Hip Fracture Surgery Experience At Banner Hospital in Phoenix, AZ

My father recently broke his hip after not being prevented from falling during an outpatient Parkinson's physical therapy in Phoenix, Arizona.  An ambulance was appropriately called after he complained of pain   and he was transferred across the street from the outpatient therapy suite to Banner Thunderbird Medical Center in Phoenix, Arizona.  From there he was diagnosed in the emergency room with a hip fracture and subsequently admitted to the hospital by a hospitalist. The next day an orthopaedic surgeon was able to fix the broken bone using the  less invasive screw fixation technique.   

His hospital course was complicated by the common peri-operative Parkinson's problems of constipation and delirium, which resulted in a consultation with a neurologist and a gastroenterologist.   He received his expected head CT and EEG and the ever so common shotgun medication approach to  constipation management,  which put him into a "severe ileus" over the next three days.   All  he really needed, I believe, was a bedside manual disimpaction three days earlier  that no  doctor was willing to order despite all indications pointing to such a necessity.

Overall, mom was quite satisfied with the physician care, especially the  hospitalist, who took the time to explain things to her.  Except for that one doctor who lied to her.  That probably upset me more than my mother because the lie would have gone undetected without my knowledge of what is and isn't standard hospital care.  I hate it when doctor arrogance gets in the way of standard of care.  Be the patient's advocate.

Luckily he did not aspirate and die from attempts to give him GoLYTELY.  I told mother not to consent to that.  No way.  No how.  And after  hearing my mother describe the 30 second constipation consultation, it's hard to understand how that experience  can support the 99222 (mid level initial visit code) that was submitted to the Medicare National Bank. It's the fastest complete history and physical exam ever.  

And those poor nurses.  God Bless them.  My mother loved their care.  They were masters of the AIDET technique but we all know my father would not be considered one of those desirable easy patients you get in the morning to skate through the day.  You nurses know exactly what I'm talking about.   AIDET can't hide that disappointment in patient assignment.   

After about seven days in the hospital, he discharged to the next level of care.    It was interesting to be that pateint's doctor son half way across the country, that every hospitalist hates, getting daily updates from mom on all the daily issues of concern and feeding her my concerns that she, as the POA, should  relay on to the medical team  As a hospitalist, I have taken care of hundreds of hip fracture patients and I know exactly what is and isn't appropriate with regards to standard of care for routine complication prevention and management.  

I bet the nurses  were quite tired of my constant attempts to be my father's surrogate advocate, through my mother, by advising her daily what she should and shouldn't expect from everyone, what rights  she had as the powers of attorney and her right to  initiate a family directed emergency response if she felt like dad's safety was in  danger.

My dad was every hospitalist's  nightmare patient.  Parkinson's.   Hip fracture.  Perma-present spouse.  Doctor Hospitalist son.  Eventually, he met the three midnight rule for skilled nursing care and he is currently recuperating at a local nursing home.  I'm sure his whole medical team gave each other high fives on his day of discharge to make room for the next complicated, high maintenance patient and their family.  

I have taken care of many patients with broken hips over the years.  Hip fracture carries an incredibly high morbidity and morality. Mobility is the absolute key to survival.  If hip fracture patients cannot ambulate again, they can expect a life filled with recurrent complications.  Add on the risks associated with Parkinson's and I fear for my father's life from any number of complications from  aspiration pneumonia and bowel impaction to ileus and pulmonary embolism.  The human body was built to move.  His key to survival will be acceptance of  any limitations, prevention of all  falls all the time  and continued aggressive physical therapy,  without dropping  him. Sometimes, it's best for patients to swallow their pride and accept a walker as their best friend.

Hip fracture care is not cheap,  Care can run into the hundreds of thousands of dollars a year for patients who lose the ability to remain independent and mobile.  My mother showed me his charges related to the inpatient hospital stay.   The cost of care is startling even though hospital Medicare margins have been negative for almost a decade. ObamaCare promises to pressure margins even more by sacrificing compensation to preserve the votes of beneficiaries.  

I will soon show you an itemized list of Medicare's payments to both doctors and physicians during his hip fracture stay at Banner Hospital in Phoenix.  It's an eye opening look at where our health care dollars and insurance premiums get spent.  Remember also on  January 1st, 2013, physicians will see a 27.5% SGR across the board cut in payment for services provided unless Congress acts.. When you look at the cost of care provided by physicians compared with the cost of care provided by hospitals in this one hip fracture example at one Banner Thunderbird hospital in on Phoenix, AZ one has to question how long Medicare can survive without extending  entitlement reform onto the backs of beneficiaries as well.  Only time will tell before this political mind field blows up.  

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