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Considering signing out AMA after wife delivers – am I crazy??

Home Personal Finance and Budgeting Considering signing out AMA after wife delivers – am I crazy??

  • wonka31 wonka31 
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    There are some things in life worth paying for, even if it’s expensive. This would be on the short list.

    MPMD MPMD 
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    Fascinating discussion.

    I agree with what others have said my understanding (not based on much) is that delivery is kind of just a bundled payment. You see the evidence for this with sparsely staffed post-partum floors and a decline in things like nursery stays and lactation consultants. There’s no reason to consider if it’s not actually money-saving.

    I definitely see the medical rationale. This is far, far, far, far less risky than a home birth which happens all the time. I really don’t know about trying to negotiate this with OB/peds prior to delivery, my guess is that you’re going to get nowhere and be labeled as “the crazy guy in room 13.”

    I also see what others have said about your status as an EM attending, I mean you could really easily just grind out a few moonlighting shifts and not worry about this at all.

     

    Kind of reminds me of a story one of my attnendings told me in residency. He was involved in a high speed rollover and came in backboarded/collared as a big trauma activation and according to him he said something like “you can take one cross table later X ray of my cspine and then I’m leaving, no one touch me.”

    Avatar treesrock 
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    Status: Physician
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    On another note, OP, why did you choose to go with a HDHP on the year you knew your wife was giving birth?  This all seems like a lot of work to gain one extra year of contributions to an HSA…  Unless you are in a position where even with the higher deductible and impending delivery the HDHP still came out cheaper than other plan choices?

    Also are you sure you’ll even need to leave AMA?  Can’t you just have a reasonable discussion with your docs, and if all looks good agree to be discharged?

    #177698 Reply
    Liked by Firefly, Peds, hatton1
    IlliniGopher IlliniGopher 
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    Status: Physician
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    I am a parent and I have been reading WCI for a while.  I notice that sometimes there are folks that blur the line of crazy and mindful of finances (ex. keeping your house at 50 degrees).  This is also just crazy.

    "Comparison is the thief of joy." - Teddy Roosevelt

    Avatar LizOB 
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    Status: Physician
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    “Nothing was done” with your previous deliveries- so there wasn’t an OB present to handle any sort of emergency that may come up, RNs/techs/other support staff present in case s*** hits the fan, she didn’t have an IV in place just in case she lost 4L of blood at delivery, there wasn’t a hospital lab with a blood bank ready to go, there wasn’t an OR ready in case of abruption or cord prolapse, not to mention more “routine” things like antibiotics for GBS prophylaxis if she is a carrier to prevent sepsis in your baby, or vitamin K to prevent your baby from having a brain bleed, congenital heart disease screening, metabolic screening (which must be done after 24h of age), I could go on and on. People can get lulled into a false sense of security when things have gone well before, but the reality is the risk of things like shoulder dystocia and hemorrhage actually INCREASE the more babies you’ve had.

    Aren’t these the same types of reasons people use to justify why ED costs are so high?

    Not to mention, your physician’s or midwife’s delivery fee is a global fee which includes all prenatal, intrapartum, delivery, and postpartum care so it really doesn’t matter to the doc how many days you’re in the hospital (as long as everything is normal, for instance if you have complications and need to be kept longer it would be different)

    MPMD MPMD 
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    “Nothing was done” with your previous deliveries- so there wasn’t an OB present to handle any sort of emergency that may come up, RNs/techs/other support staff present in case s*** hits the fan, she didn’t have an IV in place just in case she lost 4L of blood at delivery, there wasn’t a hospital lab with a blood bank ready to go, there wasn’t an OR ready in case of abruption or cord prolapse, not to mention more “routine” things like antibiotics for GBS prophylaxis if she is a carrier to prevent sepsis in your baby, or vitamin K to prevent your baby from having a brain bleed, congenital heart disease screening, metabolic screening (which must be done after 24h of age), I could go on and on. People can get lulled into a false sense of security when things have gone well before, but the reality is the risk of things like shoulder dystocia and hemorrhage actually INCREASE the more babies you’ve had.

    Aren’t these the same types of reasons people use to justify why ED costs are so high?

    Not to mention, your physician’s or midwife’s delivery fee is a global fee which includes all prenatal, intrapartum, delivery, and postpartum care so it really doesn’t matter to the doc how many days you’re in the hospital (as long as everything is normal, for instance if you have complications and need to be kept longer it would be different)

    Click to expand…

    I don’t think this is a fair treatment of the OP.

    He isn’t advocating to have his wife deliver in a tub in a cabin in the woods. Everything in bold are things that he (she?) seems to be unequivocally OK with. He is questioning the marginal utility of the extra time in the hospital after it has become abundantly clear that none of this bad stuff has happened.

    #177704 Reply
    Avatar LizOB 
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    “Nothing was done” with your previous deliveries- so there wasn’t an OB present to handle any sort of emergency that may come up, RNs/techs/other support staff present in case s*** hits the fan, she didn’t have an IV in place just in case she lost 4L of blood at delivery, there wasn’t a hospital lab with a blood bank ready to go, there wasn’t an OR ready in case of abruption or cord prolapse, not to mention more “routine” things like antibiotics for GBS prophylaxis if she is a carrier to prevent sepsis in your baby, or vitamin K to prevent your baby from having a brain bleed, congenital heart disease screening, metabolic screening (which must be done after 24h of age), I could go on and on. People can get lulled into a false sense of security when things have gone well before, but the reality is the risk of things like shoulder dystocia and hemorrhage actually INCREASE the more babies you’ve had.

    Aren’t these the same types of reasons people use to justify why ED costs are so high?

    Not to mention, your physician’s or midwife’s delivery fee is a global fee which includes all prenatal, intrapartum, delivery, and postpartum care so it really doesn’t matter to the doc how many days you’re in the hospital (as long as everything is normal, for instance if you have complications and need to be kept longer it would be different)

    Click to expand…

    I don’t think this is a fair treatment of the OP.

    He isn’t advocating to have his wife deliver in a tub in a cabin in the woods. Everything in bold are things that he (she?) seems to be unequivocally OK with. He is questioning the marginal utility of the extra time in the hospital after it has become abundantly clear that none of this bad stuff has happened.

    Click to expand…

    He said “nothing was done” necessitating admission with the previous deliveries. I beg to differ.

    Personally I’m fine discharging moms after 24h or even sooner as long as there’s no hemorrhage and she’s not hypertensive. However my understanding is you are not allowed to sign out a newborn AMA. The pediatricians at my hospital generally aren’t too thrilled about discharge before 24h but that timing will certainly vary depending on the circumstances (GBS status, bili risk, LGA or SGA needing glucose checks, etc)

    #177705 Reply
    MPMD MPMD 
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    He said “nothing was done” necessitating admission with the previous deliveries. I beg to differ.

    Personally I’m fine discharging moms after 24h or even sooner as long as there’s no hemorrhage and she’s not hypertensive. However my understanding is you are not allowed to sign out a newborn AMA. The pediatricians at my hospital generally aren’t too thrilled about discharge before 24h but that timing will certainly vary depending on the circumstances (GBS status, bili risk, LGA or SGA needing glucose checks, etc)

    Click to expand…

    He also said, “I am considering signing out AMA from the hospital after our childbirth if everything goes smoothly during delivery and our baby is looking and acting normally.”

    We don’t need to have a contest over this. I just think we should respond to this guy’s actual question. If he truly believed nothing had been done then he’d just be agreeing with his wife and having a home birth and he almost certainly wouldn’t have bothered to poll the group. He clearly doesn’t so he isn’t.

    I’m not saying I agree with his position I just don’t think we should mischaracterize it.

    #177706 Reply
    ACN ACN 
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    Status: Physician
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    Why don’t you just call the hospital and ask for a CASH rate?  No need to go through insurance.  I know my fellowship attendings did this with their deliveries due to HDHP.

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #177708 Reply
    Liked by hatton1, Firefly
    Avatar Peds 
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    Joined: 01/08/2016

    “Nothing was done” with your previous deliveries- so there wasn’t an OB present to handle any sort of emergency that may come up, RNs/techs/other support staff present in case s*** hits the fan, she didn’t have an IV in place just in case she lost 4L of blood at delivery, there wasn’t a hospital lab with a blood bank ready to go, there wasn’t an OR ready in case of abruption or cord prolapse, not to mention more “routine” things like antibiotics for GBS prophylaxis if she is a carrier to prevent sepsis in your baby, or vitamin K to prevent your baby from having a brain bleed, congenital heart disease screening, metabolic screening (which must be done after 24h of age), I could go on and on. People can get lulled into a false sense of security when things have gone well before, but the reality is the risk of things like shoulder dystocia and hemorrhage actually INCREASE the more babies you’ve had.

    Aren’t these the same types of reasons people use to justify why ED costs are so high?

    Not to mention, your physician’s or midwife’s delivery fee is a global fee which includes all prenatal, intrapartum, delivery, and postpartum care so it really doesn’t matter to the doc how many days you’re in the hospital (as long as everything is normal, for instance if you have complications and need to be kept longer it would be different)

    Click to expand…

    Nope they said nothing….

    #177709 Reply
    Liked by Tim
    Avatar Gamma Knives 
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    Status: Physician
    Posts: 122
    Joined: 06/25/2017

    I am far removed from L&D so I can’t comment medically but professionally have you discussed with your OB and pediatrician? If you discuss with the team about a safe way to have a rapid discharge (assuming all goes well) I would think they would work with you as a fellow physician. On the other hand if you just leave AMA it may sour the relationship (you stated you were worried about someone calling CPS). If they won’t accommodate your request they probably have a rationale and maybe you should defer to their expertise. As wonka said, some things are worth paying for.

    #177714 Reply
    Avatar jacoavlu 
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    it has not yet been verified that the OPs plan even saves money

    The Finance Buff's solo 401k contribution spreadsheet: https://goo.gl/6cZKVA

    #177718 Reply
    Avatar SLC OB 
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    Status: Physician
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    Joined: 06/23/2018

    Just a few thoughts from an OB…. some have already been said….

    I would not advise leaving before 24 hrs or so post-delivery because we do want to do the newborn screen after 24 hrs of life and get the congenital heart screen then as well as chances increase that the ductus is narrowed or closing when the testing is done.

    Click to expand…

    This(above) is true and the reason we keep all to the 24 hour mark.

    Is your wife GBS+? If so and you want to get out at the 24 hour mark, get her there so she has at least 4 hours of antibiotics. If not, some (Most? All?) places make you stay 48 hours if you don’t get the recommended antibiotics at least 4 hours prior to delivery.

    be labeled as “the crazy guy in room 13.”

    Click to expand…

    Too funny (above) but likely true. The saying in OB, the longer the birth plan the more likely the c-section. Likely, if you plan to leave right after the birth, something will happen and you won’t be able to… Just go with the flow. People ask me all the time “Doc, did you have a birth plan?”  I say “Yes, it said ‘Healthy Mom and Healthy Baby/Babies'” (I had a set of twins).

    Lastly, we keep our first time mom’s for two days postpartum to learn to breastfeed, care for the baby, etc. We highly encourage our second time mom’s to stay to rest and get taken care of… they almost always leave the next day to “get home to their toddler”…. third time mom’s, we have to kick out at midnight of 2 days postpartum cuz it was the first bit of quiet they have had in years and taking care of one newborn is SO EASY compared to home! Ha! Ha! Let her stay to enjoy it!

    As for your original question… not crazy but likely not beneficial and could result in unexpected complications that might haunt you moving forward… IMHO, not worth the money.

    Congrats!

    #177727 Reply
    Avatar SLC OB 
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    Status: Physician
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    Joined: 06/23/2018
    Please don’t do a home birth. We had a fourth year anesthesia resident and her ED attending husband do a home birth about 7 years ago. Baby died. Mom has PTSD and has been unable to finish residency.

    Click to expand…

    This is so sad…

    I had a Med Student rotate with me on OB after having a home birth 6 months prior… during his rotation his buddy had a home birth and lost the baby and almost lost mom.

    The Med Student had no idea the risks until he did his rotation with me and felts so horribly guilty for taking the risk for his baby and wife. Hospital birth the next time (thank goodness).

    I work in a hospital setting (OR across from the laboring suites), everyone has beautiful private rooms, bathtubs in each suite, “heating tile” in ceiling so that baby goes directly to mom’s chest and is warmed with heating tile instead of the bassinet/warmer (policy and practice has the baby’s skin to skin with mom for first 2 hours, exams of baby done on mom’s chest, etc…. unless complications), low c-section rates (~17%), extremely high breastfeeding rates (some of the highest in California) and is “baby friendly” AND we still have people in our community who deliver with home birth LAY midwives… it is so sad.

    #177732 Reply
    Avatar Kamban 
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    The deductible for the mother is $3500. I don’t think there is  a hospital n this country that charges <3500 for a 24 hour labor and delivery stay and this does not include OB, anesthesia and the CRNA fee. There is a good chance that the fees for the baby and his medications and vaccinations might exceed that. So how can the OP save $7K leaving AMA. If you have 80:20 after the initial $3500 deductible there might be some savings there.

    I am surprised we as physicians earn >$300K per year yet we tend to cheap out on medical care for ourselves and our family.

     

    #177734 Reply
    Liked by hatton1, Firefly

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