Doctor's group, hotels join to help patients' families

Sunday, January 20, 2008
Michael Kelley held the hand of Richard Kelley, a 78-year-old farmer from Elsinore who was hospitalized with a broken back. (Dr. Joel Ray ~

Michael Kelley, his wife, Alexandria, and their 6-year-old daughter, Stephany, drove Michael's 78-year-old uncle Richard to Cape Girardeau at 7:45 a.m. Thursday for an 8:15 appointment with neurosurgeon Dr. Joel Ray. Richard Kelley spent the day having tests and had another appointment with Ray at 12:45 p.m. Richard had broken his back. His surgery was scheduled for 6 a.m. Friday.

Fractured backs are complicated cases from all kinds of standpoints. Often the patient is the family patriarch or matriarch. Now he or she is incapacitated, and medical complications could include heart failure, renal failure and pneumonia. Richard runs 220 head of cattle by himself on his farm.

"The whole family stops producing, communicating and is out of control," Ray said.

Medicare and supplemental insurance policies do not pay for overnight stays at a hospital before surgery. Under the usual circumstances the Kelleys might have driven the 100 bumpy miles back to Ellsinore, Mo., on Thursday afternoon and then returned early the next morning for the surgery.

But an organization called Providers Assuring Rehabilitation Efficacy arranged for the Kelleys to have two rooms at discounted prices at the nearby Victorian Inn & Suites. This was the first time a new arrangement between PARE and MidAmerica Hotels has been used to try to achieve PARE's goals of maximizing outcomes for patients, containing costs and emphasizing the doctor-patient relationship.

Certainly the family benefited. "It probably saved us about 50 percent, and we got to rest and have a good meal at Red Lobster," Michael said.

Alexandria and Stephany went home to Ellsinore Friday while Michael, his uncle's closest relative, will remain in Cape Girardeau until Richard leaves the hospital Monday. He is able to stay at the discounted rate.

PARE is Ray's brainchild. At its heart is his desire to restore the supremacy of the doctor-patient relationship. "At some point doctors are going to have to participate in this extraordinary burden being put on society," he said.

So far PARE has been bringing vendors and health-care providers together to talk about steps that can be taken to achieve those goals. The arrangement with MidAmerica Hotels puts the theory into practice.

The bones in Richard's back had simply gotten weak. The surgery Ray performed Friday involved injecting a quick-setting plastic to brace the broken bone in Kelley's back. Ray said the procedure is successful in more than 90 percent of cases. Saturday, Kelley was already moving around.

Being able to offer a patient and family a discounted rate after surgery when hospitalization is no longer required but the patient might not be quite ready to go home may be the next step, Ray said.

He expects to be able to extend the program to other doctors whose patients would be required to make long drives. "If we can work it out and it makes sense we will offer it to other service lines," he said.

MidAmerica Hotels is prepared for that. "We would be happy to have whatever the number of patients is," said Brenda Newbern, sales manager for MidAmerica Hotels.

Both the Victorian Inn and the Holiday Inn Express are prepared to rent rooms to patients and their families at the discounted rate for a night or at a day rate if that is best for the patient and the patient's family.

"How often do you have a doctor caring about the total care of a patient?" Newbern asked. "We became part of his team and looked at ways of helping the patient from the hospitality side."

John Echimovich, director of operations for MidAmerica Hotels, called the setup "visionary. It's something you just don't see every day."

Medicare pays only a small amount of the total cost of this kind of surgery, Ray said, even though the patient can be immediately fixed and returned home. "It's an indication of how little the government understands about outcomes in terms of cost."

"We're simply saying, as a community we can do better," he said.

335-6611, extension 137

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