Archive for September, 2008
There have been many debates recently as to how to handle the situation of healthcare for individuals who are living in the United States but are not U.S. citizens. With elections around the corner, this issue has become an intense topic for discussion on all sides of the aisle.
There are many varied opinions regarding healthcare for these individuals and families. Studies have shown that the money they generate in the economy and sometimes in taxes offsets most or all of the medical expenses they incur. Other studies say the opposite.
With Medicare and Medicaid budgets and services struggling financially there have been questions raised as to how these individuals receive medical care and what it costs the system.
In Ohio, the Columbus Dispatch Newspaper stated in an article that the poor and/or undocumented in central Ohio, line up at the free health clinic near Ohio State University. The lines begin to form hours before the clinic – which is staffed by volunteer doctors and nurses - opens for services.
There is now a proposed bill requiring Clinica Latina and other clinics that serve undocumented residents to check for immigration status and turn away any individuals who do not have documentation. The bill states that the reason is that part of the funds for this particular clinic and some others come from Ohio State University. If the clinic were to receive funds only from private sources, they could continue treating these individuals without checking their status.
The issue that this leaves could have a huge financial impact on Medicare, Medicaid and the healthcare system because it would leave undocumented citizens with only the hospital emergency room for treatment. Unlike clinics, federal law states that hospitals cannot deny services to individuals based on various issues, including immigration status. As a result, seeing a doctor at the free clinic and receiving a $5 prescription for blood pressure or diabetes medication could now cost hundreds of dollars at the emergency room, and Medicare, Medicaid and taxpayers would have to absorb those costs.
The issue of undocumented residents in this country is not a simple one, nor will it be solved simply or quickly, however, it is important for lawmakers and administrators to look at the big picture and the overall costs before eliminating programs that could save an already struggling system money just to prove a point.
Most of us start getting creaky knees as we get older. Some of our knees just creak here and there and other creak all the time. Others creak and hurt too often, usually as a result of osteoarthritis.
This is actually an uncomfortable situation, but it is normal for these symptoms to begin to happen to us between age 45 and 55 and develop into chronic problems after age 60.
Medicare used to pay for arthroscopic surgery on the knee to address the issue of osteoarthritis. In 2002, a study was done stating that there was no better improvement in the knees of patients who had arthroscopic surgery than there was in those who simply had physical therapy and used ibuprofen and other medications.
Many doctors and patients were quite unhappy with the fact that this study prompted Medicare to stop covering the procedure. They felt that this particular study, which was performed on about 175 men, was too limited to make such a sweeping decision which affected hundreds of thousands of Medicare recipients. Medicare finally has the results of another study performed by Boston University School of Medicine and a separate study performed by the University of Western Ontario in Canada.
The results of both recent studies confirm the results of the 2002 study: arthroscopic knee surgery for osteoarthritis is over-performed and does no better than physical therapy and medication. Of the nearly 1300 participants in the studies, the individuals who received physical therapy reported that they felt better and had less pain after receiving physical therapy, taking anti-inflammatory medication and sometimes using glucosamine. The results of those who had arthroscopic surgery were exactly the same.
The biggest difference was that the bill for the surgery alone is about $5,000 or more, plus any doctors fees, lab and hospital fees and other ancillary fees. That is much more than some physical therapy, exercises the patient can do at home and medication. In addition, the studies show that the procedure is unnecessary.
In some cases arthroscopic surgery is warranted, and certainly, in some more severe situations arthroscopic or other knee surgery would be appropriate. It is important to get a second opinion and to try physical therapy and other treatment before you opt for arthroscopic surgery. There are two reasons: first, experts are saying that it doesn’t work and some doctors are simply making money on the procedure. Second, Medicare will not pay for it.
So, if your knees are creaking or hurting, or both, look into your options to determine what will be best for you.
Medicaid is supposed to help families take care of medical and dental needs, and this is especially important for children. A recent study by the United States government revealed that millions of poor children on Medicaid are not getting the dental treatment they need because they cannot find dentists willing to accept Medicaid as payment.
This leaves many children in a very vulnerable state. The findings, released by the Government Accountability Office stated that millions of poor children between the ages of 2 and 18 have untreated dental decay and disease because they cannot get the needed treatment.
It might not sound like a huge issue to have a cavity that doesn’t get taken care of, but think about whether you have ever had a toothache that grew worse and worse over a weekend. When you went to the dentist you discovered that you had a cavity that, if it had been addressed sooner, could have been filled. The dentist feels that you now need a root canal or other serious procedure because the cavity has destroyed too much of your tooth and that is what is causing your pain.
Now think about a child or young adult who has not one but 5 or 10 of these festering in their mouth. They are in pain. They probably are not able to eat right. Perhaps they cannot concentrate – especially in school – because of the pain and headaches due to the dental problems.
If they –or their parents – are conscientious about brushing, flossing and rinsing with mouthwash, they may avoid infection. If not, like 12 year old Deamonte Driver, even though they try to do everything to keep the condition under control, they are unable to. In Deamonte’s case, he ended up with a serious tooth infection that led to a brain infection and he died.
Deamonte had Medicaid coverage. He had a simple cavity. His mother tried to find a dentist – any dentist – that would help him and treat the condition while it was a simple situation and no dentist would do so because they would not accept Medicaid as payment. Because of a few more dollars, 12 year old Deamonte is dead.
Only 1 out of 3 children on Medicaid are receiving dental care, mainly because nobody will provide it. It is essential that while lawmakers are looking at a Medicare fix, they look at Medicaid, as well. It is also essential that practitioners, schools, lawmakers and Medicaid work together to fix this problem. 2 out of 3 children on Medicaid that cannot find dental care should not remain vulnerable to the unconscionable outcome that Deamonte Driver and his family suffered.
Seniors enrolled in Medicare should receive Medicare information in the mail regarding their benefits in October. They should receive a letter and information telling them what they are covered for, what supplements they are enrolled in (if any) and any changes to their premiums and/or their coverage.
It is important to take the time to carefully read this information and make certain that you understand it. It will tell you what your 2009 premiums will be and will tell you what is covered, including prescriptions.
Prescription coverage will be very important to check over carefully. You could currently be covered for all of your medications, but there could be changes in coverage that might cover every medication except for one. This does not always happen, but it could.
In the event that one of your prescription medications is not covered it is important that you check with your doctor and see if there is an alternative or substitute prescription that would work in its place. Then you will have to check to see if the alternative or substitute medication is covered. If you can’t find a suitable alternative medication, you may have to check for a different supplement that will cover the medications you need.
Other things to consider are how much the premiums will increase, if any. Check to see if your co-pays will increase, as well. The more you know about your coverage, the better decisions you and your doctor will be able to make regarding your ongoing treatment.
The fact that this information is being sent to you in October gives you time to get the facts you need about your coverage before the open enrollment period for Medicare Part D, which is from November 15th through December 31st. That is the time during which you can switch plans if you need to, without any penalties for pre-existing conditions or other issues.
If you receive Medicare, be on the watch for your letter describing your current coverage in October. If you don’t receive it, call 1-800-MEDICARE. You can call the Seniors Health Insurance Information Program (SHIIP) at 1-800-443-9354 or check with them on the web at www.ncshiip.com. They are an organization that specifically helps seniors with insurance and Medicare questions and issues.
Identity theft has become a huge problem in the United States and throughout the world, and it is getting worse. It seems that every day we hear about a new way that fraudsters have figured out to get pertinent information about us that they can use to purchase anything from a car to a home to illegal drugs.
Through the years, Medicare cards have displayed the individual’s name and Social Security number front and center, as well as other information that could help identity thieves to get your information and use it.
It is interesting that Medicare is finally getting around to doing this. Insurance companies and other organizations have begun doing this years ago, and when you talk to most places such as banks, insurance companies, the power company or others on the phone, they only ask for the last 4 digits of your Social Security number and they only have access to those four digits unless they are in a specific department.
More care is being taken to protect our privacy and a substantial part of that protection comes with protecting our Social Security numbers. The Social Security Number Protection Act has been proposed to Congress as a critical issue that needs to be addressed now. The senators who proposed the action have said that the Federal Government should be taking the lead in this area, not lagging behind. They are asking that the removal of Social Security numbers be mandated and that the unnecessary use of Social Security numbers be eliminated.
It is, of course, impossible to eliminate the use of Social Security numbers in many instances, however, there is a difference between using the numbers and going out of the way to protect people’s identity, as opposed to using the numbers and basically flaunting them or leaving them in plain sight as a temptation and easy road to fraud for identity thieves.
With 8.4 million people victims of identity theft last year alone, this is a critical issue. The legislation would give CMS a limited amount of time to remove Social Security numbers from Medicare cards, correspondence and unencrypted information. This should give Medicare recipients some peace of mind.
It’s not something your accountant would advise you to do if you are a physician or health care practitioner or professional. In fact, your account, financial advisor, closest friends and others would most likely strongly –very strongly – advise against making such a move.
But all business decisions are not simply made for profit only. Some are made because there is a serious need to be filled and there are people that are willing to go the extra mile to fill it.
The news is filled with stories every day regarding senior citizens who need health care and can’t afford it. Many of them receive Medicare benefits, but can’t find a doctor willing to be paid at Medicare’s lower than normal rates and even slower than normal payment pace.
A group of doctors in Amarillo, Texas decided to go the extra mile and help seniors in the area by opening a clinic that provides health care only to seniors with Medicare benefits, Medicare Supplements or enrolled in Physician’s Health Choice, which is a physician owned health plan which provides seniors with more coverage than Medicare.
The clinic, which recently opened, is designed to provide medical care to seniors, but that is not its only purpose. Doctors feel that if seniors had access to more information and accurate information regarding prevention and maintenance of health issues, they could maintain better health, therefore having to visit the doctor’s office for treatment less often.
The Amarillo Senior Care Clinic was established to address the fact that seniors face obstacles in receiving care because fewer doctors are willing to take Medicare for payment, and many will no longer accept new Medicare patients. As a result, seniors have less access to quality care, often exacerbating conditions that, if cared for regularly and properly could be controlled by medication and other interventions with less office visits, keeping more seniors out of emergency rooms, hospitals, long term care and nursing homes, because their conditions would be managed and not get to the point where they were out of control.
Many physicians say that this is a losing proposition financially; however the Amarillo Senior Care Clinic, though cautious, is not worrying. They feel that by stressing prevention and providing education, their patients will feel better and their health will stay more stable.
This is an innovative and exciting idea, and it would be great for physicians throughout the country to keep an eye on the Amarillo Senior Care Clinic and see how well it works. There are seniors in every county in every state who need this type of help to live longer, healthier lives.
With all the financial issues surrounding Medicare it has become harder to find doctors who readily accept Medicare, or even accept it at all.
Before the increase of fraud, red tape, financial woes, budget constraints and the like, doctors who accepted Medicare were not hard to find. Many doctors used to set aside a percentage of their time to devote to Medicare patients. They certainly weren’t making money on these patients, in fact, many times, they did not even break even by covering expenses, but the income from their overall practice absorbed the losses. Though Medicare was not a perfect system, it worked out for the doctors and their patients.
More recently, with all the Medicare woes, including very slow reimbursement at an extremely reduced rate, the majority of doctors say that it is too expensive to treat Medicare patients. They want to treat these patients and try to treat as many as possible, but are unable to take on new Medicare patients for financial reasons. Their regular practices cannot absorb the losses any longer.
This is not just frustrating to the doctors who would like to help these patients, but it is frightening and frustrating to patients who have spent a lifetime paying into a system that promised healthcare coverage but is now in such shambles that the doctors and specialists these patients need the most will not accept it for payment. This critical situation nationwide is leaving too many of our most vulnerable citizens without adequate care and actually making them more vulnerable because of it.
Lawmakers continue to say they are trying to fix the ailing system but are caught up in partisan arguing rather than bipartisan efforts, while the situation continues to worsen. The question arises as to whether they would rather pay out hundreds for office visits that prevent major health issues or thousands to pay for the health conditions that are not treated because of being penny wise and dollar foolish, as well as short sighted. Surely if there is enough money to fund billions for war, there should be enough to send Medicare recipients to the doctor.
As fewer doctors accept Medicare, there is the real possibility of a far worse health crisis than we see today. If you have Medicare benefits, check with your doctor and call others to make sure they will accept it. You can also call your local health department or hospital for further information about doctors in your area.
There are doctors who continue to accept Medicare, but it is becoming more difficult to find them and Medicare recipients who should be automatically taken care of are having to search for services. The system needs fixing NOW.
There was a time not too long ago when many doctors made house calls, especially for the elderly or disabled. It was more of a comfortable, less stressful and easier situation for the individual who needed medical care.
With the increase in “big medicine” people have gotten used to going to the doctor’s office. There are many reasons for this. Doctors are able to treat more patients if they can stay in one place and have the patients come to them. They also have all of their equipment set up in their office, as well as usually having a laboratory, x-rays and other services located in their medical building or close by, making it much easier for them to diagnose and treat their patients. And, of course, if they are at the office and the patients come to them, they can schedule up to 30-35 patients per 8 hour day in 15 minute increments.
Though this is convenient and cost-effective for the doctor, it has its down side for both the doctor and patients. If a doctor takes longer than the 15 minute time slot with a patient, it has a domino effect and backs all the other patients’ appointments up, making them have to wait longer. We have all sat for what seemed like forever just to be rushed through a doctors appointment and we have left wondering if the doctor actually heard anything that we said in the rushed 5 minutes that we were able to the doctor face to face.
Though most of us can sit through the wait and get through the appointment, it is often much harder for a person who is elderly, frail or disabled. Medicare knows this and so do doctors. There are still some doctors that will schedule house calls and Medicare will pay for these visits, though most patients don’t know it.
There is a quiet but powerful move by a number of doctors across the country to try to see ore patients in their homes. With an elderly or disabled patient, an appointment at home saves the often difficult trip to the office. A home visit also allows the doctor more time to examine and talk with the patient to take a closer look at any changes in health or any difficulties the patient might be having. If a problem is discovered that cannot be dealt with at home, the patient can then be seen at the doctor’s office, but most often, with regular care, most treatment and observation can be carried out at home.
If you receive Medicare benefits and find it too difficult to go to your doctor’s office, ask if your doctor makes house calls or if the doctor knows of a doctor, nurse or nurse practitioner who does. You can also ask for information from the home health care agencies and hospice in your area. There is not an overabundance of doctors who make home visits, but there are some and the numbers are slowly growing making it easier for individuals covered by Medicare to receive the care they need.
As Medicare tries to become more effective, efficient and streamlined, eliminating paperwork and unnecessary time, the Centers for Medicare and Medicare Services has planned an online system to help providers enroll to be providers. This system will be available to most states in early 2009, and will also be available in California, New York and Missouri by October 2009.
Not all enrollment materials will be available on the web-based system, however there will be enough to get the process started and move it along more quickly than the old system. In the past it took 90 days – and sometimes much longer – for a provider to complete the enrollment process. With the new online process, it is estimated that it will take 30 to 45 days instead.
One drawback that providers are talking about is the fact that since the system will not recognize online signatures, the online paperwork must be followed by actual paper forms with original signatures sent to employees at CMS who process the paperwork and combine the files. Providers are skeptical about this, as they feel it will continue to take more time, however, CMS says that they can be working on everything in the computer so that the process goes quickly and the original signatures on paper will simply be verified, not re-processed.
Another drawback according to providers is that each provider who wants to enroll as a Medicare provider must enroll in a separate and different system first. The second system is called the Individuals Authorized to Access CMS Computer Services. Providers see this as an extra and cumbersome step and wonder why there cannot be one system that can deal with all of the hoops they must jump through in one complete system.
In addition, providers are skeptical because there have been promises to speed up the enrollment system for quite some time, and this particular system was supposed to be up and running by March, 2008, according to CMS, making the debut over six months late.
Regardless of how the providers feel about some of the issues inherent in the debut of the new system, one thing is true: there is the potential to enroll providers more quickly and the potential to add further services for providers including billing, budgeting, records and more in the future.
For now, we can all wait and see how the system works and if it saves time and expense for CMS, Medicare, providers, as well as Medicare recipients.
Medicare is a system that is supposed to help seniors deal with medical issues by providing coverage for healthcare costs. As an individual works month after month and year after year, they pay into the Medicare system and the payments are taken out of each of their paychecks. The idea is that when they are at the point of retirement, the coverage that they have been paying for all those years that they worked will be there to take care of their health needs.
In theory, this works well, and until recently, Medicare has taken care of millions of seniors. Currently, there are about 44 million people enrolled in Medicare. Most of them have the coverage they need, however, during the past decade or so, Medicare has run into various financial issues, creating a situation in which seniors must pay for some of their coverage.
In addition, though the Medicare system has been overhauled to work better with regard to claims and paperwork, it become more sluggish regarding approvals and claim processing, and it has made it difficult for seniors to get good care and for physicians to give good care. The main reason for this is that many physicians have to wait extremely long periods of time to get paid by Medicare for the patients that they treat.
In fact, some physicians have had to stop treating patients covered only by Medicare or they have at least had to stop taking any new patients covered by Medicare. It is simply too long to wait for payment, and many physicians are experiencing financial trouble as a result.
One such provider is an ophthalmologist in Santa Cruz, California. Dr. Joshua Babad treats many patients covered by Medicare. He cares for his patients and knows they need his help. After all, Santa Cruz is not a large town, and even in large towns, there are not a lot of providers – especially eye doctors – who accept Medicare.
Dr. Babad has tried to do his best for his patients, and in doing so, has ended up over $50,000 in debt. He has had to use retirement money to pay expenses while waiting for Medicare to pay him for legitimate services rendered. In addition, his wife has a brain tumor, so he is struggling with serious family medical and financial issues on top of his long wait for payment. He wonders if Medicare is trying to discourage doctors from treating the elderly or disabled who depend on Medicare for their medical needs.
Dr. Babad has practiced in the same location for over 30 years. He has contacted Medicare, as well as his state representatives to try to deal with the situation. He has stated that if he had to depend on only Medicare, he would have gone bankrupt a long time ago. There are other providers in the general area who are experiencing similar issues with Medicare. Medicare’s response to recent contact is that they have communicated with Dr. Babad and his situation will be corrected soon.
In the meantime, many seniors and their providers continue to struggle with delays and hope that they can continue working together toward good health care while Medicare gets its act together.
Medicare is an essential program that was designed to help the elderly and the vulnerable. Presently, Medicare covers over 44 million people so that they can receive medical care.
Fraud has long been an issue regarding Medicare. There have been too many loopholes, a system that is designed in a manner that makes fraud easy, and too little oversight of the billions of budget dollars intended for legitimate Medicare expenses.
In addition, there have been – and still are – unscrupulous business people out there who have designed ways to defraud the Medicare system. It is one thing to make a mistake, it is quite another to intentionally set up a business network for the express purpose of taking money from the most vulnerable of our citizens, especially when that money is scarce to begin with.
The latest in a series of fraud-based businesses to take advantage of the lax oversight over Medicare dollars is a scheme involving HIV/AIDS clinics in south and mid-Florida. These clinics have made so much money that officials are asking the public for help in stopping the fraud.
Officials have announced a new “Infusion Fraud” hotline, asking the public to call and report phony HIV/AIDS treatment in an effort to stop clinic operators from receiving millions for services and treatments not provided. These unscrupulous clinic operators have been most prevalent in south Florida and purchase Medicare lists or pay patients to come into their offices, and then bill Medicare for millions of dollars in fraudulent claims for treatments never provided. Last week a couple who ran a billing service was sentenced to 14 years in prison for billing nearly $150 million in fraudulent claims for 85 different clinics.
There are several ways that Medicare is trying to combat fraud in that area. They have set up a hotline that people can call to report fraud if they become aware of it. The fraud does not have to be HIV/AIDS related; it can involve any fraudulent issues or scams with Medicare.
Medicare is also sending out Medicare statements to recipients in southern Florida on a monthly basis instead of quarterly in hopes that people will look at their statements and report any treatments or charges listed that were not received or don’t look legitimate. By doing this monthly instead of quarterly, there is less of a time lag, giving Medicare a better chance of catching the perpetrators while they are still up and running and in business.
Records show that last year HIV/AIDS claims for treatment totaled $1.5 billion in south Florida as compared to only $300 million in New York City. This is an obvious imbalance that is receiving attention.
The phone number to report suspected Medicare fraud is 866-417-2078.
