Archive for June, 2008
What do you do in a situation when your parent is having surgery and needs some recovery time? How do you deal with the situation where your parent wants to recover at home – which creates a cost savings, no matter what sort of coverage they do or do not have – but Medicare Advantage wants them to go into an expensive nursing home? You hope that the politicians who are trying to mess with Medicare figure things out soon.
So, in Medicare’s bureaucratic wisdom, it makes more sense for them to send a person to a nursing home that costs from the high hundreds to thousands rather than allowing them to stay home and have a nurse visit when necessary at a much lower cost.
This is some of the issue that creates the lack of confidence in Medicare. It is also part of the reason that Medicare is having so many financial issues and so many people are predicting the downfall of the program within the next twenty years.
On the other hand, what could happen if the people running Medicare made financially intelligent and fiscally sound decisions – such as letting people stay at home rather than in nursing homes or hospitals wherever possible – the savings for those and other intelligent decisions would most likely be enough to save Medicare, if not extend it for years. Add to that an efficient, effective and accessible system so that Medicare recipients could get good services that save the system money while helping the people that need help, and Medicare might just work indefinitely.
Certainly some of these ideas have been thought of, but why have they not been implemented? This is a question for the ages. Hopefully there will be some good answers – and solutions – sooner, rather than later.
With identity theft running rampant throughout the world, guarding Social Security numbers and other personal and pertinent information has become essential.
Private insurers issue identification cards, and they used to place the individual’s Social Security number on the cards as part of the identification or as the identification number itself. In recent years, this practice has been discontinued because too many people have had their numbers and identification stolen.
In fact, Medical Identification Stealing and Fraud has become the fastest growing form of identification theft in recent years. This being the case, Medicare has been asked by the Social Security Administration, Congress and the public to remove these numbers from their identification cards, however, so far, they have resisted doing this.
Why the resistance, especially since others have already willingly complied? One reason is that it is inconvenient. The other is that at this point, the Social Security Administration is not allowed to force Medicare or the Centers for Medicare and Medicaid Services (CMS) to remove this information.
CMS has said that the risk of identity theft by using the individual’s Social Security number on Medicare identification cards and other information is not that great. Yet, statistics show that this is not the case. There is a great risk, and predators are taking advantage of this information constantly. In addition, CMS also says that if they started to issue new Medicare cards all of a sudden, it could worry, startle or upset Medicare beneficiaries.
It seems that if there was a nice letter sent to each beneficiary announcing a newly designed card would be coming in the mail within 10 days or two weeks, it might be accepted as good news, especially if the letter explained that the individual’s Social Security number would no longer be on the Medicare card, thus protecting the individual. It would seem that this would be well received as a positive message and a positive action by a government agency – CMS – whose job it is to look out for the interests of its clients – Medicare beneficiaries.
There seem to be a lot of good options available for government decisions about situations such as this. It doesn’t have to be complicated. It is simply a matter of opting to consider the privacy and safety of Medicare beneficiaries, rather than the convenience for the CMS agency.
Ohio Congressman and Republican Leader John Boehner was praised today for advancing the bipartisan efforts to stop the Bush Administration’s plan to cut senior’s Medicare Part A Nursing Home funding. If the cuts are put through, they could badly hurt the most vulnerable seniors in the country, creating a $45 million loss in Ohio in the next year alone.
Congressman Boehner sent a letter to Health and Human Services Secretary Mike Leavitt, stating that high quality nursing home care will be seriously threatened if the Centers for Medicare and Medicaid Services (CMS) allows the proposal that would cut $770 million from nursing home funding in 2009, the most vulnerable in society would be hurt the most. After 2009, there would be $4 billion more in cuts over the next five years.
Not only will these cuts impact Ohio nursing homes and the seniors that need them most, but will also impact the economy of the state. Though Congressman Boehner is from Ohio and trying to help Ohio seniors, the same issues hold true in states throughout the nation. The bill will be detrimental to seniors in every state and the economies of every state as well, and as a result.
Boehner’s letter to Secretary Leavitt also states “The administration should be commended for its previous support for policies that moved many high acuity patients into Skilled Nursing Facilities. While these patients may have otherwise been cared for in higher cost facilities, the success of these policies helped to save Medicare $709 million in 2006 alone.”
The Ohio Healthcare Association, a non-profit organization that thanked Congressman Boehner and backs him in his efforts to stop the Bush Administration’s cuts, is the largest healthcare association in Ohio, and represents 700 of the nursing homes and long term care facilities in the state, plus assisted living residences and facilities for people with mental retardation and developmental disabilities, is the only Chartered Ohio Affiliate of the American Healthcare Association, which represents 12,000 long term care facilities throughout the United States.
With backing and endorsement from an organization of that magnitude, hopefully the results will help Ohio’s – and America’s seniors.
What happens to a Boomer when he or she is 55, has worked his or her 20 to 25 years and is ready to retire? Good question. What happens if this same Boomer wants to begin a second career at least until they are 62 or 65 – actual retirement age.
Too young for Medicare at 55 but retiring. Besides COBRA, what is available? In some cases, employer insurance can continue, usually through COBRA or through a switch to a private policy, too often with high premiums and much less coverage. Unless this 55 year old has retired with an excellent income and a ton of savings, the cost of insurance can be prohibitive.
However, there have been suggestions that 55 year olds that are eligible for retirement should be able to buy into Medicare and pay ad least modest premiums. Since this is a younger age group, usually with less health issues – especially less serious or long term heath issues – premiums would offset other Medicare expenses of the current recipients who are older, and they could help fortify and supplement the current program. In addition, part of these premiums for the 55 year olds could be used to put in a savings account that will provide some modest supplements to the 55 year old early retirees until they reach the age to actually draw Medicare and Medicaid, and the government could borrow from the interest on that money to help supplement current or future premiums.
The issue of early retirement of Boomers, as well as what they can and will do is an important one and needs to be explored thoroughly so as to create an appropriate solution. It is hopeful that the time will be taken to research the issue at great length and several solutions can be proposed that will help a great many people now and in the future.
Medicare Centers for Medicare and Medicaid Services (CMS) has been working on a pilot program for three years. The pilot program has involved over 250 hospitals and has monitored quality measures in those hospitals during that time, offering rewards for high quality.
This partnership between the hospital consortium and Premier and the CMS spent the three years working on the quality measures in the 250 hospitals that were part of the pilot. Premier reported that the results that were achieved included a 15.8% increase in quality in these hospitals that served 1.1 million patients. Premier President and CEO Richard Norling said, “The findings from the first three years of the project clearly show that transparency with rewards for quality achieves a higher level of performances in American hospitals.
This project actually brought up the performance standards of all hospitals involved to a better level, bringing those on the lower levels closer to the higher levels and closing the gap between them. This is great news, and if the pilot program works to raise quality levels in these 230 hospitals, it would be a tremendous idea to expand the program or at least use the standards and rewards in the pilot to improve quality of more hospitals throughout the country. The money saved because of the improvements of quality and efficiency could be used to fund the pilots or other programs for other hospitals in other areas across the country.
There was an announcement by Acting CMS Administrator Kerry Weems said in a statement, “Given these results it is time for us to take the next step and implement hospital Value Based Purchasing for the Medicare program, so that citizens across the nation can benefit from improved safety and quality [and] get the right care every time.”
Long term care has long been an important issue that needs to be addressed and has been debated many times. With Medicare and Medicaid systems under so much financial strain and with proposals in the works for revisions and provisions, it seems that Congress on both sides of the aisles is grappling with the issue of Long Term Care funding.
This is a serious issue, as it affects millions of individuals and their families and over 10 million individuals who are living at home and receiving services in there homes and in the community. These people need assistance and services and are normally on a very limited income, being cared for by family and friends. They are often in situations where they are trying to stay at home and in the community in which they live, receiving their supports there, rather than ending up in an assisted living or long term care facility.
It has been shown that when a person can stay in the community and in familiar surroundings receiving long-term supports that is the best situation for them if their situation and condition permits. Congress – and other organizations – is looking further into the cost savings and health effects of helping people stay in the community vs. a healthcare facility. There are various studies that have taken place and are taking place – especially in the recent past and currently – trying to determine to continue to fund the essential service of long term care.
With Congress presently looking at ways to buy time so that Bush Medicare cuts - which affect Medicaid drastically – won’t take place immediately, there is a good chance to work on long term care issues at the same time.
In the meantime, if you are dealing with long term care issues, be sure to keep current with what is happening. For current information you can log into www.CMS.gov.
There are stories about individuals and families having some issues with services through Medicaid because of misunderstandings with providers or not understanding their coverage. Sometimes mistakes are made and must be fixed. The majority of the time providers try to work with Medicaid recipients to provide the best service they can.
In New Jersey, however, there is a company that has been in the news lately for doing just the opposite. This story has been touched on before, but there are more details continuing to come out.
The company, Assisted Living Concepts, based in Wisconsin has a large number of assisted living facilities. As in any business, some things work well and turn out right and some things sometimes do not. There are many excellent assisted living companies throughout the country who work hard every day to balance their budgets, help the residents – whether on Medicaid or not – and deal with issues – especially financial ones – that come up.
Unfortunately, at least in this case, Assisted Living Concepts has handled a situation with eight of its facilities in South Jersey in a harmful and totally inequitable way. In these particular facilities, Assisted Living Concepts had a number of individuals staying there and receiving service who were paying for their services out of their life savings. The individuals say that they were told that if their savings ran out, they would be switched to Medicaid and could stay where they were in Assisted Living Concepts facilities.
Instead, when their savings were totally gone – because they had been paid to Assisted Living Concepts for their care – they were told that they had to leave. A complaint was made and a few weeks ago the Public Advocate began an attempt to review records to see how many more individuals were – or had been – in this position with Assisted Living Concepts.
The case has gone to Superior Court, and a judge will decide on whether the records will be released for review. The case is difficult because, though all Assisted Living facilities are supposed to keep 10% of their beds for Medicaid recipients (in New Jersey), some are exempted. The lawsuit being brought by these eight evicted residents has to do with the promises that were made to them that after they used their funds – in one case over $300,000 - they would be able to stay and be switched to Medicaid. These promises were broken, and it is not known how many other promises to other individuals were handled the same way.
It is important to get to the bottom of this so that individuals who are most vulnerable are not taken advantage of in this (or other) ways, but are protected by the system and by the individuals and organizations who are supposed to serve them.
As most of us who read or listen to the news know, there are some extensive efforts by Congress at this time to stop the Bush Administration from enacting regulations making cuts to the pay of doctors and creating other problems for Medicare and Medicare beneficiaries.
There are many points that AARP is looking at backing as far as the Senate Bill by Max Baucus along with several Senators, because AARP thinks these will improve Medicare.
Some of the most important issues AARP has highlighted have been limiting premium increases to Medicare beneficiaries and not limiting payments to physicians treating and caring for Medicare beneficiaries.
AARP CEO, Bill Novelli, states that the bills improvements will directly benefit Medicare beneficiaries. By the same token, Novelli says that “physicians treating Medicare beneficiaries need to be paid fairly.”
The bill will include some other important benefits. It will ensure that more lower-income people in Medicare have access to more financial assistance and a better, more streamlined application process, rather than the sluggish process that leaves individuals in limbo for months and sometimes years, waiting to be accepted for much needed, medically necessary services.
AARP states that the bill that Chairman Baucus has proposed improves Medicare, keeps doctors in the program and does it without unnecessary increases in premiums for people in the Medicare program. This is essential because in the past, some benefits were subsidized and saved by unaffordable increases in premiums. Though premiums have to sometimes be raised to balance the programs out, some raises have been simply unacceptable and unaffordable. AARP feels that this bill will keep all parts of the puzzle balanced and give Congress the time to look at long-term solutions that will work as a win-win for as many parties as possible.
We will provide updates as the deadline later this month draws closer. There is more information available almost daily. This is an important issue and AARP plus many others throughout the country are happy and relieved that there are some sensible options and solutions being explored.
It has been known for a long while that not all healthcare is equal. In fact, whether you are on Medicare or Medicaid, have no benefits at all or are self-paying, studies show that most often the quality of healthcare has to do with the area you live in and your economic status among other things.
For instance, diabetes testing, breast cancer screening and other essential tests are not provided as often in low-income situations as in areas that have higher income levels, more doctors and hospitals and less Medicare and Medicaid restrictions. Aside from lack of essential tests and treatment, the results end up being more leg amputations, kidney failure and eye disease leading to blindness.
It is not that low income individuals and families that have some sort of assistance from Medicare or Medicaid do not work, are not legitimately disabled or don’t deserve to be treated as well as others who need medical attention. The issue is how to provide quality services to everyone who needs them, regardless of their income or neighborhood.
Studies have shown that the differences in care levels are not just simple; they are dangerously different and uneven throughout the country. This disparity begins with BASIC care to keep people somewhat well or medically stable. We are not talking about complicated, high priced procedures; this is basic medical care, which could save money, taxes and, more importantly, lives.
One example is that one in three women receiving Medicare did not receive a mammogram in the two year period between 2004 and 2005. Black patients were less likely to receive mammograms than white patients.
Diabetic patients are not receiving essential blood tests necessary to monitor and maintain safe blood sugar levels. Black patients are losing legs at a rate of 4 to 1 above whites. Heart and vascular issues are not being addressed. And the disparities are even greater between different states than they are between blacks and whites. There is also a disparity between those beneficiaries who have regular primary care physicians and those who do not.
These disparities are beginning to be addressed in the hope that raising awareness will begin to eliminate the disparities – or at least start working on them. It will take forward thinking and planning, plus incentives for doctors and hospitals to serve in underserved areas and to realize the importance of preventative and maintenance care, rather than reactive care that leads to amputations, blindness, heart failure, decreased quality of life, and often, death.
With deadlines looming, there has been much discussion between members of Congress, CMS, physicians groups, Medicare and Medicaid beneficiaries and others trying to sort out a decent bill that would be fair to all in light of the Bush Medicare cuts that are proposed.
One of the latest situations to crop up is that Senate Majority Leader Harry Reid, a Democrat from Nevada is warning that he will try to stop the debate about the proposed bill to delay the 10.6% cut in pay to physicians for 18 months. To stop the debate, he will invoke “cloture” and do what he can to let the bill pass.
There is legislation that has been introduced by Senate Finance Committee Chair Max Baucus, a Democrat from Montana that would delay the cuts from going through. The Baucus legislation would cost $20 million dollars, but would include some positive provisions including promoting electronic prescribing by physicians, expand some other services and require Medicare to pay pharmacies that provide for Medicare recipients with prompt payment. In addition, recipients who pay for Mental Health Services would have their copays lowered from 50% to 20%.
Some funding would be decreased, such as funding for certain education and marketing programs to get physicians and private health insurance to participate in or to accept Medicare, as these are not as essential as many of the provisions that the proposed legislation is trying to save or enhance.
It is no secret that Medicare and as a result, Medicaid are experiencing difficulties and that, from all reports – Republican and Democrat, alike – the outgoing administration has not made it better, but have weakened it substantially. To be fair, we can’ blame everything on this administration, and there are many things that have happened over the past decade or more that have weakened many services that should be available to the vulnerable individuals and families that need such services.
The debate may have many points of view, but there is little time left to enact some legislation to avoid eliminating even more benefits. It is important for us to watch what is happening to the benefits and services at stake and how Congress works to block these proposed cuts from going through. Keep on the watch.
Lately there has been a rush to access various personal and confidential medical records for research purposes. The latest information being requested is Medicare prescription drug benefit claims.
The Centers for Medicare and Medicaid Services (CMS) has issued a ruling allowing researchers access to records for only specific purposes. They will be able to study the effectiveness and safety of medication used by elderly and disabled Medicare recipients.
One of the reasons that researchers want to try to explore this information is that elderly and chronically ill patients are often not included in clinical trials and the information that can be obtained through Medicare could help study results of specific medications.
CMS has stated that under the rules, the information regarding the individuals and the identities of prescription drug plans will not be accessible and will remain encrypted. CMS will also combine cost information for Medicare prescription drug plans because not doing so “could negatively affect the ability of plans to negotiate medications, favorable to Medicare beneficiaries and taxpayers.”
There will also be regulations to guide research in what they can do and what they cannot when it comes to the research they are working on. The Kaiser Family Foundation has said that the release of this information is a good thing. Researchers will not have the ability to access certain claims data, nor will it be able to discover the amount of rebates that Medicare prescription drug plans receive from pharmaceutical companies and the amount they charge beneficiaries.
One important part of the research will be allowing researches to determine how many beneficiaries reach the “donut hole” amount where there is a gap in prescription coverage, but they will not be able to identify which plan they are enrolled in. Determining the gap in coverage at the “donut hole” may help many avoid financial traps in the future by identifying a way to avoid that trap.
In some respects, if handled appropriately, this research can certainly be helpful to many parties involved.
There are many creative ways that are being explored to help individuals and families come off of Medicaid and subsidize their payments for employer sponsored health insurance if it is available to them. Utah is one of the states that will be working with Medicaid to have Medicaid help low-income families offset these premiums, as this would help people be able to buy their own insurance.
The question is whether these individuals and families will be better off. Will they actually have access to and actually be able to receive better care. Advocates are asking whether or not individuals will not only be able to get the care they need, but also receive it without limits on copayments and deductibles.
The plan that Utah is trying to put in place involves Utah’s Premium Partnership for Health Insurance (UPP) which presently provides up to $150 per family toward their premiums. The problem is that employer-sponsored health plans are not available to everyone, so in these cases, this pan could seriously limit these individuals’ and families’ access to health care. The aim is to provide coverage to about 5,000 adults and 1,000 children.
There are issues with this, however. One issue is that if adults enroll in the plan, their children would have to be enrolled, and this would exclude them from the Children’s Health Insurance Program (CHIP). The problem: there are cost protections built into CHIP that are not available with UPP. As a result, there could be unlimited out of pocket costs to parents of children whose illnesses or injuries are extremely expensive. With unlimited out or pocket expenses, children would be put at great risk if their families are unable to pay, and, in addition, family finances could be in great jeopardy.
Before the plan goes into effect permanently, it will be extremely important for these issues to be addressed and solved or families will potentially be in a worse situation than they are without these changes.
Medicaid is supposed to help low income and poor individuals, plus individuals with disabilities get medically necessary medical treatment. Like any program, Medicaid has its good points and bad. The bad pints can usually be attributed to limitations on services and quite often a very narrow view of what is medically necessary. In addition, every state develops its own Medicaid guidelines and determines what it will cover and what it will not.
One state that is dealing with a very serious case right now is Georgia. This is a particularly difficult case because it involves a 38 year old mother of eight children who needs a small intestine transplant in order to live much longer. The sad part is that if she lived in several other states, getting approval for this surgery would not be an issue. In fact, another state close to Georgia – the state of Florida – has offered to provide the hospital if there can be approval by Medicaid.
This is a situation where a woman is being fed by a tube 16 hours per day because she cannot eat, due to the fact that her intestines don’t work. She is in massive amounts of pain that rarely let up. Infection is an issue that has sent her back and forth to the hospital. Her husband and children – whose ages range from 10 to 20 years of age - keep the home running and take care of her IV feeding treatments. Her bedroom looks like a small town ER, stacked with bandages, medical tape, surgical gloves and more.
The operation that Ms. Holloway needs would cost somewhere between 200,000 to 450,000 dollars. Though that is a lot of money, doctors have stated that Medicaid will actually save money by addressing and correcting the problem once and for all. Instead of running up bills of $20,000 to $50,000 at a time with each visit to the hospital, the surgery could give her – and her family – her life back and eliminate the problem.
It will be interesting to see how this case and its appeal are handled. They may set a precedent as to whether states will refuse to look at the long term cost of keeping Holloway alive and in pain vs. the same cost for approving her surgery. Will states, such as Georgia cut off their nose to spite their face and let people die in the process? Only time will tell. Let’s hope that the Holloway family – Ms. Holloway, in particular – has enough time to wait.
A bill proposed by Senator Mandy Dawson, Democratic Senator from Ft. Lauderdale, Florida, was signed into law this week by Governor Charlie Christ.
This is an essential bill that extends for two years the Medicaid Waiver Program for Alzheimer’s patients. The bill was co-sponsored by House Representative Hugh Gibson.
This is a continuation of a waiver that as passed in 1981 providing home care for Alzheimer’s patients that would otherwise have to be institutionalized. The waiver was scheduled to be reconsidered for legislative renewal in 2008, but the newly passed bill delays that reconsideration until 2010.
The bill also requests that there be a comparison between Medicaid home and community services that are available to these individuals’ waiver programs to determine cost effectiveness of allowing these Medicaid recipients to remain at home rather than be institutionalized.
The intent of this law is to see that Alzheimer’s patients and others with similar memory disorders and their families receive the types of assistance they want and need, that is best for themselves and their families, and have the choice to continue living at home, receiving supports and having the option to participate in their community to the extent possible.
It has been shown in a great many cases of Alzheimer’s and other memory conditions, that when individuals are able to remain at home with family, receive supports and have access to their community – which is usually a familiar place to them – they are able to do well longer and digress more slowly.
In this growing climate of strong suggestions to cut benefits as a short-term solution to a long-term issue, it is good to see that in some cases – including this one involving Alzheimer’s patients and their families, - taking the next two years to look at the situation closely and determine viable and acceptable solutions is the reasonable thing to do.
Once again, President Bush’s attempts to save and/or move money around are being called “ill-considered” and “a serious detriment to seniors and long term care.”
Bush has proposed $770 million in cuts to Medicare A national nursing home funding cuts scheduled to take place in a few weeks. Not only is the bill considered harmful to seniors, even Mike Leavitt, Health and Human Services Secretary and key members of the House and Senate are working hard to garner opposition to these cuts.
The consensus is that the Bush Administration’s proposed cuts will drastically and negatively affect high quality skilled nursing care for seniors. There is also extreme concern that reductions of this magnitude will severely diminish access to nursing home care and compromise quality of care received by the nation’s seniors.
In addition, there are studies and reports by the American Healthcare Association and Alliance for Quality Nursing Home Care showing the economic impact of the proposed Bush cuts. Not only would they compromise access, quality and care, they will also have a net negative economic impact of $4.5 billion for 2009, approximately $1.8 billion in lost wages, 43,530 lost jobs, and $661 million in lost federal, state and local taxes.
“In the final analysis, the Administration’s ill-considered change to Medicare policy would have unfortunate results for patients, taxpayers and the Medicare plan itself,” was the comment by Patty Cullen, President of the Care Providers of Minnesota. Leaders from South Dakota, Maine, New Hampshire and other states have explained in various ways that because nursing homes rely on Medicare reimbursements, these cuts would have a visible and devastating effect on state Medicaid programs.
Whichever side of the issue people are on, it is good that both sides are being revealed and it would be good for all sides to truly study the situation – and the information from all those who are making points about how this could seriously cripple nursing home services to seniors. It is important to explore the facts before it is too late.
Every day we hear more and more information about Bush tax cuts, Medicare and Medicaid cuts and all sorts of issues that will confront the most vulnerable individuals in the country.
There are members of Congress on both sides of the aisle who are not at all happy with the fact that Alzheimer’s patients and nursing home/long term care patients may lose their care, but now, let’s add physical therapy to the mix.
Members of Congress are not happy. Healthcare advocates are upset. Individuals with disabilities that need the services, and disability advocates are, well, almost livid.
To their credit, Congress is doing all they can to stop this situation from happening. What will happen if Congress is not successful is that after July 1st, a large number of patients will learn that they have exceeded their cap on their therapy benefits and will have to start paying – sometimes very high amounts – out of their own pockets or find hospitals that will treat them.
All courtesy of the Bush Administration’s Medicare plans for the future. The very near future. It is possible that over 650,000 beneficiaries could lose their therapy benefits by the end of this year. Congress is against this happening and both Democrats and Republicans have ideas on how to stop this. Regardless, both sides are trying to do what they can to prevent these regulations from going through, protecting those that need this care the most.
The Medicare Rights Center has stated that it will be perilous for beneficiaries if the deadline passes without Congressional action stopping this. Patents with these benefits can be in therapy for everything from broken bones to strokes to traumatic brain injury. Those with more minor issues can choose to wait, address their issues in a different way or, if possible, they can make arrangements (possibly by negotiating block or discount prices) to pay the costs themselves if they can.
However, those with severe issues may have a much more difficult time. For instance, when dealing with long term therapy, if the person needs to stop because of these provisions, their condition could digress and they could get worse, reversing progress they have made.
The catch is that current regulations allow about $1,800 for physical therapy for year in a doctor’s or therapist’s office; however there is no cap for receiving these services as an outpatient in a hospital. Though patients can choose to go to a hospital for treatment, there are not enough hospitals or therapists available at those hospitals to treat them.
This is a quandary for those who need these benefits. It is important and notable that Congress is trying to act in time to overcome the July 1st deadline to block the Bush Administration from allowing these services to be curtailed for people who truly need and depend on them.
Dynamic Response Group, a large Medicare supplier, has announced that it created a subsidiary, Medico, that will serve mainly Hispanics who are extremely underserved when it comes to Medicare benefits.
Medico plans to provide direct-to-consumer products to Hispanic individuals who have serious and/or long term health issues in the United States, Puerto Rico and the Virgin Islands.
Dynamic Response Group is already strategically positioned to serve this population so adding Medicare to the mix should be a relative problem-free way to move forward to assist a population that is traditionally and extremely underserved.
Dynamic Response Group’s goal is to provide assistance to individuals in the easiest way possible for the Medicare recipient so that individual can get well or at least improve their health and get somewhat better and get back to living their lives. To do this, Medico will determine what critical care products will help patients the most and deliver those products directly to their homes, per their primary physician prescription. By dealing directly with the patient, this should save time and money for all involved.
Phase II of the project will help Medico establish relationships with doctors and other providers, as well as community groups, partnering with them to help get information and assistance to people who need it and working with the community, positioning the company higher than its non-Latino counterparts. Part of the foundation of Medico’s goals will be to work hard to gain friends in the community, providing social benefits to its clients.
The creation of Medico as part of Dynamic Response Group is a positive addition which will serve a seriously underserved population, making sure they have the supplies they need to be able to deal with their heath issues in a more effective way.
It has become common knowledge that people in different communities in different parts of the country receive better care and access to care, treatment and services than in other areas. That has prompted a study by the Robert Wood Johnson Foundation. The study tracked the number of black patients with diabetes that needed amputations vs. the number of white patients who did.
Overall numbers vary throughout the states, however, in the study; blacks needed more amputations than whites did. The study stated that individuals with diabetes need amputations partially because of the care they get and also because the difficulties they have receiving treatment. Other factors are also included, such as whether patients smoke or drink, and particularly, whether they can afford the special diabetic shoes that help with circulation and other factors which could lead to gangrene, thus eventually lead to possible amputation.
Except for Arizona and Kentucky, blacks were less likely to receive annual diabetes blood test than whites. They were also less likely – by quite a lot – to get mammograms, not only because they didn’t’ know about the need, but because they weren’t being told about the importance of the tests and given the prescriptions by doctors to go have them taken. The biggest disparity was in Colorado where 88% of whites were tested, vs. a little over 60% of blacks.
Part of the issue is the need for outreach and availability of Medicare and Medicaid coverage in the poor neighborhoods. Most of the people who are the poorest and live in areas and situations where they are not covered by Medicare are in very compromised health situations by the time they are able to get Medicare or Medicaid coverage.
It is no secret that there are disparities in coverage and treatment throughout the country. The unfortunate point is that people are losing a great deal of quality of life and even losing their lives because of these disparities.
In the wealthiest nation in the world, hopefully there will be a solution to the situation in the near future. Though issues are being looked at, this is a complicated issue, but, complicated or not, the results are overwhelming to the poor and vulnerable among us who deserve quality health care just like anyone else.
As President Bush’s administration winds down, you would think he would give a few folks a break at home. After all, all the candidates running to take Bush’s job are addressing issues such as the billions being spent on the war vs. the millions of dollars needed for programs at home, such as Medicare.
Even members of Bush’s party have flatly told him that regardless of the war, cutting benefits to the most vulnerable individuals in society is just not OK. Bush’s answer to the pleadings of both parties: let’s cut doctors payments and make sure that insurance companies continue to get theirs. So, it’s fine to take money from doctors who are already underpaid by Medicare and Medicaid, deducting their Medicare payments by 10%. Since there is a shortage of doctors who are willing or able to provide services to elderly individuals on Medicare, what an idea: let’s penalize the ones that are – and have been- willing to keep providing necessary medical care to our most vulnerable individuals.
Since some of these doctors are operating on a slim margin that makes it difficult to pay malpractice insurance premiums, it seems unimaginable that Bush is not at least leaving their payments alone. Instead, this 10.6% payment reduction to doctors is scheduled to begin on July 1.
Congress – on both sides of the aisle - is working feverishly to find $9 billion in other Medicare programs over the next five years to keep Bush’s plan/veto from going through. The other hope is getting enough votes on a workable program that will keep Bush from vetoing or doing anything else that will further jeopardize healthcare for those who need it most.
This is an issue to keep an eye on – especially in the coming days and weeks, as the outcome will affect many individuals, families and physicians dramatically.
We have heard about the Medicare and Medicaid issues, including inequities and disparities throughout the country. One of the biggest disparities is between Los Angeles and surrounding areas in California and the rest of the country, particularly New York.
New York just got some great news – its new resource level for Medicaid applicants has been raised from $4,350 to $13,050 for individuals and from $6,400 to $19,200 for households of two. Medicare applicants and recipients now have more flexibility in terms of eligibility and access of care. The new legislation is retroactive to April, 2008, and is based on a New York Social Services Law through the 2008 Budget Bill. Previously, people who had to cash in insurance and burial policies in order to qualify for services can now qualify for benefits and keep the assets they will need in the event that they pass away, such as the burial policies. This is not only good business, it is a fair, dignified and equitable way treat people who are vulnerable and need services the most.
Aside from financial fairness, there is the emotional peace of mind that comes along with the new levels.
Now, let’s head to the opposite coast. In the South Los Angeles area, ever since Martin Luther King – Harbor Hospital – closed last summer, there are so many patients in need of care that they start lining up in front of the clinic between 6:00 and 6:30 A.M. each day. The clinic doesn’t open until 8:30 A.M. The number of patients has risen 70% since the hospital closed last year and only a hand full of clinics have replaced the hospital, which was once considered the jewel of hospitals for South Los Angeles.
King-Harbor Hospital was the 17th acute care facility to close in or around South Los Angeles in the recent past, leaving some of the most vulnerable, low-income, uninsured with few choices for care. It has been hard to attract doctors to the area and in an emergency, ambulances often take patients to three or four hospitals before they can get them into an emergency room.
Why the inequities? After all, there are poor and vulnerable individuals throughout the country, and New York is no exception. This is not speculation; it is simply a statement about the facts. In a country that is basically the richest in the world, there might be difference in care and benefits in various states or region for a number of reasons, but the extremes that can be seen in just these two cities are not just slight differences. They are major differences from one end of the scale to the other.
It is time to look at the entire picture and truly try to come up with some solutions for helping the most vulnerable individuals no matter where they live.
Previous Posts
