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It’s Not Just Patients Who Can’t Stand the Broken Health System

May 29, 2019


Dr. Hasan Shanawani, a high-ranking physician at the Department of Veterans Affairs, faced a frustrating, confusing, situation when his father was admitted to hospital for a spinal fracture.

His father, who is also a physician, was admitted to the facility under “observation care” rather than inpatient. As a doctor, Shanawani knew that this could be bad news medically, financially or both.

While speaking with a hospital care coordinator, Shanawani wanted to know why his father, who had a spinal fracture and metastatic stage 4 prostate cancer, wasn’t eligible for a hospital admission. An emergency room doctor told the family that Shanawani’s father met the criteria the night before their visit, so why was there a sudden change? The care coordinator wasn’t able to answer any questions and a senior nurse in the hospital didn’t respond when he prompted her to find out what was going on.

Empty bedroom in a hospital looking sterile

When an individual is in observation care, they can face co-payments for individual tests and medical services under Medicare Part B. Medicare will also not pay for short-term rehabilitation in a skilled nursing facility for observation care patients.

The hospital offered two surgical options, which the family immediately turned down and instead requested a spinal brace. However, they were told that Shanawani’s father couldn’t receive a brace in the hospital because they only offer it to in-patients. To receive a brace outside of the hospital takes time, and his father was at risk of permanent paralysis.

This experience, frustrating and confusing as it was, is not uncommon. “I wish I could say that this was in any way unique or an isolated event,” said Dr. Richard Levin, chief executive of the Arnold P. Gold Foundation. “But his description of a broken system is so common.”


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