Thursday, February 28, 2013

Can We Calculate The Price Of Human Dignity?

I never claimed I was brilliant.  I never bragged that MENSA representatives were knocking on my door and pleading for me to join.  But I am smart enough.  Smart enough to matriculate medical school and residency.  Savy enough to own and operate a business.  Lucky enough to be married and have kids. Most difficult projects in life require hard work and a certain amount of stubbornness.  And I rejoice in that I have been given the mental faculties and vast opportunities to succeed.

I reluctantly admit, that I have always found a way around most of the hurdles in my path.  I either jumped over, ducked under, or swerved to the left or right.  Occasionally, I turned and ran the other way.  Nothing extraordinary here.

Recently, however, everything has changed.  I've met my nemesis.

It takes the form of a colossus of metal, rubber, and a little bit of padding.  One can see it hocked on the Internet, and in infomercial like segments with elderly people cheerily scooting around with smiles on their faces.

Yes, I'm talking about power wheelchairs.

Now, in general, I'm not a fan.  Of the thousands of geriatric patients I take care of, I may have ordered twenty in ten years of practice.  Occasionally, no matter how much I don't like them, some patients are so disabled that there is no choice.  As their doctor, I want to help these patients.  I want to protect them from falls and increase their mobility.  I want to restore a modicum of dignity through the wonders of lost agility.  I want to be a Doctor. 

But no matter how I try, every order I have written in the last 6 months has been denied by Medicare. 

It's not that I don't understand.  Fraud happens, and these machines are expensive.  So I get that in order to have this kind of service covered, a face to face evaluation of the patient must occur documenting the disability and the reason for the need.  I get it!

Unfortunately, I can longer traverse this process without messing it up.  Either I document too thoroughly...or not thoroughly enough.  My review of systems is inadequate or my review of systems is too adequate.  One patients note did not describe to enough detail the weakness requiring a power chair.  When I addended my note and clarified, I got a denial message saying that the patient was to weak to maneuver the chair.

Huh?  So this poor, frail, elderly person who has been tripping over her walker because of inadequate strength will not be able to move her hands enough to operate a joystick? Really?

We often use the word draconian to describe the clunky nature of governmental regulation.  The collateral damage of dealing with small amounts of fraud is often greater that the cost savings from such measures.

My unstable octogenarian will not get her power wheelchair.  Instead she'll trip over her walker and land in the hospital with a broken hip.  Instead of a five thousand dollar piece of medical equipment, the bill will likely be over fifty grand.

Let's not forget the cost of a hundred covered days in a nursing home.

And can we calculate the price of human dignity?


Anonymous said...

One of those popular power wheelchair co.s is being investigated for large scale Medicare fraud I believe.


suziq38 said...

One "bad apple" spoils it for the rest of us.
This reminds me of medicare denying my FIL's request to go to a major rehabilitation center for help after 3 major strokes.
He was completely paralyzed on his right side, aphasic, and in a diaper.
They wanted to send him to a little nursing home with a tiny room for a rehab room.
I said "no way."
They refused my request for a transfer, saying that he did not need such intense rehabilitation at the age of 72.
I got so mad that I called then up and threatened litigation. I said that they were denying my FiL care based on his advanced age. Had he been 37, and suffered a stroke during a surgery, he would have been allowed to go to the major rehab center.

I told them that his second wife (remarried at age 70) had left him, hired a lawyer and filed for all of his assets (including the family business) while he was in the hospital. I told them that since I had already hired 2 lawyers anyway (one for FIL, and one for our interests as far as POA) that it would be nothing for me to sue them too. He had "Secure Horizons" or something like that. Basic, cheap medicare.
I said "You had better not make this decision without consulting your boss and your lawyers. If my father does not get the proper care because you have discriminated against him because of his age, I will sue you for denying him care."

The rep called me back within an hour and said that the full on rehab hospital was approved for 6 weeks.

My FIL flourished in their care. He came home without a diaper and could walk with a claw cane.

suziq38 said...

Just testing..I hope my other comment came through.

suziq38 said...

About your 80 year old patient:
Someone has to try this: Get a friend that is a lawyer to write a letter on her behalf.
Get a person that has the time that cares about her to make the phone calls and continue to badger them until they agree.
I was a part-time SAHM at the time that I cared for my FIL. I was a "thorn" in anyone's ass.
I had opposing counsel worried as to what I was going to do next.
We got everything we needed for my FIL.
I would have tried for one of those wheelchairs, but I thought that he would run over someone with it.
I didn't want him to hurt anyone, as his reaction time was terrible. I also thought he might become too lazy and rely on it too much.

If you really want her to get a wheelchair, encourage the family to get a lawyer friend to donate their time and write a letter or to demand a hearing of some sort to complain to medicare about the person that denied the claim.