Recently, a member of my family was involuntarily admitted to the psychiatric unit of a major teaching hospital in New York City and remained there for two and a half weeks. During that time, the unit kept him safe and provided medication for mood stabilization and thinking. After seeing my family member, my first priority was to talk with the attending physician and care team.
Evidently, the attending doesn’t like to talk to families or visit patients daily, but the nurse manager assured me he was supervising the care provided by the first year resident.
“Well then, I assume he’s not billing for visits under the teaching physician rules.”
The attending appeared, annoyed, three minutes later. You can read about the teaching physician rules for E/M and psychiatry services, and both require more than “supervision.”
I checked in, voluntarily and without restrictions, need for supervision or care, to a newly opened nearby Hyatt hotel. At check in, I asked to see the general manager, to let him know that I had a sick family member and that I might need help during my stay. He gave me his name, direct phone number, and email, and said to call when needed. Why was it easier to see the general manager at the Hyatt than to see the attending physician for a ten minute meeting about an involuntarily admitted psychiatric patient?
At the Hyatt, the young staff greeted me with a smile when I returned from the hospital, looked me in the eye, and asked after me and my family member. One security guard at the hospital welcomed me upon my arrival, although I visited twice daily for many days. The nurse manager and social worker interacted with me in a professional way when I was able to see them, which was infrequent. Most of the staff avoided eye contact and responded to requests with as few words as possible. There were many of them, and they appeared to be busy maintaining the electronic medical record.
I never saw anything spilled or dirty at the Hyatt, so I don’t know how staff there would have responded. But the ice/water machine in the activity room on the unit leaked every day, at every visit. The staff would drop a bed sheet or towel to contain the moisture: it seemed like a tripping hazard to me. After that bed sheet had soaked up the water, was it laundered and put on my family member’s bed?
The clean lobby at the Hyatt was a stunning contrast to the activity room, where I sat with my loved one. I didn’t lean my elbows on the tables, which always had crumbs or leftover food or were sticky. The floor was dirty. Occasionally, I saw someone empty the over flowing trash.
Some patients wore scrubs instead of street clothes, confusing other patients.
“Nurse, can you help me.”
Often the young patients did help.
“Here, I’ll get some water.”
“I’ll ask the nurse for a blanket.”
Going out to the nurse’s station and asking for help may or may not have elicited a response. I did need help at the Hyatt with my wireless connection, a few hours prior to giving a coding webinar. My email to the general manager provided an instant response. No one at the hospital provided an email address. A few calls were returned.
I arrived in NYC on short notice, for a room rate of $359/night before taxes and the inevitable Jacob Javits Convention Center fee. My family member arrived at the teaching hospital on short notice, insurance paying four or five times my day rate. Not a fair comparison? The cost of doctors, nurses, medications, food and security on an involuntary floor? And my loved one was safe and received the needed chemical treatment. True.
But couldn’t the hospital be clean? What does it cost to smile, welcome, be available to answer questions? Is it too expensive to treat a grieving family member with compassion and humanity? And, if that is how I’m treated, how are they treating my loved one when I am not there to watch? And how are they treating the homeless patient who has no one visiting or asking questions?
Betsy Nicoletti is president, Medical Practice Consulting and author of Auditing Physician Services. She blogs at Nicoletti Notes.
