Everyone sees ads about how wonderful Medicare is. Here’s a story about hoops and rules that make patients seem like pawns in the hands of boards of directors.
My Mom had AARP insurance along with Medicare until 2003 when the rules changed. Because she lived in a small southern NM city, she could only get Humana. She was very healthy until she slipped & fell when she was in her 80’s. At first, they took reasonably good care of her but slowly decreased her care & completely stopped all care & nurse visits by the time she died at 96. My siblings & I had to hire a caregiver during the day. Thankfully, my younger brother who lived with her took over in the evening. I too only have Medicare.
It’s food for thought when we get to the point that our spouse dies or there are no children able to care for us. Anxiety. Other cultures are far ahead of us in that older family members move in and are taken care of until death. We depend on insurance. As always the rich do what they always do, pay big.
Hopefully her end will be without pain. My husband wish is to make my coffee in the morning. Follow the sun around the house. Look after houseplants. Watch avian life on Barnegat Bay.
The hospitals have become complicit players in the insurance shell game.
I was involved in managed care in the mid 90’s here in NJ there were too many hospitals. In Newark NJ you could walk to the 6 hospitals that did open heart surgery. As hospitals reconfigured and bought each other up in to competing health systems, physicians also consolidated and sold themselves to the hospital systems. Even now with ubiquitous computerized information systems, problems of information sharing is rampant.
The problems of corporate primary care, hospitalists, syndicates of specialty care groups has not improved healthcare.
My advice used to be to patients was just get sick and die quickly.
Now I have my 84 husband with stage 4 pancreatic cancer who has survived well past the over all survival statistics. This has come about due to my relentless advocacy.
His survival is due to my relentless pursuit of following medical common sense.
Now hospital administrations are all crying about nursing shortages. This is their own undoing.
Nursing entry in to practice with a BSN as a standard is nuts. How many of these BSN prepared have given a patient a bed bath or for that matter a washcloth. This basic opportunity for observation is now dedicated to techs with dubious training.
My observation on my husbands recent hospital stay I am 67 and I bet that most of the staff was at least half of my age, and many not as old as I have had professional nursing licenses.
My heart goes out to you and your husband. Your story of advocacy resonates with me after 2 friends were hospitalized, and neither had family still alive to advocate for them. It’s important to have someone present fighting in the patient’s corner. One friend died after months of trying to get a diagnosis. 2 weeks ago, she got the tests and diagnosis. She refused a biopsy. They sent her to hospice. It’s never ends.
I’d like to add that this indifference and bean counting is not restricted to Medicare coverage. It’s insurance companies across the board, along with Giant hospital conglomerates. An associate of my wife was admitted to an HCA facility in our area due to passing blood. Began on a Thursday.
On Friday, when she requested to be transferred to a larger hospital in our area, she was told that a particular specialist would have to determine the necessity for that. She never saw one. Her blood loss continued so she was put on an IV of isotonic saline. Slow drip. This was to be monitored and replaced when needed. No monitoring occurred. When empty, mid Friday afternoon, she called the nurses station. One nurse responded but said she had no standing orders for additional containers. Worse yet, the only doc who could have done so had left for the day! So she stayed and bled all week end.
Additional details aren’t the point. Her lack of adequate care and the lack of proper staff to provide care 24/7 shows our cash cow status upon entering a hospital like you have spoken of. And we have the highest cost for medical care in the world.
Gary, that’s a very disturbing story, and I’ve heard so many like it. The ER’s here are like going to purgatory: my husband went for afib, and it was 36 hours before he got a room. They had beds but inadequate staff. It’s just awful.
Straight Medicare does not deny coverage or services only medicare dis-advantage. Arent you mixing these two up? Medicare and Medicare Advantage are two different things, they use completely different denial standards. MEDICARE advantage is private health coverage, Medicare is not.
I’m very sympathetic to this story although as Paul posted it’s hard to hit the like button. I will do so to let you know that I appreciate your sharing. As a 78 year old on Medicare myself, I learned early on to rely on the original when I had breast cancer and Sloan Kettering didn’t allow any of the so-called advantage plans (I believe they now have changed the policy somewhat). But I continue to muddle through with just the original. No horror stories yet . . .
I dealt with some similar issues on my mother’s behalf almost ten years ago when she was in her ‘90’s. The issue centered around hospital readmission, length of stay, and post hospital step-down facilities. I didn’t then do I now fault Medicare for their rules, they’re stringent and unwieldy, but necessary to draw boundaries for typical situations, where at times untypical unique circumstances make the rules look illogical and lacking common sense. The issue then was, and as I understand it is one that occurs frequently, are doctors and facilities putting their Medicare rating and reimbursement rate above the health and best medical care of the patient. Hospitals and step-down facilities try to get low pay Medicare reimbursement patients out the door as fast as possible to make room for high pay insurance patients; then those same doctors and facilities fight to make sure those same early discharged patients don’t return to the hospital because Medicare black marks them for poor patient management and care which results in a penalty of lower Medicare reimbursement rates and star-rating.
Folks, Medicare Advantage (where you are taken advantage of) is focused on making the big bucks off of us. It’s all fun and games (over the counter $ for you to “buy” overpriced bandages, fiber, hemorrhoid cream and other drug store paraphernalia (from their drugstore!) gym membership, rides to a medical appointment. All “nice” until you really need them. The fuckery (no other decent word for it) begins.
Wendell Potter was a V.P. at Cigna years ago and since he left, has sounded the alarm about how badly M.A. is screwing us.
Hard to Like this but OK. Seems to me the hospital should have some autonomy to make the decision to allow the patient to stay as is until the procedures are completed. Common sense in an uncommon world?
My Mom had AARP insurance along with Medicare until 2003 when the rules changed. Because she lived in a small southern NM city, she could only get Humana. She was very healthy until she slipped & fell when she was in her 80’s. At first, they took reasonably good care of her but slowly decreased her care & completely stopped all care & nurse visits by the time she died at 96. My siblings & I had to hire a caregiver during the day. Thankfully, my younger brother who lived with her took over in the evening. I too only have Medicare.
It’s food for thought when we get to the point that our spouse dies or there are no children able to care for us. Anxiety. Other cultures are far ahead of us in that older family members move in and are taken care of until death. We depend on insurance. As always the rich do what they always do, pay big.
Hopefully her end will be without pain. My husband wish is to make my coffee in the morning. Follow the sun around the house. Look after houseplants. Watch avian life on Barnegat Bay.
The hospitals have become complicit players in the insurance shell game.
I was involved in managed care in the mid 90’s here in NJ there were too many hospitals. In Newark NJ you could walk to the 6 hospitals that did open heart surgery. As hospitals reconfigured and bought each other up in to competing health systems, physicians also consolidated and sold themselves to the hospital systems. Even now with ubiquitous computerized information systems, problems of information sharing is rampant.
The problems of corporate primary care, hospitalists, syndicates of specialty care groups has not improved healthcare.
My advice used to be to patients was just get sick and die quickly.
Now I have my 84 husband with stage 4 pancreatic cancer who has survived well past the over all survival statistics. This has come about due to my relentless advocacy.
His survival is due to my relentless pursuit of following medical common sense.
Now hospital administrations are all crying about nursing shortages. This is their own undoing.
Nursing entry in to practice with a BSN as a standard is nuts. How many of these BSN prepared have given a patient a bed bath or for that matter a washcloth. This basic opportunity for observation is now dedicated to techs with dubious training.
My observation on my husbands recent hospital stay I am 67 and I bet that most of the staff was at least half of my age, and many not as old as I have had professional nursing licenses.
It is a sad state of affairs.
My heart goes out to you and your husband. Your story of advocacy resonates with me after 2 friends were hospitalized, and neither had family still alive to advocate for them. It’s important to have someone present fighting in the patient’s corner. One friend died after months of trying to get a diagnosis. 2 weeks ago, she got the tests and diagnosis. She refused a biopsy. They sent her to hospice. It’s never ends.
I’d like to add that this indifference and bean counting is not restricted to Medicare coverage. It’s insurance companies across the board, along with Giant hospital conglomerates. An associate of my wife was admitted to an HCA facility in our area due to passing blood. Began on a Thursday.
On Friday, when she requested to be transferred to a larger hospital in our area, she was told that a particular specialist would have to determine the necessity for that. She never saw one. Her blood loss continued so she was put on an IV of isotonic saline. Slow drip. This was to be monitored and replaced when needed. No monitoring occurred. When empty, mid Friday afternoon, she called the nurses station. One nurse responded but said she had no standing orders for additional containers. Worse yet, the only doc who could have done so had left for the day! So she stayed and bled all week end.
Additional details aren’t the point. Her lack of adequate care and the lack of proper staff to provide care 24/7 shows our cash cow status upon entering a hospital like you have spoken of. And we have the highest cost for medical care in the world.
Gary, that’s a very disturbing story, and I’ve heard so many like it. The ER’s here are like going to purgatory: my husband went for afib, and it was 36 hours before he got a room. They had beds but inadequate staff. It’s just awful.
Straight Medicare does not deny coverage or services only medicare dis-advantage. Arent you mixing these two up? Medicare and Medicare Advantage are two different things, they use completely different denial standards. MEDICARE advantage is private health coverage, Medicare is not.
Both are still tied to hospital ceo approvals for special treatments.
I’m very sympathetic to this story although as Paul posted it’s hard to hit the like button. I will do so to let you know that I appreciate your sharing. As a 78 year old on Medicare myself, I learned early on to rely on the original when I had breast cancer and Sloan Kettering didn’t allow any of the so-called advantage plans (I believe they now have changed the policy somewhat). But I continue to muddle through with just the original. No horror stories yet . . .
Me, too.
I dealt with some similar issues on my mother’s behalf almost ten years ago when she was in her ‘90’s. The issue centered around hospital readmission, length of stay, and post hospital step-down facilities. I didn’t then do I now fault Medicare for their rules, they’re stringent and unwieldy, but necessary to draw boundaries for typical situations, where at times untypical unique circumstances make the rules look illogical and lacking common sense. The issue then was, and as I understand it is one that occurs frequently, are doctors and facilities putting their Medicare rating and reimbursement rate above the health and best medical care of the patient. Hospitals and step-down facilities try to get low pay Medicare reimbursement patients out the door as fast as possible to make room for high pay insurance patients; then those same doctors and facilities fight to make sure those same early discharged patients don’t return to the hospital because Medicare black marks them for poor patient management and care which results in a penalty of lower Medicare reimbursement rates and star-rating.
Folks, Medicare Advantage (where you are taken advantage of) is focused on making the big bucks off of us. It’s all fun and games (over the counter $ for you to “buy” overpriced bandages, fiber, hemorrhoid cream and other drug store paraphernalia (from their drugstore!) gym membership, rides to a medical appointment. All “nice” until you really need them. The fuckery (no other decent word for it) begins.
Wendell Potter was a V.P. at Cigna years ago and since he left, has sounded the alarm about how badly M.A. is screwing us.
Another Bush legacy.
Hard to Like this but OK. Seems to me the hospital should have some autonomy to make the decision to allow the patient to stay as is until the procedures are completed. Common sense in an uncommon world?
It’s too logical for big institutions.
Paul Wittenberger: Quite logical.
The real situation is absurd.
As usual, absurd situations are pushed, because they push cheapness and a company's bottom line.
Alas!
Yours and Diane's postings are very good.
Thanks, Armand!
That’s a sad commentary on communication between doctors and patient procedures. So bad.