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 wasn’t. 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 Mom’s 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 doesn’t 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 isn’t 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 2009—from 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 don’t get admitted don’t 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 can’t undergo an MRI, the test that would provide evidence of a stroke and its severity.
Helen is now at St. Mary’s nursing home. St. Mary’s is also feeling the Medicare pinch and support Bob and Peggy’s efforts to get the “observation” status changed to admission. The matter is going to an appellate board.
When I heard Helen’s story about a new crackdown on government rules that can impact a patient’s care because of their age. I couldn’t help but think that maybe Sarah Palin was right.
I have a brother-in-law who is retired military and when he turned 65 I think he was given the normal choices, he could continue to use retirement Tricare (primary) as his first choice with Medicare as secondary. He and my sister chose Tricare as Primary. (they say Tricare is continuously raising cost etc.)
As I understand it, if not retired military and currently depend on the VA for healthcare, you will still have to enter into Medicare for Part A (hospitalization) which you have already paid for. You can choose to forego Part B and not have the monthly SS deduction (payment) and still use VA to cover for doctors, tests etc. (have a neighbor who does this, but take note of below, for he once really had to pay through the nose for such)
But, if you have an emergency, have to see a doctor or other outpatient services and no VA hospital is immediately available, you will be stuck with the full charges for treatment.
You might want to Google any questions may have for more accurate and up to date answers.
Because if you don't believe that, then you have to decide where the limits are.
Because if you don't believe that, then you have to decide where the limits are.
I’m sorry? The article stated upfront that the woman lived with the author’s brother and sister-in-law at the time of her injury. Where do you get that her family does not want to take care of her?
The article is about the tests and treatment for a spot on her lung, not where she’s living!
Well it certainly isn't the Government's decision.
Personally if I follow your logic I would recommend that you self terminate before you start using up resources. In fact the UN has already proposed that.
If you don't want to take care of your parents then take Alinsky's advice, kill them.
Welcome to the New World Order, where your rights come from a committee and are subject to change.
First off, you do not need to be admitted to the hospital to have tests on your lungs.
She went to the hospital due to the consequences of a fall- not anything to do with her lungs.
They probably did a routine chest xray, and found the spot.
This article is about her not requiring an acute level of care, and the fact that since she was admitted as observation- Medicare will not cover the cost of a nursing home bed.You have to be inpatient level of care for 2 days before Medicare will pick up nursing home costs.
I am willing to bet her relatives did not want to care for her, and that is why they are appealing the observation decision to Medicare.
Her PCP can easily order tests regarding the lung spot as an outpatient.
This was what we call in the medical field a ‘social admit”. Now, Medicare is no longer going to pay for the costs of social admits.
Perhaps you should read the original article.
No one was proposing that Mrs. Walker was going to be euthanized or starved.
Mrs. Walker's kids were bitching because they were being asked to pay for her nursing home stay.
What they wanted was for the Government to pay for it so they wouldn't have to.
Anyone who wanted to take care of their parents wouldn't run whining to the Government.
I work in health care and I see plenty of this all the time....people with resources of their own who connive and lie to get their care on the taxpayer's dime, and then whine like babies when they are denied or caught. They can go pound sand as far as I am concerned.
For many years, there were doctors who would admit a patient for three days for "tests" so that the kids could get Mom or Dad into a nursing home for a month or two on Medicare's dime.
"Doctor, what can you do to help us? We just can't care for her any more. We've got to get some decompression time!!"
Medicare has (correctly in my opinion) caught onto this and is threatening both doctors and hospitals with fines and penalties if the practice continues.
Medicare is not intended to provide long term nursing care. If the person is indigent, there is Medicaid. If not, they or their families need to pay their own way.
I am also willing to bet that this patient had money, because most nursing homes will not accept patients who have minimal assets, and as a result, do not qualify for Medicaid.A nursing home did accept this patient. The family did not want to spend down her assets for a nursing home bed. They wanted us taxpayers to do that.
This was a ploy to have the taxpayers pay for the nursing home, instead of the patient.
I see it all the time.
This article has nothing to do with death panels- it has to do with the home/living enviroment of a person who does not need hospitalization.
If you’ve worked in SNFs, I bet you’ve seen plenty of elderly on Medicaid who are visited every weekend by the kids who drive up in their new Range Rover or Lexus.
Think of all the unnecessary costs, multiplied across the nation over many decades, due to health care funding for the common cold in patients of all ages.
Think of how different things would be if funding treatment for the common cold, and other unnecessary costs, were prohibited.
Imagine a privatized insurance industry, with interstate competition and a focus on coverage for catastrophic conditions.
You don’t have to get used to anything, you just have to think better and vote for people like Sarah Palin who would raise the standard of thinking (through common sense) on a government-wide basis.
The ultimate problem always comes down to government interference in the health care industry, which started many years ago.
To discuss the matter in any other context is a complete waste of time.
Because if you don't believe that, then you have to decide where the limits are.
That's exactly what the Death Panels are supposed to do.
They will decide what the limits are, and who will and won't get healthcare at the taxpayers' expense.
In the civil war, it was called "triage." The field doctors decided how to allocate their limited resources, who would get care and live, and who would die.
At some point, the Death Panels will allocate the healthcare money and services, and decide who lives or dies. The current reality in the medical field is to highly pressure those with a few months to live, no matter how cognizant they are, to give up and die. From the moment they enter the hospital they are pressured to agree to living wills and other advanced directives, and to die with dignity in hospices -- doctors get drugged-up elderly patients to literally sign away their lives while their while their relatives were not present.
With the Death Panels, patients will not have a choice. When the government Death Panels decide the money is better spent on younger and healthier people, the unlucky ones will not get medical services and they will die.
.
Practically everybody here knew she was 100% correct about Death Panels, even the PDSers.
did they want you to sign a DNR or a living Will? big difference.
SHHHH! Don’t say that!
The title draws posters in so they can write loving posts about Sarah!
No one wants to be educated about Medicaid.
"People like Sarah Palin" but who are actually running, I presume.
Actually, when Palin was a kinda-sorta-maybe-yes-maybe-no-I'll get back to ya candidate, she was not particularly vocal about how to handle the imminent crash of the Medicare program.
Paul Ryan and Mitch Daniels are still the only ones to talk candidly about this, and most of the rest of the GOP are giving the facts a wide berth.
Please tell me which of these three alternatives you favor.
Banning the Scooter Store would be a good start.
Those commercials really irritate me.
YES! The “Scooter Store” AND FREE Shoes, too!
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