Hospital rehab can be expensive—up to $1,000 per day—so payment plans are often part of the discussion.
The majority of Dr. Reinstein’s patients have Medicare insurance, and this has some advantages because these individuals don’t need prior authorization to enter the rehab unit after surgery. Of course, he adds, Medicare does have a right to conduct a post review.
With Medicare patients comes the Medicare prescription drug benefit, and this has presented some challenges for Dr. Reinstein. He recalls one patient whose drug plan refused coverage for a prescription medication. Frustrated and in pain, she called Dr. Reinstein in a panic. He contacted the drug plan and tried to wade quickly through the red tape, but was unable to help. In frustration, he finally suggested that the patient contact her Congressional representative. She called Dr. Reinstein back an hour later to say that she had gotten her prescription filled. “Sometimes you have to be persistent and creative to get things done,” he says.
Dr. Reinstein has a great deal of experience fighting claim denials and other insurance-related issues, and he is not afraid to go to bat for his patients. “If I think there is a medical reason to keep the patient here, I will do so,” says Dr. Reinstein. “And I will fight the insurance company later.”
Of course, dealing with insurance companies isn’t his only challenge. In fact, Dr. Reinstein notes that his major frustration is that “I set high standards for myself and others. Sometimes, things don’t work the way I would like them to. I want everything done right, and I can’t control all of the details.” He adds that such frustration “is not unique to this setting. It actually is a larger societal issue that we all face.”
Smooth the Way with Communication
Working—and potentially clashing—with private-practice physicians can be a challenge for many hospitalists. Dr. Reinstein has mastered this skill.
“The key to working with primary-care doctors is communication,” he says. “The first thing we do here is to write on the patient’s chart all of the physicians involved in his or her care—their specialt[ies], phone number[s], and so on. Then we keep these practitioners abreast and involved. The patient’s primary care doctor may have seen this person for 20 years and knows things that we don’t, so reviewing issues with this practitioner is key.”
Dr. Reinstein also stresses communication as part of ensuring a smooth transition from the hospital to community care. For example, “We type a discharge summary on discharge day,” he says. “We give a copy to the patient and fax or mail one to his or her referring physician. We also keep a computerized copy.”
He also has the patient’s family bring in the bottles for all of the medications the patient is taking, and he goes over every one to make sure prescriptions are up to date, filled as necessary, and not likely to interact with other medications. “This only takes a few minutes, and it is an important part of great patient care,” he explains.
What Keeps Him Going?
“I take a lot of personal satisfaction in my work here,” says Dr. Reinstein. “When patients come here, they can’t do much. When they leave, they are prepared to take care of themselves. We make sure that they have the level of functioning, medications, assistance, and personal confidence they need to continue their progress and resume their lives.”
Watching his community-based colleagues rush from the hospital back to their offices or to other hospitals, Dr. Reinstein appreciates the fact that he spends his entire day at one facility.