Posts tagged 'health care'
In three western states – California, Hawaii and Nevada – doctors who accept Medicare as payment for patients are stuck between a huge rock and a very, very hard place. They are in a situation where Medicare’s payment backlog has created a multimillion dollar problem. They now have to make some vey difficult choices between their patients and their practice.
This is not a small thing. This is a situation where many doctors have not been paid by Medicare since February. How many of us could go through almost a full year with a large part of our salary unpaid?
It is understandable that there can be backlogs from time to time in a system as large and complex as Medicare, but no payments for almost 10 months is much more than a small backlog. It is a backlog of epic proportions.
The situation has forced some doctors to have to drop some or all of their Medicare patients. Other doctors are on the verge of declaring bankruptcy or have already done so. This has hurt the doctors in many ways – including, of course, financially – but it leaves thousands upon thousands of patients without a personal physician who can provide adequate services to keep their health conditions under control.
What does it say when the doctors who are willing to treat the most needy patients are being forced out of business or forced to drop those very patients because the system that is supposed to care for them is hurting them? How can the system be fixed so that the most vulnerable among us get the care they need from the system that they paid into for year after year?
Medicare says that the reason is that doctors who were to switch to a new identification number for claims (sort of like a social security number) did not do so. The doctors say that the numbers were never given to them until they contacted Medicare time after time over several months to finally get their identification number. In addition, Medicare moved processing to another area and there were “glitches” in the move – many of which are still not fixed.
At present, Medicare says they are fixing the problems, but for many of the doctors who were severely affected, the damage has been done, and for their patients, they are left looking for medical care.
Medicare reform is a top priority at this time. With changes that have come to pass recently, Medicare recipients and their doctors can hope that the future goes much better than the present and the past.
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.
The Arizona Hospital and Health Care Association launched a new web site Tuesday called the Hospital Choice Web Site. This is an innovative move to help consumers determine costs at hospitals throughout Arizona. The site compares average charges, lengths of stay, and the number of procedures performed at each hospital.
This is extremely important for the growing number of uninsured or underinsured individuals. It follows the pattern that Medicare started two years ago when they began posting information about their payments for medical procedures and the range of costs in each county, plus the number of procedures performed at each hospital.
Medicare also provides information online regarding how well hospitals take care of their patients, mortality rates, and how well they care for individuals who have had issues such as heart attacks and strokes.
The idea behind having this information readily available is so that it is easy for individuals – especially potential patients – to comparison shop just as they would at the grocery store or when buying a car. They can now decide - along with insurance or Medicare/Medicaid benefits, which hospital would be best to suit their financial and medical needs. As a result, they become more in charge of their own personal healthcare, rather than leaving it in the hands of a program and its administrator.
The hope is that the quality of care will continue to rise while costs diminish due to public scrutiny. With an easy to understand, transparent reporting system that is available to the public, it will be easier to hold hospitals accountable, and it will be in their best interests to create more or better quality control mechanisms so that they will hold themselves accountable.
Transparent reporting is a positive step in improving health care and increasing the dialogue between patients/consumers and providers to come up with real solutions for the short and long term.
Durable equipment, such as wheelchairs, walkers, hospital beds and other medical equipment has long been the subject of frustration because of their costs. If an individual has Medicare, often Medicare pays for some or all of these items, with little cost to the recipient.
However, the costs of much of this equipment are extremely high, and not affordable to most Medicare recipients. Even though Medicare helps with the expenses, there are still issues that are being addressed.
Medicare has determined that the costs are too high for them, as well. They have proposed a solution that would help consumers and help the Medicare program itself. To save money for recipients and the Medicare system, Medicare wants to institute a competitive bidding process for some durable medical equipment. This would mean that companies that supply these items would have to bid toward the lowest price in order to be given contracts through Medicare. In addition, these lower price savings would be passed on to Medicare Beneficiaries.
On the surface this seems like a good idea, and in many cases, it would work. The problem is that many of the companies that provide this equipment are small businesses that have a small profit margin. Some of these businesses have no room to decrease their prices and as a result, might be shut out of the process of providing durable equipment through Medicare. This could severely cripple the businesses or even put them out of business.
Another drawback is that there would probably be fewer choices for Medicare recipients along with fewer knowledgeable providers. Patients might have to switch from their current providers to a new one that they don’t know. Some beneficiaries have been affected already, as the bidding process has started. It is taking longer to get their equipment. A high percentage of providers have already had to cut back or go out of business.
In the long run, things will even out. In the short term, however, if you are a Medicare recipient, try to deal with durable equipment in advance. Put your order in early, and try to be patient as everything is sorted out. We can all be hopeful that the discounts will truly be passed on, saving beneficiaries money on essential equipment they need.
During the past decade or more, there has been a push by citizens, advocates and, yes, even congress, to allow individuals to have home health care rather than staying in a facility. As many of us know, a person that can live at home and interact in the community, while being taken care of medically, will most likely live a longer and fuller life.
One state, Connecticut, has moved into the cadre of states who are working to allow individuals to stay at home, get home health care, and live full lives. Senators there have passed a bill that will move about 5,000 individuals who are elderly or disabled out of care facilities and institutions back to their homes and their communities.
This is vitally important. Statistics have shown that individuals that have community support and independent living, live longer and are healthier than those who are confined to hospitals, institutions and long-term care facilities. This does not mean that everyone is capable of living on their own and interacting in the community without assistance. Some individuals might be better in a variety of care settings. However, it has long been known that there are many individuals in facilities, hospitals and institutions that should really be able to live in the community.
This is a win-win situation. Medicaid will save money – it is much less costly to live in a group home or apartment and have a variety of supports defraying the costs, than it is to stay in a hospital, facility or institution where rates range (depending on the area the person lives in) from nearly $200 per day to over $1,000 per day.
I have personally worked in several states with individuals who were involved in independent living programs. Some lived in group homes and others lived in their own apartment. Still others were able to live at home with their families. Many of them had gainful employment, meaning that in many cases, they either needed less benefits and actually paid taxes, helping the economy; or they had small jobs that prepared them to move forward in the community and eventually be self-sufficient.
No matter what the situation, helping individuals that are able to integrate into the community and work toward independence is a huge step forward for the individual, the community they live in, and society in general.
At this time, it looks as though the trend has caught on and is continuing. In the long run, it can save Medicaid and communities millions of dollars. In the short term and the long run, it will heal individuals, families, and the community and make all of these entities stronger and richer for the progressive change.
