The call came around 10 pm on Saturday night. Helen was concerned by her mother’s cough and lethargy. I checked my schedule, and we agreed to meet at the house first thing in the morning. 

I awoke before the sun rose. My car rustled through the half-melted snow as I sped down the freeway. Thirty minutes later, I pulled up to the small bungalow at the end of the street. Helen and her husband greeted me at the door. The look of concern was apparent on both their faces.

We chatted for a few minutes before I went to the bedroom to do my exam. Helen felt her mother was generally doing well at home by herself, but the last few days had been rough. She caught a cough from one of the grandchildren and was slow to recover.  

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I knelt at the bedside and examined my patient. She was alert and coherent.  There was a deep rattling sound coming from her left lower lung. Her mucous membranes were moist, but she was weak and resistant to getting out of bed. 

She had pneumonia.

We huddled again in the living room. Helen knew her mother hated the hospital, but they didn’t feel comfortable standing vigil on their own. I felt that with a few days of antibiotics, and possibly a little physical therapy, she would recover well.

We eventually decided to bypass the hospital and send her to a nursing home in the neighborhood. I could watch her closely there, check labs, and begin antibiotics. Helen would have to pay out of pocket, but the respite rate at the facility was comparable to what she would end up paying for hospital care after copays and deductibles were figured in.

A week later, Helen’s mother is now back home and feeling better. She stayed 3 nights in the nursing home and then returned with home health care. Her experience was pleasant and less stressful than a visit to an emergency room and inpatient hospitalization. 

Helen paid roughly $600 dollars out of pocket for the full episode.

Medicare, however, saved thousands of dollars because of Helen’s atypical choices. Her choice to elect my concierge services, and pay the nursing home directly, allowed for an agile, cost-effective approach to her mother’s care. If she had chosen to go to the hospital, as most would, the bill to our government would have been well over $10,000.

The more I practice outside of the Medicare system, the more I see the benefits of being apart from the government’s rigid framework. 

To truly provide the highest-quality care and bend the cost curve of our national health care system, we need to encourage agility and innovation.

Not squash it.