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Inside the RI Hospital settlement

February 13, 2012

At 11:27am, this press release appeared in my email box. According the U.S. Attorney’s Office, Rhode Island Hospital owes the federal government $5.3 million dollars.  The settlement was the result of an investigation with the U.S. Department of Health and Human Services and even the freaking FBI! What horrible thing did the hospital do?

…during the period from January 1, 2004, through December 31, 2009, medically unnecessary overnight hospital admissions were ordered for approximately 260 patients who underwent stereotactic radiosurgery, otherwise known as Gamma Knife treatment.

Oh. Patients spent the night at the hospital when they really didn’t need to? Seems sort of anti-climactic. A patient might argue that it’s nice to stay at the hospital after a procedure, just to make sure everything is OK.  Why is the FBI getting involved in where Rhode Islanders sleep?

Here’s the reality- our health care costs are completely out of control. Every time a Medicare or Medicaid patient spends the night at the hospital when they could have gone home, they’re adding unnecessary costs to the country’s health care safety net.  This move signals to me that the federal government is getting serious about slimming down the system. That, or it’s making an example of Rhode Island Hospital.

I’d never heard of Gamma Knife treatment, so I did a little research. Turns out it’s a procedure that uses radiation to stop the growth of brain tumors. This is how Weil Cornell Medical College describes the procedure-

Gamma Knife radiosurgery is routinely performed on an outpatient procedure. The entire procedure typically lasts four to five hours. Because it avoids lengthy hospital stays, expensive medications, and occasional long-term rehabilitation, it has the added advantage of being cost-efficient.

So Gamma Knife is supposed to save money specifically BECAUSE it can happen without expensive hospital stays. Rhode Island Hospital sent me this statement, arguing that’s not necessarily true.

For more than 10 years, Medicaid and other private payers routinely preauthorized gamma knife as an inpatient procedure. Rhode Island Hospital staff applied this same level of care to Medicare patients.

Rhode Island Hospital says it’s not admitting it did anything wrong and it only settled to avoid the cost of additional legal fees. What do you think? Is the federal government being too harsh, or are these sorts of investigations necessary to get our health care costs under control? Has anyone out there received the Gamma Knife treatment? Did you require an overnight stay or did you go home?

One Comment leave one →
  1. Chuck Vincent permalink
    February 13, 2012 6:26 pm

    Quote: “This move signals to me that the federal government is getting serious about slimming down the system. That, or it’s making an example of Rhode Island Hospital.”

    I bet it’s probably a little of both your theses. In either case, bravo! It’s high time for the long standing practice of assessing patients (or tax payers) any charges they want received public scrutiny

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