I got a call from my cousin Pete W. the other day. He is a recent double-lung transplant recipient and is experiencing a remarkable recovery. In spite of the large doses of anti-rejection medication he's taking to combat his own body from attacking his new lungs, he continues to amaze his doctors.
Pete's story is remarkable because he was "double-covered" by insurance, a situation that is ideal for this procedure. Pete just received the bill for his surgery and 10-day hospital stay: $269,000. That is not including medication, physician services or physical therapy.
The sad part of this story was what Pete called to tell me. First a little history.
Iowa, as a small, efficient and cost effective medicare state, is given the lowest Medicare reimbursement rate in the nation for the procedures performed here. Back in 1965 when the program was started, Iowa was measured against the service delivery systems of all other states, and its reimbursement rates were determined at that time. The formula has not changed, despite the fact that Iowa, and other states for that matter, have changed dramatically since the 1965 formula was set.
One of the arcane rules that is in place astounds Pete and his doctors. Iowa has to do 10 Medicare-paid lung transplants per year to be eligible for reimbursement by the Medicare system. Which means, in any given year, if you are the unfortunate 3rd or 4th person to come forward to get a transplant, you have a choice to make. You can either move to another large transplant facility to wait for a suitable transplant organ, or you can stay in Iowa and die. That's what happened to Pete's brother Chris. He chose to stay in Iowa and live out the rest of his days near family, instead of possibly dying in another city.
When Congress rewrites Medicare rules, as I'm sure it will in the next democratic congress, I hope they include a common-sense reimbursement policy so that patients like Pete and Chris will never be challenged with such a heinous decision.
Comment Preview