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Health & wellness

Essay winners talk of struggle to give care, get care with cost in mind

Four winners have been selected in the Cost of Care essay contest aimed at promoting awareness among patients and providers about how much health care costs. Dr. Neel Shah, director of Cost of Care, said in an e-mail that the contest received more than 100 entries.

Among the winners, each of whom won $1,000, was Dr. Andrew Schutzbank , a doctor at Beth Israel Deaconess Medical Center, who wrote about a patient in her 70s named Peggy who could not be discharged from an expensive cardiac care unit because she was taking a drug for pulmonary hypertension that costs $1,400 when a person is inpatient but less as an outpatient.

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The result was that no rehab facility would accept her -- or the cost of her medication. So she remained in the hospital. Schutzbank writes:

Think about that for a moment. A critical care bed was tied up for days for a patient that was well enough to leave the hospital, just not ready to go home. Arbitrage was suggested -- would it not make more sense for our hospital to buy the drug for her at rehab, freeing up the CCU bed (which costs far more than daily dose of treprostinil). But we are doctors, not financial engineers. We work in the world of medicines and were unable to orchestrate such an unusual arrangement. So we did the only thing we know how to do. We stopped the expensive medicine. This was not a financial decision. Peggy had been describing vague body pain, a known side effect of all prostaglandin medicines. Think of treprostinil as a 24-hour infusion of anti-Ibuprofen. Her breathing was actually quite good despite her recent trials in the hospital, so stopping the medicine made medical sense. We monitored her closely during the transition and she quickly improved! She was able to move around more and started on recovery. She was transitioned to a rehab shortly thereafter and continued to improve.

My colleagues’ decision to stop treprostinil was a medical one. But ironically, we would not have considered it if [it] were not for the cost factor of the medicine. Peggy would have gone on for some time on an expensive medicine that was not helping her. At the same time, it was through one party’s insane attempt to “control costs” that simply caused costs to be shifted and multiplied. The entire health care system spent much more on Peggy’s care because no one had the vision or authority to deal with $1400 a day. Pennies compared to the amount wasted, and nothing compared to the risk undertaken by Peggy and her family during this trying time.

The other winners include Renee Lux, a patient from Connecticut who was branded as having a pre-existing condition after getting an unnecessary CT scan for neck pain that was quickly treated; Court Nederveld, a patient from Florida who explains how he saved money by engaging his doctor in a conversation about cost; and Molly Kantor, a medical student in Massachusetts who writes about how she helped treat heart failure on a budget for a patient who couldn’t afford a hospital admission.

Judges included former White House Budget Director Peter Orzsag, former US Surgeon General C. Everett Koop, former Michigan Governor Jennifer Granholm, cancer research advocate Dr. Susan Love, and Dr. Alan Garber, Harvard University provost and health economist.

The winning entries will be posted on the Cost of Care website in the coming weeks. Cost of Care also plans to use lessons learned in the entries to create “quick guides” and online videos, Shah said.

Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.
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