Posted on 10/20/2011 8:58:06 AM PDT by 2ndDivisionVet
Sarah Palin warned of government death panels on her Facebook page and was nationally ridiculed. Politifact.com awarded Palin with the Lie of the Year for that statement. President Obama called her out during a joint session of Congress saying the claim is a lie, plain and simple.
I thought of Sarah Palin when I heard the story of Helen Wagner. Helen is 91 years old and is the mother of my sister-in-law Peggy. Give Helen five minutes and she will list a dozen times she has held death at bay. But now she is up against a much greater force: Medicare.
Helen lives with Peggy and my brother Bob. In August, she fell and broke her arm. In the emergency room at Lansdale Hospital, a doctor examined her and determined that the fall was probably caused by a minor stroke, possibly two. He was also concerned about a spot he saw on her lung on an X-ray. The doctor ordered more tests and said Helen would be admitted.
Only she wasnt. Instead she entered a Twilight Zone of new Medicare regulations. Two days later the hospital called and said Helen would have to be picked up. When my sister-in-law asked about the tests, she was told they had not been done. In fact, Helen was never admitted to the hospital. She was just being held for observation.
A flurry of dialogue among the hospital, my brother and sister-in-law and doctors lasted four days and ended with a threat that Helen would have to be picked up or she would be transported to a nursing home with an available bed and the family would be billed.
My sister-in-law rushed to the hospital where, she says, her mother was weak and barely conscious. Peggy navigated her Moms broken arm and bruised leg as she dressed her and wheeled her out of the hospital. There were no discharge papers. (Lansdale Hospital would not comment on this specific case because of privacy laws.)
Helen and her family are just one of the latest victims of new Medicare regulations, and an even more recent crackdown on those regulations that cause agita for hospitals and heartbreak for families who care for the elderly.
The cost-saving rule is just a few years old and requires hospitals to hold some patients for observation instead of admitting them. The difference in terminology means that the hospital is reimbursed far less money than they would have if the patient had been admitted. When I asked a spokesperson from the hospital to tell me the difference in care between admission and observation, I was told, There is none. It is just billing. And yet, one would have to believe, that hospitals are reluctant to conduct tests that will be under-compensated or not covered at all.
Observation can last up to five days, according to the new rules. That may explain the hurried need to get Helen out of the hospital on day four. If a hospital doesnt adhere to the Medicare regulations, it will face an audit that could mean a huge loss of federal reimbursement dollars.
The burden on families is even greater. If a patient is not admitted, rehab at the nursing home is not covered by Medicare. Even if you have private insurance, many companies base their criteria on Medicare. If Medicare is not covering, the insurance company isnt either.
My brother and sister-in-law recently had a meeting with administrators at Lansdale Hospital, including the COO, who called the new Medicare rules the bane of our existence. Thousands of families have complained since observation started over five years ago.
According to the Centers for Medicare and Medicaid Services, observation status claims climbed 26.7 percent from 2006 to 2009from 828,353 to 1.131 million. The increase in claims for observation patients kept for more than 48 hours is startling. It tripled from 26,176 to 83,183.
Observations are supposed to be limited to 24 or 48 hours, with five days being the absolute maximum. CMS believes this shows hospitals believe many patients are too sick to go home and feel pressured into not admitting them under Medicare rules.
So what is the criteria for who gets to be admitted and who gets observation? Those who dont get admitted dont meet the evidence-based criteria. A minor stroke, for instance, can be seen as part of the normal aging process. Helen Wagner, like many people who make it to 91, has a pacemaker and cant undergo an MRI, the test that would provide evidence of a stroke and its severity.
Helen is now at St. Marys nursing home. St. Marys is also feeling the Medicare pinch and support Bob and Peggys efforts to get the observation status changed to admission. The matter is going to an appellate board.
When I heard Helens story about a new crackdown on government rules that can impact a patients care because of their age. I couldnt help but think that maybe Sarah Palin was right.
“So we’ll never know what she’d be like in national office”
Holy cow don’t give up on that possibility, and don’t give up on the possibility that she can do this country enormous good from whatever perch she chooses to occupy.
The commie rats knew immediately when Sarah came on the scene - here is one not afraid to speak out boldly and one to be reckoned with. Did any one with a platform stand in her defense against the media - nope. But Americans knew here is someone finally saying what we believed all along and gravitated towards her and the attacks were fired up 24/7 against her. The weak and clueless submitted to the evil media and bought the lie.
Nothing new under the sun. Darkness hates the light. Evil hates truth.
I do not consider Mrs Wagners nursing home placement a medical issue- it is a social issue.She could be taken care of at home, it appears to me her family does not want to take care of her.
Why does healthcare have to take into account of social issues like home placement?
The government should have social issues into a separate fund.Then we can differentiate between the true cost of healthcare, and the true cost of social issues.
I have long term care insurance- when I can no longer ambulate or take care of my ADLs. I do not consider that ‘healthcare”.
An overwhelming percent of medical care is delivered in the last weeks of life. It’s understandable that some would want to get the number down. Unfortunately, because of the government, people don’t trust the doctors when they say someone is terminal so no one trusts them not to kill a patient to free up a bed.
</useless food gobblers
Couple tips to the unaware. When your doctor refers you to a specialist, for imagining, lab work etc. Make damn sure they are a medical necessity by Medicare's standards. If not and turned down, Medicare will not pay a cent, neither will secondary ins, and you will be stuck with the full costs.
Also, be absolutely sure whatever health provider you go to is in the Medicare Assignment Participation program. If they are not, you can again get stuck with some horrific medical bills.
If not careful, the term Medicare assignment can come to have great negative meaning in many peoples’ lives.
I took my heart monitor off about midnight, no one came to check on me until the Doctor came by to release me that morning.
Remember how Republicans were pilloried for even suggesting Medicare reforms and were branded as wanting to gut Medicare? Obamacare actually cut $800 billion out of Medicare and nothing gets said, but now as Rev. Wright preached ...the chickens have come home to roost.
She is no longer of use to the regime. No resources to be wasted on her.
Likely true...however, in the past those who had worked hard and could afford it could buy their care here in the US...in the future, they’ll just have to go off shore...or underground.
When financial incentives are placed ahead of medical outcome, “death panels” are the natural result and no amount of political ridicule will change that reality.
Obamacare only heightened the focus on financial incentives, ensuring bureaucrats have more control than the Dr. in charge of the patient.
Clarification: The 91 year old woman, not Sarah!
Maybe you can or someone else here answer a question for me: I am 51 and use the Veterans Affairs medical system. When I turn 65, do I have to start using Medicare, or can I keep using VA?
You are correct, this was started under Bush.
If 80% of your costs go towards covering retirees, and if you reduce the amount of money spent on health care, then retirees are going to take the brunt of those cuts.
The part that drives me crazy is hearing the liberal argument that turning our entire health care system over to a monopoly is somehow better than a fully competitive market. When I ask them to show me any place in history where a monopoly provided better service at lower cost than a fully competitive market, they can't do it. Yet they are still convinced that it will work with health care.
In a fully competitive market, there will be some entrepreneur somewhere who will find a way to make money off of MRIs and will purchase a machine to capture that business. And another, then another, then another entrepreneur will join him, and they will each find themselves minimizing their costs in order to secure enough business from their competitors to remain in business.
With the government monopoly, there is never an incentive to purchase an MRI machine. MRI centers become cost centers instead of profit centers. So in order to cut costs, the government shuts down the MRI centers. And this is repeated throughout the system, except of course for the government bureaucrats who will reserve for themselves a separate system to cover their own needs. Think of the State Party Stores in the USSR where Communist Party officials could purchase the finest consumer goods while the rest of the proles were stuck in line hoping that there would be something left that might fit.
I think I saw you daughter at the OWS on TV. She wants to move to primitivism. When asked about people who wouldnt be able to survive in a hunter gatherer system, she replied they would learn, or die, after all everyone dies. </Useless Food Gobblers>
“In my judgment, the government should get completely out of health care.”
Yes, absolutely correct.
What government can do is tort reform, otherwise stay the “H” out of ________________ name of private enterprise you wish to mention, in this case Medical Industry.
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