Controlling costs is essential for all healthcare systems. How costs are controlled is key. Here is a case study of a healthcare system gone awry in its efforts to control costs.
Bill is a 69 year old Israeli citizen. Originally from Ohio, he came to work in Israel about 35 years ago. He liked his job and his life in Jerusalem. He chose to stay.
About 2 months ago, he started to feel off. He became short of breath. He was weak. He had moments of what felt like panic. He went to his doctor.
His ECG was abnormal. A 24 hour long recording of his heart beats (Holter monitor) was very abnormal. His beat was very slow and then it would stop for up to 5 seconds.
His doctor told him that the decision about a pacemaker was up to him. By giving the decision to Bill, the procedure became elective. The Israeli healthcare system does not fund elective procedures. So Bill would have to pay for this pacemaker. And this is not inexpensive.
Here’s What RCM Did For Bill:
Rupert Case Management Inc. (RCM) was engaged by Bill. Bill scanned and emailed us his Holter monitor recordings. We immediately flipped them to 2 prominent cardiologists. One is an academic university affiliated cardiologist. The other is an accomplished community cardiologist. Both reviewed the Holter and suggested that he immediately go the ER. They both concluded that the pacemaker was medically necessary. It was not elective. He had chronotropic incompetence. We defined the term for him.
This work by RCM is called patient advocacy. That is what Rupert Case Management does to help our clients. We advocate for our clients in order to assert and protect their rights to treatment.
Bill’s back to feeling better now with his new state of the art pacemaker. You can see him riding up and down the pathway on the beach in Tel Aviv.