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View Diary: Making Medicare a "more profitable line of business" (71 comments)

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  •  Medicare nightmare (9+ / 0-)

    On March 28 my mom was out-patient recieving blood for her anemia. They released her in respitory distress because there was no medicare authority to keep her. We wheeled her to the ER of the same hosp. Back now as inpatient, but medicare guidelines sent her home still not better. She was sick on and off till a week and a half ago when she stopped peeing and pooping.

    Back to the ER, the doc and the nurses did all they could to qualify her for admit, no dice. She's on the mend now and I talked to her doc yesterday.

    She told me after I explained to her that I knew what pressure she was under, that medicare has a guideline book for every diagnosis. Gall bladder? You get X amount of hours in hosp. A case manager tells the doc to release you. If a hosp. keeps too many patients longer than the set time they are investigated for fraud. She said they haven't come for the docs yet, but soon will.

    I told her that many people don't know about this, and she asked me to tell as many as I could. I know that this is old news to many of you, but there are a lot of people who have no idea. If you are younger, insured and can't breath, have not pooped for a week, and have a raging bladder infection you will be treated much differently than someone on Medicare. This is mistreatment of our elderly and a national disgrace.

    Shut it down is so yesterday. Now it's time to FIRE IT UP!

    by high uintas on Sat Apr 14, 2007 at 07:23:48 AM PDT

    •  Unfortunately... (7+ / 0-)

      ..these "guidelines" that allow or disallow admission and dictate how many days are allowed for any particular diagnosis have been around since the early 80's.  Those of us who had to change our way of practicing medicine have had to learn how to "game" the systme...
       The for-profit health care plans are using similar guidlines now.
       The interesting thing now is that traditional Medicare is often much easier to work with than all those advantage/plus/extra plans...and reimburses hospitals better.
       Still - as a physician, I'd rather know which game I'm playing, and would rather play by one set of rules, rather than wading through the maze of different blood-suckers.  
       The health of a nation should not be a source of profit for anyone.  Our blood is NOT their money.

      In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

      by drchelo on Sat Apr 14, 2007 at 07:36:25 AM PDT

      [ Parent ]

      •  It's not that I haven't known this (6+ / 0-)
        Recommended by:
        nyceve, splashy, Morrigan, Tigana, awakenow, drchelo

        As a family we've been thru too much to be smiled our way out of the hospital without knowing what's going on. It's just that many who have aging parents may be hitting this for the first time. They don't understand that their mom or dad are expendable.

        There is something you can do if you find yourself in a situation where you credibly believe your loved one is being shunted out and in real danger. I learned this from a patient advocate for the Division of Aging and Family Affairs in our state.

        You call the hosp. admin. and tell them you want a Notice of Non-payment. That stops everything in it's tracks. It calls medicare to investigate the problem and they will not pay the hosp. untill the investigation is resolved.

        As I said, this has to be a situation where there is real danger to the patient if they are released. We had to use this once and it was amazing how fast the wheels got greased to help mom.

        Shut it down is so yesterday. Now it's time to FIRE IT UP!

        by high uintas on Sat Apr 14, 2007 at 08:46:40 AM PDT

        [ Parent ]

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