Medicare Bonanza: Ka-ching!


A senior citizen I know recently had a trip to the emergency room at El Camino Hospital in Mountain View, California. This person has Medicare and Medicare Part D insurance coverage.

Who knew what extravagant, concierge-level service you can get with this coverage!  Here’s what happened. [Note: Ka-ching is for the hospital’s cash register ringing with a billable to this person’s insurance company.]

The patient showed up with a vertigo problem. When this individual lay down in bed, their head started spinning. I’ve since learned this person’s condition is referred to as “positional vertigo.”  This patient had had cardiac surgery within the last year. Here’s what happened:

    • The patient was given an electrocardiogram heart test EKG (Ka-ching!) right near the ER door entrance. I joked that if they were any closer to the door, they could start the process in the passenger unloading zone. Someone may pass that idea on!
    • The patient was taken to an ER exam room (Ka-ching!).
    • The patient was hooked up to heart/blood pressure/oxygen saturation monitoring system (Ka-ching!).  
    • The on-call physician (Ka-ching!) concluded the issue was an inner ear infection and immediately prescribe 3 types of oral medication (Ka-ching!) to stop the vertigo. The vertigo symptoms resolved in less than 30 minutes.
    • The patient was very unsteady so, they decided to have the patient stay overnight which required being admitted to a regular hospital room (Ka-ching!). It was hard to argue with this appropriate suggestion.

Now things really started rolling!

  • A chest x-ray was ordered (Ka-ching!) while in the ER prior to be admitted to a room. A state-of-the-art portable x-ray machine was rolled into the ER examination room to get the x-ray.
  • A phlebotamist showed up minutes later to take a normal blood test (Ka-ching!) plus gather sufficent blood for blood cultures (Ka-ching!). Blood cultures take 2 days to grow out, so the results would have been ready after the patient left the hospital.
  • A urinalysis (Ka-ching!) was ordered.
  • The next morning, the attending physician wanted to order a CAT scan to make sure there had been no stroke. I offered, that, since the medication administered for vertigo had worked so well the night before to resolve the symptoms, my unlearned opinion was that a CAT scan was overkill and we didn’t need to do it. The doctor reluctantly agreed to not do the test.  She added, “We can never be too cautious.”  Missed Ka-ching! The doctor probably lost bonus points.
  • Because the patient has a  chronic, long-term swelling of one lower leg that is being treated by the patient’s regular physician, the doctor ordered a doppler scan (Ka-ching!) “to make sure there was no blood clot” in the patient’s lower leg. Why was this necessary? What did this have to do with vertigo? Why the medical scope creep?
  • Occupational therapy (Ka-ching!) was ordered to assess the mobility of the patient and ability of the patient to get dressed, etc.  They oncluded the patient would need to use a walker to move about the patient’s residence.  Okay…good call.

Does this seem a over-the-top to you?  It certainly does to me. Yet, once someone arrives at the hospital, the patient is given little option about what happens next. It is almost as if the arriving patient is seen not as a patient but more as “how much money can we extract from Medicare while insuring we cover our butts should something go wrong later?”

I have no idea what this acute episode cost but it seems to me much, much more than it needed to be.

How do we balance patient needs without piling on unnecessary tests and procedures?  How do we balance patient needs without taking advantage of Medicare insurance and unnecessarily driving up the national cost of patient health care?

What do you think?

Dave Gardner, Gardner & Associates Consulting

© 2014 Dave Gardner

Photo Credit:, Christiaan Triebert




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