“TLC and TCC join together in the transformation of healthcare delivery.”
—Mary Mirabelli
I don’t typically quote myself. But please, humor me this once.
Reflecting on the topic for this month’s issue, I thought about the honor we have to provide care to people and about how “tender loving care” (TLC) and “total cost of care” (TCC) are inextricably entwined and never mutually exclusive. This belief goes back to my humble beginnings as a clinician, where early experiences taught me many valuable lessons, two of which have withstood the test of time: Always love your patients and your community, and always do the right thing for your patients and their families.
I’ll always remember one patient who had suffered a stroke that left his right side paralyzed and his speech impaired. He was a tailor and owned a shop, making custom curtains, cushions, and sofa covers. The stroke, however, cost him far more than the cost of acute care, rehab, scans, consulting physicians, and durable medical equipment. His work life as he knew it was gone. His identity and reason for getting up every morning were forever altered.
My job as his occupational therapist was to help him regain as much day-to-day functioning as possible, but it was much more than a transaction. It was about helping him to thrive again and touching his and his family’s lives using a powerful treatment tool: TLC. We worked on returning range of motion using simple tasks like turning the pages of the newspaper, putting a pot on the stove, washing his face, and singing because song “memory” sits in another part of the brain and can sometimes help aphasiac patients find their voice.
Although my patient never fully returned work, he kept his shop, finding others to do the manual work as his wife assumed additional business responsibilities. He, in turn, took on more simple tasks at home. Each change required significant, intangible investments with no associated transaction—no ICD-10 codes, no CPT codes, and no edited claims.
And that’s the point here. When we compute the total cost of care, especially for chronic care patients, there are multiple other costs in the longitudinal equation—costs beyond the chargemaster, the dropped charges, the coinsurance, the copay, and the actual payment. “Copays” for patients and their families extend far beyond the financial transaction to include time, emotional energy, lifestyle changes, and modified behaviors.
So as we think about this issue, I encourage us all to look beyond the transactions that add up to the total cost of care and remember that truly thriving requires that “tender loving care” be part of the equation. It’s also part of being human.
Thrive on.
