Results 1 to 10 of 10

Thread: Medicare coverage

  1. #1

    Medicare coverage

    This doesn't seem fair to me. What do you think?

    http://blogs.wsj.com/health/2007/08/...-remedy-flubs/

  2. #2
    Senior Member justadildo's Avatar
    Join Date
    Mar 2005
    Location
    rocky mountain high
    Posts
    1,396
    fair.

  3. #3
    It's about time. Hospitals and doctors are incentivised to make mistakes. Maybe it's not intentional but subconscious. The longer the patient is under their care, the more money they make. They only understand one thing, the almighty dollar. Only when it starts to hit them where it hurts, financially, will they begin to "really" change things. You go into a hospital to get a broken finger set and the next thing you know you're infected with a deadly strain of MRSA or some other disease and die from it. Or better for the hospitals and doctors, are admitted to the same damn hospital for weeks or months as they pump you full of gallons of expensive antibiotics at thousands of dollars a damn day. Incredible, but true. Stay away from hospitals if at all possible. They just "look" clean!

    Bob.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  4. #4
    Senior Member Wesley's Avatar
    Join Date
    Jul 2003
    Location
    Pennsylvania
    Posts
    1,785
    as I understand it, Medicare will often not pay for preventative care, for example, an alternating air mattress that would prevent bedsores. They will pay for the mattress once you get the bedsores and remove it once you've been cured.

    so, does this mean that Medicare is no longer responsible for the complications its own policies create? It seems like an easy way to get off the hook. man, I'm glad I'm not a doctor these days.

  5. #5
    Senior Member
    Join Date
    May 2006
    Location
    Somewhere in the Rocky Mountains
    Posts
    8,152
    Quote Originally Posted by Wesley
    as I understand it, Medicare will often not pay for preventative care, for example, an alternating air mattress that would prevent bedsores. They will pay for the mattress once you get the bedsores and remove it once you've been cured.

    so, does this mean that Medicare is no longer responsible for the complications its own policies create? It seems like an easy way to get off the hook. man, I'm glad I'm not a doctor these days.
    There are lots of things like this Medicare wont pay for. I am worried about the small hospital that I work at because I dont think we will be able to stay open through the winter. If you dont have certain diagnoses Medicare wont pay for tests that you may need. The patient may be asked to sign a paper saying they will pay if Medicare doesnt....Most patients will not sign the paper and then we get yelled at by the physician because the patient really needs the test.

    I can see how Medicare will use this like every other regulation to get out of paying for services patient's need.

    In the end it will be the patient that suffers under this kind of ruling. Some things are preventable but alot of things arent.

    Hospitals will be forced to close their doors eventually or refuse to see Medicare patients. We have lots of doctors here that wont take Medicare or any insurance associated with Medicare.

    Bob I am not sure I understand your statement "the longer the patient is under their care the more money they make". You do realize Medicare has an alloted time for each individual diagnosis. If a person has pneumonia and the average length of stay is seven days...the patient is going to be discharged in seven days or less unless there is something else complicating their stay and Medicare "oks" additional days for the patient to stay.

    A doctor just cant admit a patient to the hospital for no reason because Medicare wont pay for it unless it is necessary. My little hospital gets lots of claims denied so we eat the charges....as we cant bill the patient. A highly critical patient is a drain on the hospitals resources ....that is why you get "patient dumping" by lots of hospitals. Medicare will only pay so much according to what is wrong with you.

    Hospitals dont make alot of money off of Medicare patients I can assure you of that. Blue Cross Blue Shield pays nearly the same amount because of all these little hoops we have to jump through to get paid.

    In the end, the patient will end up paying for this in some way or another.......
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  6. #6
    I agree with Darkeyed Daisy. There are too many loop holes and hoops to jump thru with insurance and medicare. A smaller facility may not be able to make the changes necessary or be able to absorb costs that are refused, and many times these costs are refused due to billing and coding errors. There is a horrible amount of paperwork involved for just one patient. Instead of medical personel being able to give you the care and time they would like to, they have to go back to a pile of paperwork and computer and document everything correctly. Everytime. No mistakes.

    I don't know what the answer is to medicare, medicaid, and heath insurance in general, I do know some day someone will have to fix it. It gets worse every day, the numbers of the american public that have no access to medical care.

  7. #7
    This will go way beyond Medicare. Insurers base their payments on Medicare policies. So treatment, for example, for a pressure sore acquired in the ICU (it happens) will not be covered. The insurer will refuse to pay. Does the hospital simply write it off? Fat chance. They are in business to make money. So guess where they'll send the bill? To you and me, the patient (Although as Darkeyes points out, the hospital often ends up eating it, I've sure paid a bunch of bucks where Blue Cross refused to. I've also successfully fought back a number of times and gotten BC to pay). What's the probability that this policy would result in decreased insurance premiums? Pretty near zero, I'd guess. Seems like a lose-lose situation to me. Except maybe for the insurance companies. I'll bet they have a lot of say in the definition of Medicare policy.
    - Richard

  8. #8
    Quote Originally Posted by bob clark
    They just "look" clean!
    LOL, Check out Washington Hosiptal Center. "The United States, Nations Capitol's Hospice" After 8+ months and Barley Surviving 3 Bonus Rounds, Makes One Wonder If Haviing Insurance Is a Wise Idea??

  9. #9
    I think its a great move. The hospitals have to pay for their mistakes now. This will make them more accountable.

  10. #10
    Quote Originally Posted by darkeyed_daisy
    There are lots of things like this Medicare wont pay for. I am worried about the small hospital that I work at because I dont think we will be able to stay open through the winter. If you dont have certain diagnoses Medicare wont pay for tests that you may need. The patient may be asked to sign a paper saying they will pay if Medicare doesnt....Most patients will not sign the paper and then we get yelled at by the physician because the patient really needs the test.

    I can see how Medicare will use this like every other regulation to get out of paying for services patient's need.

    In the end it will be the patient that suffers under this kind of ruling. Some things are preventable but alot of things arent.

    Hospitals will be forced to close their doors eventually or refuse to see Medicare patients. We have lots of doctors here that wont take Medicare or any insurance associated with Medicare.

    Bob I am not sure I understand your statement "the longer the patient is under their care the more money they make". You do realize Medicare has an alloted time for each individual diagnosis. If a person has pneumonia and the average length of stay is seven days...the patient is going to be discharged in seven days or less unless there is something else complicating their stay and Medicare "oks" additional days for the patient to stay.

    A doctor just cant admit a patient to the hospital for no reason because Medicare wont pay for it unless it is necessary. My little hospital gets lots of claims denied so we eat the charges....as we cant bill the patient. A highly critical patient is a drain on the hospitals resources ....that is why you get "patient dumping" by lots of hospitals. Medicare will only pay so much according to what is wrong with you.

    Hospitals dont make alot of money off of Medicare patients I can assure you of that. Blue Cross Blue Shield pays nearly the same amount because of all these little hoops we have to jump through to get paid.

    In the end, the patient will end up paying for this in some way or another.......
    Hi Darkeyed_Daisy,

    I don't know where to begin. The healthcare system in this country is so complicated. I once saw a 3 or so hour gathering of healthcare professionals on C-SPAN who were discussing this issue. There were a dozen or so of these professionals, all highly educated in their little niches of this huge industry. They had a Medicare expert, a Medicaid expert, experts from half a dozen private health insurers and actuarial experts from the Congressional Budget Office (CBO) and from the executive branch, the Office of Management of Budget (OMB) and other private healthcare experts from differing "Think Tanks" from all around Washington and elsewhere.

    It was rather funny if not sad to watch. Someone from the audience would pose a somewhat simple question about some healthcare issue in a particular field and the experts had to look around this large oval table to see who was the best expert to answer the question. And what I saw were these looks from the experts sitting around the table with expressions on their faces... saying in effect, "it's not my niche of expertise"... these experts didn't even know among themselves who was the best person to answer the question. How in the world is a busy working person, a parent or a small business owner etc. supposed to figure it out? Anyway, some mumbling would go on around the table until someone finally agreed to "take a stab at it". If the freakin' highest qualified group of experts probably ever assembled around a single table can't even agree on who's the best qualified person to answer a single simple healthcare related question, please don't expect me to have an answer to this monster we call the "best healthcare system in the world".

    It's definitely the most confusing.

    I think most of us could probably agree that the US' healthcare system needs to be standardized in some form or fashion. Maybe keep everything the way it is... God forbid we ever get a single-payer plan like most modern industrialized nations have. Too many lobbyists on K Street preventing that from ever happening. But at least standardize the treatments and the billing procedures... in other words use the same standardized form and treatment options for every private healthcare system so people can "shop around" for the best price and not have to spend a day or two in a lawyers office, taking notes, trying to figure out what is covered and what is not and how is this healthcare plan better for me and/or my family than the other available 100 healthcare plans are. The overhead for hospitals, doctors and the private healthcare insurers for creating, monitoring, approving or disapproving (doorkeeping) and filling out all these different forms is somewhere around 30% of the cost of doing business. I believe Medicare, since it's the largest supplier of healthcare in this country, is somewhere around 5-8% because the office billing clerks are most familiar with it so know how to deal with it. And there's no profit margin involved. Needing so many billing clerks to figure out what's covered and what isn't and how much co-pay and annual deductible there is for each plan... I'm getting a headache just writing about the very tip of this huge iceberg that even a panel of over a dozen experts from every imaginable healthcare niche in the US' healthcare system can't even figure out among themselves. It's unbelievable.

    And filling out the initial forms isn't all that difficult (I imagine) to do in the bigger picture of things. But we all know that probably 90% of them are sent back and need to be refiled using a different form and then that one gets rejected, put aside, lost, etc. and on and on until they finally head into an arbitration hearing that can take months etc... and this has nothing to do with healing anyone. It's all about the shuffling of papers from the hospitals and doctor offices to and from the 100 (that's just a wild guess) different healthcare companies, corporations, private doctor offices, HMOs, PPOs, Medicare, Medicaid... Medicare and Medicaid combined and all the differing healthcare plans within each of these entities that I just touched on listing. On and on and on. It's a JUNGLE out there. And let's not forget about the newest jewel in the Medicare system, Part D... the Prescription Drug Plan with the $250 annual deduction that only pays 70-75% after that amount is met. Plus the infamous "Donut Hole" starting at around $3500. There are 78 different Part D plans for me to choose from in the State of Florida alone. Every State has their own different list.

    That's one reason why the healthcare inflation rate is 2 times higher (I've read that it's 3 times higher also) than the normal inflation rate that's used to index wage COLAs (Cost Of Living Adjustment) that is determined by the Consumer Price Index (CPI) which is the measurement used to determine it and is provided annually to the Social Security beneficiaries to maintain the purchasing power of their benefits. It's also used as the standard in industry, at least it was when I worked at a steel mill up north 30 years ago. It's a "grocery basket" of consumer goods that someone (many people do it from all around the country) goes out and fills up every year in order to figure out the inflation rate and adjusts that against other determining factors and then voila, the COLA or "normal" rate of inflation. Well, the healthcare system has their own "special" inflation rate. What causes it to be so much higher is debatable. Doctor's practicing defensive medicine for fear of malpractice lawsuits is the one of the most mentioned. President Bush would like to cap the "pain and suffering" award at $250,000. Excuse me... a SCI pain and suffering award is only worth that pittance? Obviously President Bush isn't paralyzed, at least not from the neck down. The cost of malpractice awards is less than 1% of the total healthcare costs that in this country was $2 TRILLION in 2005 or $6,700 per person, so that argument is bogus. And the good news is that the U.S. health care spending is expected to increase at similar levels for the next decade reaching $4 TRILLION in 2015!

    I believe there are special US government grants available to "small hospitals" that serve certain communities that have no other means of healthcare. But I can only imagine the piles of bureaucratic paperwork that would need to be filled out to prove this necessity and then finally receive the money for it.

    Quote Originally Posted by Darkeyed_Daisy
    the patient is going to be discharged in seven days or less unless there is something else complicating their stay and Medicare "oks" additional days for the patient to stay.
    Now I could go on about my mother's little bout with bronchitis. She went into the hospital on her doctor's order and was supposed to get a simple IV drip of antibiotics for a couple of days. They did a "Three Stooges" approach to medicine on her. They almost killed her twice because she caught some strain or strains of perhaps MRSA in her lungs or whatever these cesspools have hanging around in them and was transferred back and forth between different hospitals and I guess picking up different strains of bacteria/viruses in each one. Plus she was probably allergic to some of the antibiotics that she was put on. Can't or don't they have simple skin prick tests that can determine this in advance? She's was 75 years old at the time. Since her condition kept changing throughout this whole ordeal the hospital and doctors were able to bill Medicare, her Medigap policy and I think her Veterans Administration (VA) benefits. They made a small fortune from their mistakes. How is that fair? They should be paying her for screwing up her care so badly. Actually, we need a much more robust and available home healthcare system so people don't need to be subjected to all the different infectious diseases that run rampant throughout every damn hospital in this country. And every hospital does (or should) have a communicable disease expert and/or staph... oops, I meant staff on duty, testing the hospital for these nasty pathogens and preventing them from spreading by educating all hospital workers and regularly testing their hands and clothes. If they are found to have any infectious bacteria or virus on them, they should be fined... and warned about being fired or losing their privileges for "practicing" or working in that particular hospital. We all know how these things are spread... by the doctors, nurses and hospital workers not properly washing their hands or wearing gloves or surgical masks between patients and their rooms who they know are infected. And even if they don't know of an infection, it's common practice to "assume" that everyone has a communicable disease... be it skin, blood or air transmissable.

    In the end, the patient will end up paying for this in some way or another......
    Another reason for a single-payer system... if the patient is going to end up paying anyway, let's spread the cost across the whole population and simplify the paperwork in order to reduce costs. And have "surprise inspections" by qualified infectious disease experts (the FDA does it for food products) and fine hospitals and doctors and all healthcare workers if they fail the inspection. Only when it costs them money out of their own pocket will we ever get the spread of infectious diseases and the cost of hospital stays down to the bare minimum in our hospitals.

    Bob.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

Similar Threads

  1. Replies: 0
    Last Post: 11-21-2005, 09:32 PM
  2. Replies: 4
    Last Post: 10-08-2005, 10:59 PM
  3. Replies: 0
    Last Post: 03-16-2005, 04:24 PM
  4. Replies: 0
    Last Post: 10-31-2003, 12:09 PM
  5. Medicare Plan Lifts Premiums for the Affluent
    By Wise Young in forum Funding, Legislation, & Advocacy
    Replies: 0
    Last Post: 10-05-2003, 07:02 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •