Dr. Berry’s Snippets

Cost-effective care at its clinical best

Every week from now on, I (Dr. Berry) will be providing clinical snippets – examples of patients treated at our practice (no names mentioned) where we help them navigate our complex, expensive healthcare system and save them sometimes thousands of dollars.  Many problems we can handle here.

Take for example a 43 year-old healthy (fairly buffed) uninsured man (non-smoker) with a physically demanding small business who came here during the middle of flu season with a 4 day history of fever & chills, muscle aches, cough, stuffy head, and nausea with vomiting.  He had the flu, right? Wrong. 

He had pneumonia so bad that he couldn’t return to his work, even for a few hours, for about 3 weeks.  Most if not all medical practices would have sent him to the ER, where he might have been treated for the flu and not had the X-ray.  He might have been sent home with a prescription for Tamiflu rather than an antibiotic where he (stubborn guy that he is) probably would have toughed it out at home for several more days until someone called an ambulance to take him back with an even worse pneumonia and perhaps end up on the ventilator because of a misdiagnosis in the ER.

Had he initially been admitted to the hospital from the ER he would have paid on average $9,763 for uncomplicated pneumonia and roughly $20,000 for complicated pneumonia (according to a recent article in the Wall Street Journal).  He was not a member here and paid us $1,645 for 9 office visits.  Had he been a member it would have been $545.

Here is the full story.

We tested him twice for influenza and both tests came back negative. When I listened to his chest it sounded like he had pneumonia, so to confirm this I sent him for a chest X-ray at Health Express for $50. I don’t have an X-ray machine here because it would require a licensed technician, more room, and more cost to the monthly membership. Health Express has generously offered to do our X-rays for $50 including the reading.

He brought the X-ray back within about 30 minutes, and I could see he had pneumonia which a radiologist confirmed a few hours later in a fax to our office.  Since the oxygen saturation in his blood was 96%, I felt we could treat him as an outpatient with the promise that he go to the ER if he felt short of breath.  If he had had a pulse oximeter at home, he could have checked it and called it to me if it dipped below 90% or and the I would have oxygen delivered to his home if his condition was otherwise stable.

He was dehydrated as well (his tongue was parched) from all the vomiting and sweating from his fever, so we gave him 3 liters of IV fluid before he felt the urge to urinate.  We also gave him an IV antibiotic for his pneumonia (ceftriaxone which is generic for Rocephin) and IV Phenergan for his nausea.  We left the IV stub (called a heplock) in his arm, drew some labs, dispensed oral Levaquin as is the protocol for community acquired pneumonia and oral Phenergan for nausea and brought him back the next day for more IV fluids and ceftriaxone.  He didn’t even have to go to the pharmacy because he got all of his medicines here.

The next morning when he returned, he was wheezing pretty bad with an oxygen saturation down to 94% so we gave him a nebulizer treatment that made him less short of breath.  We then dispensed a nebulizer machine for $25 here along with albuterol nebulizer solution and Prednisone to go home with.  Again, he did not have to go to the pharmacy.  He came back 4 more days in a row (twice on the weekend) for IV antibiotics using the same heplock, then we took it out and he returned the 2 days later (the day after Christmas) for an intramuscular injection of the antibiotic.  He wasn’t completely better so we dispensed oral Zithromax. 

To make a long story short, he returned here 3 more times because of fatigue and had multiple labs done because the illness made him anemic.  This pneumonia drained him of energy so much that it took him 19 days from his first clinic visit to be able to work for just a few hours, and then he was exhausted afterwards and had to take the next day off.  It took him several weeks to be able to return to his normal workload.

If an illness like this could happen to a strapping middle age man like this, it could happen to any of us (and has happened to me more than once).  This patient was not a member here, but we agreed to treat him because he had been coming here since 2006.  His total cost was $1,645. Had he been a member his total bill would have been $545, $290 of which would have been for my coming in on the weekend.  There is no professional charge for visits during office hours. 

His total bill for actual care had he been a member was roughly what a man his age would pay every month for a typical health insurance premium with a $5,000 deductible and 20% co-insurance beyond the deductible. Remember, this is just for insurance – not for actual care.  This means that had he gone to the hospital (what other practice in town would have provided this level of care to an uninsured man – or to an insured man, for that matter?) it would have cost $5,000 + 0.2X(9,763-5,000)= $5,953.

This goes to show you that you can receive quality medical care for serious but non-catastrophic illnesses affordably at our practice.  Everyone should have a way to share the cost of catastrophic medical problems.  Some people purchase insurance to do that.  My family has chosen a Christian medical cost sharing plan that is less than $500 per month in case we have large medical bills, and so far for 3 outpatient surgeries it paid.

Something for you all to think about.