Archive for February, 2009
Most of us hope we and our loved ones won't end up in the hospital. In the event that we do, we have the hope that we will get through what we are in the hospital for and go home better off than we came to the hospital for.
The remarkable thing that many people don't know is that nearly 100,000 people per year get terrible infections in the hospital and die from them. One out of 20 patients get infections that they contracted in the hospital and some patients survive but have to be on medication for months or years, or even end up with long term or permanent illnesses or disabilities due to these infections.
What are some of the ways to avoid this situation? Several things have been suggested. A 2005 report showed that hospitals could charge the cost of health care-associated infections to third-party payers such as Medicare and Medicaid. Medicare has changed its rules in response to these concerns and will no longer reimburse hospitals for the excess costs associated with the care of patients who contract a hospital-associated infection. But now hospitals have no incentive to accurately report their infection levels. If Medicare were to provide hospitals with more resources for infection control, rather than just penalize them for caring for very sick patients who contract a hospital-associated infection, hospitals might perform better. Really? Why not just perform better and be more careful now?
Last month, the U.S. Department of Health and Human Services released a plan urging hospitals and other health care facilities to adopt increased use of sterile techniques and follow strict protocols to prevent such infections. These include guidelines on the proper insertion of catheters and disinfection of ventilators, as well as practices that minimize risk of infection before, during and after surgery.
The University of Maryland Medical Center screens all patients at high risk for MRSA when they are admitted. Screening includes patients in intensive care units and those who have been in another health care facility during the past year. The tests are repeated during the hospital stay. Isolation precautions are instituted for those who test positive for MRSA. During the past year, the hospital has performed more than 33,000 MRSA screening tests. This aggressive action has slashed the hospital's rate of MRSA infection by more than 30 percent and has saved lives.
Patients with health care-associated infections move among hospitals, other health care facilities and nursing homes, and can spread the infections regionally. That means that a specific hospital does not necessarily receive all of the benefits from its infection control activities.
What's the solution? Infection control efforts should be a coordinated effort involving hospitals and HHS and the Centers for Medicare and Medicaid Services. Hospitals could be provided with tools and incentives to work together so that they can coordinate infection-control measures. If regional coordination existed, infections wouldn't just be transferred from one place to the next.
Health care-associated drug-resistant infections are a complex problem. The overselling and overuse of antibiotics, as well as the lack of new antibiotics in the research pipeline, are driving the high rates of resistant infections. Timely prescribing of antibiotics can help reduce infections in hospitals, but we have to work to reduce overprescribing as well. Hopefully government and hospitals will work together to come up with a policy that will bring this situation under control.
There is more and more information being looked at regarding hospitals and their performance. Now it is being released to the public on various websites that show which hospitals do the best work and keep patients safest and which are not.
For example, one particular website, HealthGrades.com, includes valuable information about mortallity rates and complication rates about every U..S. hospital.
If your mom has a stroke, wouldn't you want to take her to the absolute best hospital available that would give her the highest chance of complete recovery? Of course you would. Why not look at some of the web sites that examine the hospitals and let those hospitals - and us - know how well they are doing taking care of their patients.
Written in everyday language, there’s also a wide array of information at your fingertips about stroke, heart attacks, hip replacement and just about every medical issue that your family could face.
In a recent study, HealthGrades carefully analyzed nearly 41 million Medicare hospitalization records from 2005 to 2007.
The study found that only 5 percent of U.S. hospitals meet quality clinical standards to receive a HealthGrades’ designation as a Distinguished Hospital for Clinical Excellence.
An estimated 152,666 lives could have been saved and 11,772 complications could have been avoided had all Medicare patients been treated at a Distinguished Hospital for Clinical Excellence, the study found. In addition, these elite hospitals have mortality rates that are on average 27 percent lower, and complication rates that are on average 8 percent lower, than the U.S. average.
If you had the choice to take your mother to a hospital where mortality rates are 27 percent lower than average, wouldn’t you take her there?
HealthGrades also provides “star ratings,” which are quality ratings of 26 procedures and treatments for virtually every hospital in the country. Each hospital receives a star rating based on its patient outcomes for mortality or complication rates for each procedure or treatment.
Do your homework. Make sure where the best hospitals are in advance.
This is a story about a man named Don. It really happened, and it really happened to Don.
Don really enjoys playing his guitar.
Tuning it, he says, is so much easier than getting into tune with his Medicare prescription provider, called Medco, (one of the largest Medicare medication distributors), which kept telling pharmacies Don's benefits had ended.
He recalls his first trip to the pharmacy this year.
"I gave them my card, they looked it up and they said that's been terminated."
Since Don needs seven different prescriptions every month for his heart, blood pressure, and diabeties, he started getting concerned, as those bottles were nearly empty. Many of us can relate to that situation. I get nervous when the number of pills I have left gets low , especially if my doctor is out of town, I don't have a new prescription or my check hasn't arrived. I take 6 different pills every day for heart, blood pressure and a few other issues.
Back to Don. He kept calling Medco. Over and over until it was ridiculous.
"I probably made 35 calls to them."
Medco kept telling Don he wasn't covered, while Medicare kept telling him he was.
"I was getting really frustrated about it."
Then he thought the frustration would finally end, when he got this letter from Medco, which said he was covered.
But despite that letter, the pharmacist said his records showed Don still wasn't.
"I call Medco and I fight with them on the phone about it, they keep telling me I'm terminated."
Now, Don really started getting worried. When you are in a situation like this it seems like you get stuck in the middle and everybody is going back and forth with no end in sight.
He says he certainly can't afford the $700 it would take every month to buy his meds without Medicare's help.
"I just figured I'm going to have to quit taking them and take my chances, whatever."
Most local news channels in every city and state have some sort of consumer problem solvers segment where the news channel will help you with your problem. Don definitely had a problem and it could have turned out to be fatal for him. With his pills running out, Don finally called the 2News problem solvers, and they contacted both Medicare and Medco.
Later that very same day, Medco called Don, to clear up his situation.
"They just wanted me to know that they had updated everything in my file and the card is now working and I could go pick up my prescriptions anytime I wanted to."
Finally, Don finds himself in perfect harmony, with his music, and his meds. If you find yourself in a similar situation, don't give up. Keep trying to deal directly with your drug company, medicare and your pharmacy. If that doesn't work, do what Don did and get extra help. There is usually a way to work it all out.
On July 1, 2006 the Deficit Reduction Act went into effect. The act required all immigrants to give proof of legal immigration or citizenship when they are applying for Medicaid for the first time. This applies to children, as well. Most legal immigrants cannot receive Medicaid benefits for the first five years that they are in the U.S. Undocumented immigrants can only receive emergency Medicaid services.
Once the bill became law, it also restricted citizens, as well. Medicaid enrollment has declined since the law was enacted, partially because even U.S. citizens are finding it difficult to locate some of the documents required to enroll for Medicaid services. This is because some of the documents need to be original documents, and it can be difficult to obtain original documents in many cases.
As far as Medicaid goes, they receive matching federal funds to help run the program and pay claims. As a result, even if they wanted to assist individuals without documentation it would be a problem for Medicaid both in a financial sense and in a legal sense.
The rules for Medicare and Medicaid are so stringent that CMS has instituted a rule that even requires child welfare agencies to document citizenship for children being placed into foster care. There are some issues where people receive extra time to provide documentation, however, they are limited and must adhere to very specific rules and time frames.
Once an individual has completed the documentation process and is approved for coverage, they will be covered retroactively to the date of the application or to the month of the application depending on the state they are living in and a few other variables. Trust me when I tell you that this can be a true adventure that seems to take forever. Just when you think you have sent in everything that is needed you get a letter or phone call asking for more. Just take a deep breath and send the requested paperwork in. Be prepared for at least a couple of follow-up requests. As long as you comply with the requests, you will get the coverage you applied for and qualify for.
The primary types of identification include a state driver’s license, Certificate of Naturalization, Certificate of Citizenship or a U.S. passport. Secondary types of identification for naturalized citizens include a U.S. Birth Certificate, data verification with Systematic Alien Verification for Entitlements (SAVE) documentation, or documentation and data match with a state verification agency, as well as other documents.
It is important to know the law, your rights, your responsibilities and your entitlements in order to receive the benefits you need. You can research them on the web by going to the CMS website.
As the new administration takes on the responsibility of fixing some of the issues left behind from the old administration, it has become apparent that this will be no easy task.
Everybody from people on main street to the people on Wall Street have known for quite some time that things have needed to change. Main street is just trying to survive, and as the economy has gotten worse many on main street are losing the battle of surviving financially.
Folks on Wall Street are not immune, either. They may not feel the pinch as much, but many of them have lost millions and more. Some of the wealthiest people in the world have committed suicide due to the fact that they lost so much money, yet they were still some of the very richest people in the world even after they lost the money.
One of te issues that begs to be cleaned up is Medicare and Medicaid. With general budgets out of control and lawmakers divided as to how to fix a number of programs, especially healthcare, this is a battle that will be hard fought.
As it is, people can barely keep up with various premiums and copays. Time will tell what affect lawmakers will have in trying to adjust benefits and premium so that people can still afford Medicare and Medicaid and not lose some of the services they need.
Even though there have been promises of non-partison ways to work on the many serious issues facing Congress, from the beginning there has been a tremendous divide between Republicans and Democrats. In fact, trying to fix the economy by passing a bill was a tremendous task. The President and many of the Democrats adjusted the proposed bill over and over to accommodate Republicans. In the end however no Republicans voted for the bill. In other words, the President and the Democrats could hav left the original bill the way they wrote it rather than take the time to give the Republicans the changes they asked for and not get any support anyway. That would have saved a lot of time and delivered a more solid bill, according to the Democrats.
The President and Congress are trying to fix the Medicare Mess as well as the entire financial situation that has gone from bad to worse. Here's hoping that this can be done sooner rather than later from Main Street to Wall Street.
If you are looking for Medicare Supplemental Coverage, there is a new website to visit called The Medicare Supplement Shop. Their new site compares all the plans in a fair way as far as what they cover, what they cost and how well they perform.
If you log onto www.MedicareSupplementShop.com you will find screens to easily sign into and allows you to click on the plans you wish to compare. In addition to this, there is a phone number (1-888-891-9280) to ask questions if you need further information or feel more comfortable on the phone rather than on a computer.
Some nice features of the website are that it shows browsers how to choose the best plan. The site allows you to take your time to be able to determine which companies cost the least and the most and which companies have the best and most coverage for the money. The site also helps you to figure out which coverage is best for you and will take care of your needs.
There are many sites that claim to help you look at the Medicare supplemental coverage that is available, but most of them are trying to guide you toward buying a particular type of coverage from a specific company.
The difference with The Medicare Supplement Shop is that it truly does compare companies that sell Medicare Supplements and lets the consumer make the decision as to which coverage would suit them best.
The site even has a learning center that can help you understand what to look for in good prescription drug coverage and other supplemental coverage. The new Medicare Supplement Shop website is a good place to search for the right coverage.
It seems that the Boomer generation is in a no man’s land when it comes to many things. Too old for this, too young for that. And Medical coverage is at the top of the list. Especially if you are ready to retire.
The issue is that if you retire early and try to keep your health insurance, it costs a fortune that most people cannot afford. On the other hand, finding your own individual plan can also cost an arm and a leg and provides less coverage than your medical coverage from work.
There may be a solution coming soon. Medicare may shortly have a buy-in for individuals between 55 and 64 years of age. This could solve a great many problems. The doctors and hospitals would get paid. The insured would be able to continue with their services and with their personal physician in most cases and the Medicare system would have money coming in to offset the expense of treating this group of people.
In addition, statistics show that people age 55 to 65 usually have less medical issues and less medical treatment than most people 65 and older. As a group, they have taken care of themselves better, they are healthier – or at least, the onset of serious health issues that come with age haven’t set in yet – and they tend to see the doctor less, using prevention rather than a cure.
The Medicare Buy-In may take a little time to put into place. Lawmakers are working out the details that would help cover the over 5 million boomers between age 55 and 64 who are uninsured. There would be premiums on a monthly basis to the tune of a few hundred dollars, but the premiums should be less than keeping up with payments for the insurance from the old job and COBRA.
Though the idea has been discussed for years, conditions right now are just right for a program like this to start. For questions, contact the Medicare office nearest you.
