A few days later, a violent diarrhea slammed her even worse than before. She went back to the ER and soon was on a gurney and hooked to a morphine drip.
Klein, 56, was too sick to know or care, but she was the subject of a conversation taking place down the hall between her ER doctor and an admission review nurse:
Should Klein be admitted to the hospital or treated there but as an outpatient, in what is known as observation?
This may sound bureaucratic, even benign. But this question - and where it leads - tells a lot about the state of health care today, the tension between hospitals and insurers, the impact on patients.
Abington wants to avoid treating Klein as an inpatient, then getting paid only an outpatient rate from the insurer - half as much.
Insurers see themselves as good citizens, responsible parents, doing the difficult job of holding down health-care costs, in part by refusing to pay for what they view as unnecessary care.
Doctors see this as second-guessing by insurers and an erosion of the doctor's role.
And hospital finance people say these cuts in reimbursement will affect the care of Randy Klein, thousands like her, and eventually all of us.
Short-stay reimbursement
One of the biggest challenges in health care is controlling costs. A primary way to accomplish that is keeping people out of hospitals, which are very expensive places, and paying hospitals less money.
In the last year, a central front in this war on cost has been short-stay, or one-day, admissions, cases just like Randy Klein's. Insurers feel hospitals have too often been providing care that isn't necessary, and been paid too much for it.
These skirmishes over reimbursement take place gurney by gurney, patient by patient, like a thousand paper cuts, but the dollars add up.
