I was on call this past week for my local hospital.  This means that I cover the hospital for all eye problems including emergency visits and in patient consults.  Since I do all my surgical procedures in an Ambulatory Surgical Center (ASC), and since my hospital call obligations are only once a year, I have very little contact with the present day hospital environment.

Saturday afternoon, I received a call from an attending at the hospital, requesting a consult for one of his patients.  He stated that the patient had left eye pain and needed to be seen that day. After dinner, I went to see this patient.

The patient was a 52 year old woman. She was in the hospital bed, hooked up to an IV, receiving pain medication for her eye pain. A brief history revealed that she had been experiencing some eye pain and light sensitivity for the past 3 days. She decided to go to the ER when her condition had not improved on Saturday. She was admitted to the
hospital thru the ER for this eye pain!

Exam revealed hat this patient had a simple conjunctivitis with some inflammation in the front if her eye,  Treatment was simply some antibiotic and steroid eye drops. I called the attending doc the next day REAL early, before my Sunday bike ride, knowing I would wake him up. I told him what I found and what I recommended. He said he would discharge the patient and have her follow up at my office this week. I than asked him why she was admitted to the hospital. I was hoping there might be another reason, other than the eye pain. Wrong, she was admitted for unexplained eye pain! I conveyed my displeasure with the attending and said goodbye.

On would think that this patient had no insurance. It would less “expensive” for her to go the the ER and be treated for “free” than to spend $125 at an eye doctor’s office and another $75 at the pharmacy for the eye drops. But this patient did have insurance through an HMO! The HMO will now incur the ER costs of around $500 to treat this patient, but to make matters worse was the hospital admission.

I would estimate that the total cost to the HMO to treat this woman’s conjunctivitis will be in excess of $2500 as opposed to the $200 it would have cost as an out patient!  This translates into higher premiums for you and me…

I have no answers… Something is drastically wrong with the system, and it needs to be fixed fast! What do you think??

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