May 6, 2019

'I'm struggling and livid': One physician's battle to navigate his father's care

Daily Briefing

    After Hasan Shanawani's father was taken to the hospital with a spinal fracture, Shanawani—chief informatics officer for quality and safety at the Department of Veterans Affairs—embarked on a frustrating journey to navigate the "broken" U.S. health care system, Judith Graham writes for Kaiser Health News.

    Shanawani's story

    Shanawani's 83-year-old father, who was a physician himself, had been battling metastatic Stage 4 prostate cancer when he ended up in the hospital with a spinal fracture, Graham writes.

    Rather than being admitted as an inpatient, which the ED doctor had recommended, Shanawani's father was marked as an "observation care" patient—a classification with important implications for Medicare patients, Graham writes. For example, observation care Medicare Part B patients can face copayments for tests and medical services. Medicare also doesn't cover for short-term rehabilitation in a skilled nursing facility for observation care patients.

    When Shanawani asked a hospital care coordinator why his father had not been deemed eligible for an admission, he didn't get any answers, Graham writes. Later, when he asked a senior nurse in the hospital unit the same question, he got no response.

    Shanawani later learned that his father had two treatment options: a vertebroplasty—a surgery in which bone cement is injected into the spine—or a fitted spinal brace. His family decided against the surgery, but they were then told his father couldn't receive a brace at the hospital because he wasn't an inpatient, Graham writes. Instead, Shanawani's father, who Shanawani described as having an unstable spine and being "at risk of permanent paralysis," would need to make an appointment with a spine specialist.

    Frustrated, Shanawani took to Twitter to post about his frustrations, and his tweets went viral, eliciting responses from both providers and reporters.

    Shanawani said he had three specific complaints about the care his father received, Graham writes. First, the hospital staff didn't acknowledge or address Shanawani's family's concerns. Second, no one at the hospital seemed to care or be willing to listen to his family. Finally, Shanawani said the decision to place his father in observation care was poorly handled.

    A 'common' description of a 'broken system'

    According to Richard Levin, CEO of the Arnold P. Gold Foundation, Shanawani's experiences are not uncommon. "I wish I could say this was in any way unique or an isolated event," Levin said. "But his description of a broken system is so common."

    Theresa Edelstein, VP of post-acute care policy and special initiatives at the New Jersey Hospital Association, said that attending to the "humaneness and patient-centeredness of care" is something "we need to focus on and be better at." She added, "If a patient is expressing concern about their observation status, the whole [hospital] team should be involved in understanding what the concerns of the patient and the family are."

    Ultimately, a physical therapist helped get Shanawani's father admitted to a hospital, and a palliative care nurse addressed the family's concerns surrounding Shanawani's father's care. "She was a 'one-in-a-million' person," Shanawani said of the nurse. "She said 'We will fix this, we will figure this out with you, we're working on the same side of the table.'"

    Sometimes the kindness of a single person is all it takes, Grace Cordovano, a professional patient advocate at Enlightening Results, said. "It takes just one person to really listen to make a profound difference in a patient's care" (Graham, Kaiser Health News, 5/2).

    Create the links you need for effective acute/post-acute information exchange

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    Learn several ways you can optimize data transfer and communication between settings—even without an EHR.

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