Medicare – 2015
by – Sheri de Grom
The biggest and best commercial insurance companies have a brand new battle cry.
” IF THEY can do it, WE can do it” has become the medical industry’s standard with the enactment of The Affordable Health Care Act. [Known as Obamacare]. THEY refer to Medicare and THEY [Medicare] are out of control.
The numbers don’t seem large until you review them cumulatively. A frightening reality is that all other methods of medical payments are cutting their reimbursements to match Medicare’s payments. Medicare is accountable to no-one. Every provider everywhere is receiving less.
Many medical facilities are operating with a dangerously low profit margin and rotating temporary layoffs have become routine. This lower level of payment and fewer Medicare-approved days for a designated hospital stay has driven some facilities to close their doors forever.
Physicians and hospitals alike are receiving a single payment from commercial insurance companies per diagnosis. They started this payment system upon reviewing the cost savings of Medicare. Loss occurs when treatments and tests pile up for the provider of care. Laboratory tests, x-rays and other exploratory findings became a part of the amount allowed per doctor visit or hospitalization.
My husband and I have each experienced this single payment fallout.
Those of you who’ve followed my blog for a time know that during a surgery in 2012: I lost well over one-half of my blood, sustained permanent nerve damage to my right arm and hand resulting in chronic pain leading to Complex Regional pain Syndrome. This past week my Scleroderma became a direct link to the 2012 hospitalization. In addition, I acquired a hospital staph infection. Medicare didn’t care how sick I was. They sent me home. I was too ill for any skilled nursing facility or home health nursing agency to accept me as a patient. Yet Medicare sent me home from the hospital knowing I was without a caregiver in the home.
The code for the surgery I had allowed a minimum number of hospital days and out I went. My doctor and the hospital didn’t attempt to fight for the complications involved in a six-hour surgery that Medicare coded as one and one-half hours.
You may read of my experience here.
Tom’s admission to our local hospital on September 22, 2014, for an infection diagnosed as cellulitis of the left foot, seemed to be the answer for receiving powerful antibiotics he could only receive in a hospital setting.
The admitting physician, an orthopedic surgeon, misdiagnosed Tom’s problem. I recognize misdiagnoses do occur but, seven subsequent medical specialists have also misdiagnosed Tom’s illness. Many of the doctors have been so arrogant I wanted to drop kick them back to medical school for a class on both ethics and another on communication skills.
A few days before Tom’s hospitalization of September 22, 2014, he had been diagnosed with psoriasis on the bottom of his feet and palms of his hands. I asked the orthopedic surgeon if this might have contributed to the infection in his left foot and he looked me straight in the eye and said, “Absolutely not.” With visible signs of outrage that I’d questioned him, I continued, “Tom has open wounds on the bottom of his feet and this is dangerous for a diabetic. It seems to me this would be a perfect place for bacteria to enter and become out of control.”
The good doctor in the long white coat, [the orthopedic surgeon] announced, “If you have all the answers, Mrs. de Grom, why did you bring your husband to me for treatment?”
I’ve asked myself that very question many times. At the time I thought I was making the correct decision.
Tom was released from the hospital with a prescription for powerful antibiotics, pain medication which would later lead to delirium and today, five months later, he’s still in so much pain he cannot walk.
I’ll blog in another post about the new path we’ve been on since Tom’s discharge from the hospital five months ago. At five months post the hospitalization for the infection in Tom’s left foot, he cannot walk on either foot. The pain is horrific and it turns me inside out to watch this man I love when he does his best to move from one place to another.
Tom worries about being even more of a burden on me. I urge him to let me know when he needs help.
A recent study in Health Services Research based on fifteen years of hospital data suggests that cuts in Medicare prices under the Affordable Care Act may slow the growth of overall Medicare spending. Many current hospital standard practices will not withstand the loss in operating capital.
The reports indicate that when Medicare tightens reins on its inpatient hospital prices, hospitals scale back overall capacity. This results in less hospital use by non-elderly patients, not just elderly patients, a senior policy researcher with Rand concluded.
Changes in Medicare prices affect our healthcare system broadly. Medicare is by far the largest payer of hospital bills in the U.S., accounting for more than thirty-percent of total hospital revenues.
A substantial majority of Medicare enrollees—roughly 87% have at least one chronic condition, and nearly half have three or more, compared to 21% and 7% of the general population, respectively. Forty-seven percent of Medicare enrollees have an activity limitation.
Medicare has announced that, “The party is over. The sort of money, where whatever you do, the more we’ll pay, and the more complicated thing you do, the more we will pay you, and the more risky thing you do, the more we will pay you – there’s a recognition now that, we aren’t doing that any longer.”
The above announcement would have cost Tom his life if his heart surgeon hadn’t bucked the Medicare rules for Tom’s emergency heart surgery June 11, 2014. However, as insult to the surgeon, Medicare pays more for three chiropractor visits than it does to a heart surgeon saving lives. I’m having a hard time accepting this fact!
At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients – and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why.
The same chair of surgery also demands that patient’s with end-stage dementia not have three or four hospitalizations in the last three months of life or die in the intensive care unit. He closed his comments with, “This is a terrible experience for the patient and family and we lose far too much money.”
In my opinion, Medicare has become all too powerful. They have minimal oversight from any other governing body. Presidential appointees and their staff charge ahead making new laws within the administrative law division. The new laws have resulted in not only how little Medicare will reimburse providers of care but they are dead set on holding everyone seeking medical care hostage. THEY especially have their eyes set upon those ages sixty-five and over.
A physician in private practice, treating primarily Medicare patients can expect an average yearly income of $85,000. Take away the operating expenses of being in business, paying back student loans, attempting to maintain a middle-class standard of living and supporting a family – it’s easy to understand why doctors can’t afford to accept Medicare patients into their practice.
Medicare has taken away the health care I once thought I had securely protected and provided. Doctors must now fight bureaucracy to provide limited care. Often the medical care isn’t what the physician would choose for his/her patient.
Medicare is an agency brought about by congressional legislation in 1965 with the sole purpose of providing medical care for American citizens 65 and older. How has one agency within the government lost sight of the citizens it is to serve and protect?
In my opinion, Health and Human Services, [the agency with oversight of Medicare] must review the actions Medicare has taken within the last four years and the end results its had on the American people. It’s time for change!
Voices must be heard before change will come about.
Thank you for reading with me. I’d love to hear about your encounters with Medicare. Please share.