choking, but Aetna won't cover more than 60 four-hour visits per year. Medicare is an option to fill in some of the gaps, but only for a few hours at a time.
"It's the stupidity of insurance that's keeping him in the hospital," Jacoby told the Bergen Record.
Yes, that's one way of looking at it. But it also seems to be the ignorance of caregivers. Why would Stanzione need full-time nurse coverage if he could get set up with a home monitoring device that sends automatic alerts to an on-call nurse in case of any abnormalities? Insurance doesn't often cover remote patient monitoring--yet--but I wonder if anyone's even considered the option?
Just last week, FierceMobileHealthcare reported that Aetna is one of several major insurance companies testing remote monitoring for congestive heart failure. You'd think someone would find a way to get Stanzione a waiver to treat Pompe disease remotely.
But it's always easier to blame the system than to apply some creative thinking. - Neil