I have to admit my FEET ARE UGLY! 15+ years as a ballet dancer will do that. I have a bunion removal procedure scheduled for Sept 12. The podiatrist inferred that because I have type 1, it has to be as an inpatient. What!!! I have had several successful outpatient procedures as a PWD on an outpatient basis (including a foot repair, cataracts, and a fairly major breast cyst-ectomy).
My data: I am in very good control, my A1c'S are consistently between 5.0 and 5.4 for many years (at least 8). And, it is because I keep myself in a narrow range - not because it is the average of highs and low, thus looking like a good A1C. That is thanks to my pump and CGM. My weight is very appropriate, and I am in great health and fitness - aside from 30 years type 1 (maybe because of it)
Aside from resenting the assumption that as a PWD I cannot take care of myself, my main concern is that I do a better job than most inpatient hospital staff. Most often, "They" (hosp staff) won't use my pump - which boluses best and has my basal finely tuned and often take away my meter. IV hydration includes way to much glucose (rather than just saline) and it can take me days to recover from the poor D management.
Anyway, any ideas I can use to convince them that I deserve outpatient status? I am seriously considering not having it covered by insurance (I have Kaiser) and going the out-of-pocket route if I am forced to be an inpatient. Oh, but the way, there are no other foot issues at play here. Thanks in advance for any advice and for listening.
I would tell them I'm using my pump. I've had 2x outpatient surgeries and they both went smoothly and all docs, particularly the anesthesiologists, seemed pleased I had it and just left it on. Sometimes with a mobility type of issue, perhaps they want to be able to assist you with getting around while your foot is recovering? I wouldn't want to take any chances with recovery or anything like that but it does sound a bit over the top on their part.
Thanks. I used my pump (and adjusted basals etc) during procedures back in Southern CA. I agree it does seem like its over the top. I did hear back from my CDE and she's gonna see what she can do to help to. But I still want to be prepared to fight my own battle if I have to.
Kaiser may very well deny an inpatient admission. There are certain criteria that have to be met for a surgery that is normally performed on an outpatient basis to be approved on an inpatient basis. That being said, your doctor CAN for an outpatient surgery if there are problems, outpatient surgerys can be performed as a short stay type procedure (think like observation following your procedure) for up to 72 hours. BUT that is usually ONLY if complications occur. Just cause your diabetic esp if you are in good control does NOT automatically get you inpatient admission. My surgeon is getting ready to remove my gallbladder and most likely barring I get nauseated and have vomiting afterwards, I'm going home that day, if not its just a overnight stay.
Just in the last couple of years I've had ankle surgery, knee surgery, breast surgery and now my gall bladder...ALL on outpatient basis, and all of them I have went home a few hours after the surgery. Maybe look for a different podiatrist, if this one is instant upon it. Unnecessary hospitalization just increases your risk of nosocomial infections, and drives up the cost of health care to you and the insurer.
Exactly (your last comments) - aside from hardship for my family responsibilities. I have to admit I resent the assumption on the podiatrist that I am old-school-non-compliant-diabetic. Like you I have had several surgical procedures on an outpatient basis (none related to having D) and did well. Besides, the outpatient surgical suite is within the structure of the inpatient facility. I admit I also resent the fact that Iit seems as though I have no say. I'm not having major surgery.
I highly doubt it is anything personal, it is probably more related to a potential malpractice issue than anything else. You go home, get a nasty infection and then the potential that a lawyer would come back and say...."your honor....my client has type 1 and you know all the issues PWD's have with their feet. How could any doctor in good conscious release my client to go home under those circumstances!"
It's cheaper for the doctor to keep you and make sure everything is ok, then send you home. Right or wrong that is what you are probably seeing.
But wouldn't that same logic have been applied when I had the cataract surgery within the past year? And I looked at other patients in the waiting room and they all couldn't have had D. But a lot of them looked in wore physical shape than I am. I just want the option of choosing outpatient. Oh well. It does, however, feel good to have a place to vent.
You STILL have to meet certain criteria for inpatient admission, I work for a insurance company, and bunionectomy surgery is a surgery that routinely is considered as outpatient. AS I said above outpatient surgery typically IF a complication occurs can allow you up to 72 hours for observation but the majority of time 23 hours TOPS is all that is needed. Based on what artwoman has posted, I do not see where she has any indications that would meet criteria for an inpatient admission. Short of her having any complications I don't see where she'd require anything longer than 23 hours at most. ANY surgery has potential for infection, I had my knee scoped, most simpelest thing I've EVER had done, and it got a post op infection. That is a risk ANYONE who undergoes surgery faces, that alone does not make criteria for an inpatient admission.
Is there not another podiatrist you can go see in regards to your surgery. If you are unhappy with this ones recommendations, I'd go get an opinion from a different provider.
I am toying with going out of the system, and paying out of pocket. My main concern is that those of us who live with type 1 D know a whole lot more than most hospital staff. I don't want my insulin to carb and insulin sensitivity rations to fall under the heavy-handed "sliding scale" used on the "generic patient" Thaks again.
I agree it's over the top and also agree with the insurance specialist who said it's odd(especially for Kaiser!) that they are not making money their first priority rather than insisting on unneeded hospitalization! But I also agree (so agreeable this morning!) with the person who said it's probably liability cover your ■■■ nonsense. I would have your endo (not cde) advocate for you. If that fails, before I did out out of pocket I would consider going to a different Kaiser even if it involved a bit of travel. I can understand why you don't want unnecessary hospitalization with its implied giving away of D management.
I think the real issue is that they want to take your diabetes control away from you and you (like many of us) don't trust them. They will put you on a glucose drip, stop your pump and try to keep your blood sugar as high as possible in order to avoid an chance of a hypo.
Dr. Bernstein actually recommends that you flex your rights as a patient and simply write a letter that should act as a standing order. You can read his recommendations on that letter including a suggested draft here. I think if you employ this type of letter, many of your concerns will be addressed and in fact the request for inpatient care will probably just "disappear" since the letter will disallow them from messing with your diabetes.
I must live in a really pro active area for diabetes management, I have had no issues with our hospitals here letting me keep my pump, and maintaining my own control. The doc's have all been really supportive and so is my endo. I'm going to be looking at knee replacement sometime soon, and my endo is behind me already with doing all the necessary paperwork for me to manage my own diabetes care. The doctors are supportive as well.
The problem with getting the Endo to write Bernstein’s letter is that this “surrender your mgt” policy comes from the Endo Dept. Can’t wait for my employer open enrollment (mid-June) to switch plans.
