Wednesday, April 27, 2016

I wish this was available then!

In 2005 I took my Grandparents on vacation. I wish we had the Healthcare Technology we have now back then. They retired many years prior. They spent their days in a small lake house on Lake Murvaul in East Texas. They didn't fish much. They didn't own a boat and they had a hard time being away from their home due to the need for Oxygen Therapy. They didn't really have any hobbies. Their family was their hobby. They attended Baseball, Softball, Football and other activities their grandchildren participated in but always had to drag around cylinders and regulators just to have portable oxygen. They were smokers. To my knowledge they had always smoked. Looking back at pictures of me at the age of 3 or 4, you could find my Grandmother or Grandfather holding me with a Cigarette hanging from their mouths. Some may be shocked by the thought of someone smoking while holding a toddler but it was a different time and smoking was just part of their lives. They had started smoking before we knew what the consequences were and are. Years of smoking packs of cigarettes a day had damaged their lungs and in their later years prevented them from going, doing and seeing what they wanted. After all these years, it still stings a little when I think that they had just missed technology that could have changed their lives in profound ways.

By 2005 they both required Oxygen therapy. This made taking them on a trip very difficult. My wife and I decided that we wanted to gift them a vacation and include the entire family. We searched and planned and decided that a trip to the beach would be manageable. We rented a beach house on Galveston Island big enough to hold my Grandparents, all of their kids and Grand Kids. It’s a memory I cherish. We enjoyed great meals, dominoes, cards, movies and all around Family fun. Using a beach house allowed us to store the Oxygen Concentrator, Tanks, Stands, regulators, soft goods and all of the equipment and supplies we would need for a week’s vacation. All together the equipment for both of them weighed well over 500lbs. The oxygen equipment alone took up one room in the house. In those days oxygen wasn't even close to being portable or affordable. So we made the best of it. They didn't get to spend much time on the beach. They were kind of tethered to the beach house because they needed to be close to their oxygen equipment. They still had a great time. They were just very limited on what they could and couldn’t do. My Grandfather did venture out to the beach once during the trip. It literally zapped him. His oxygen saturation dipped into the 60s and his trip was pretty much over.

That was then. This is now. My grandparents may be gone but the need for light weight portable oxygen is as great as ever. Let’s Fast Forward to 2016. Cross Medical currently rents an all in one portable oxygen concentrator that weighs less than 7 lbs. I personally believe that the ability to travel, move about and spend time with one’s family is critical to overall health and wellness. Consumers now can board a commercial airline with all of the oxygen they will need in a bag the size of a small purse. They can now go on a cruise without worrying about leaving their oxygen. All of the oxygen they need is in the small bag on their shoulder. Had we had that technology back then, they WOULD have been able to walk on the beach, go on a shopping trip or play with their Great Grand Children in the surf. Unless you are looking for it, you would never even know someone is wearing one of these new systems.

I can’t look back with regret about the things they couldn't do. The technology just wasn't there at that time. What I can do is educate our public on the fact that this technology now exists. You can spend time with those living with COPD of CHF. These patients can jump in a car, catch a flight or book a cruise without the fear of being away from their oxygen. They can get out and move about with worrying about their oxygen supply. They can LIVE life to the fullest!

Monday, March 21, 2011

Dr's Visits are going to take longer

Medicare is changing how they pay providers which impacts how long you wait to see your Doctor!
Over the next few months I will be discussing the current state of Medicare and changes that are coming from the Patient Protection and Affordable Care Act or Obama Care as some like to call it. Here is the first installment. Please post comments. Let me know your questions and thoughts on the current state of Health Care.
Your wait to see your physician will keep growing over the next several years. Medicare and Medicaid are fighting fraud by slamming your Doctor and other Healthcare Providers with mountains of paperwork. Government agencies are notorious for knee jerk reactions. Someone will point out a flaw in the way they do business, ignoring the issue for years until Budget constraints, Political Pressure or intense Media attention slaps them in the face. Then, they take action.
Part of the “Patient Protection and Affordable Care Act” sets aside 350 million dollars largely outsourced to outside agencies to curb fraud and abuse. HHS or Human Health Services reports that they have recovered 4 billion in “fraudulent” claims in 2010, but is this truth or another sleight of hand by our government? I do not disagree that they have spent 350 million dollars. I do question their claim of fraud detection. What HHS and CMS (Center for Medicare/Medicaid Services) are not telling us is that they have left the vault door unlocked and open for the past 30 plus years. “You would like to steal 50 million dollars sir? Help yourself; we will catch you in a couple of years”
They do not work like any other profitable business in the world. Businesses have Accounts Payable offices. Their function is to receive invoices, make sure the services or products were ordered and received then issue payment. This is not the way it works for Medicare. Anyone, including Nigerian, Mexican and Eastern European Criminals can come to the United States and get a Medicare provider number. They bill Medicare millions of dollars for services not provided. Medicare pays these claims without question. They refer to the procedure as “pay and chase”. The problem is that by the time they have decided to “chase”, many of these people have left the US to return to their native land with millions of US taxpayer dollars. Their new “revolutionary fraud fighting process” is to actually look at the claims prior to payment. They do not look at all of them, only a small sample to find errors in claims. This is called a Pre-Payment audit. They do not look at the simple reasonableness of the claim, but the now require up to 6 inches of paperwork to decide if your physician is correct in the assessment that you or your loved one needs a wheelchair. Gone are the days when you can take your Grandmother to the Physicians office and describe her need while the physician confirms the need with education he/she has worked so hard for. He must do face to face examinations. This is a fancy word for a lot of paperwork. He then must provide years of progress notes detailing the patient’s deterioration. People with no legs have been denied wheelchairs because the documentation and progress notes are not in the chart or not written as CMS would like them to be written. Claims are denied and eventually paid when appealed. First it was pay without question, now it is overkill with paperwork.
A great number of physicians report that they need to see 20 patients a day to break even. A physician can easily spend 18 hours a day completing paperwork to satisfy these new requirements. So be prepared to wait longer and longer, because your physician has a 6 inch stack of paperwork on one patient he/she must complete.
Did the Government actually recover 4 billion dollars or did they just delay the delivery of needed services while the actual problem still exists. It’s too easy to get a Medicare provider number. Medicare numbers are given to non-citizens that can submit claims on patients that have been dead for years and get paid.
I believe the key is to keep criminals out of the system to begin with. Could you run a business by contracting with criminals and paying them without looking at the bills? The knee jerk reaction now is treating all physicians and providers like criminals. Where is the middle ground between common sense and protecting Medicare?
I will keep writing until we have positive answer.
Michael Isbell

Friday, September 17, 2010

It's easy to become Cynical and judgemental in today's political climate. like I said, that's the easy thing to do. I think a lot of the cynicism in today's vernacular is from all the noise. I don't know if citizens realize how well our government uses the Media to get out the message that whomever wants out. As we all know very few in our national government agree on anything, so the messages get a little convoluted.

I regained faith in our political system this week after watching an hour and a half Congressional Energy and Commerce Meeting on Medicare's implementation of Competitive Bidding , often called suicide bidding. I have been under the delusion that Medicare is pulling the wool over Congress's eyes on this suicide bidding issue. I have written in the past that this Competitive Bidding is Competitive in name only. It is a deeply flawed Bidding process for Medical Equipment and Supplies that required delivery by trained and licensed staff. Low ball bids have plagued the process. Many out of state companies have submitted low ball bids and then declined the contract when it was offered. Medicare then moves on to the next Corporation and offers them the contract with the same Low ball price. Lincare, one of the nations leading suppliers of Oxygen, actually received 20 contracts at prices lower than their bid. Their leadership said they will accept the bids at a financial loss hoping that Medicare will change this flawed policy soon.

What impressed me was that Congress makes the law. They gave CMS (Medicare) the task of reducing price through competitive markets. CMS did the exact opposite. They have awarded un-sustainable contracts to out of state suppliers. It is estimated that 80% of small medical suppliers will go out of business when this program is implemented. WHO WILL BID NEXT TIME?? One elderly but very intelligent congressman stated that Medicare is creating a climate for an inevitable monopoly that will eventually increase prices to a level that Medicare will not be able to pay and stay solvent. The members of the committe, Republican and Democrat seemed to really have the interest of the Medicare benificiaries and the General Public at heart. A glimmer of light is that the House has 270 co-sponsors to a H.R.3790 that will stop this suicide, monopoly making bidding. With the hearings and the strong support from the House, I feel that the program will be stopped. Make no mistake. Our government has issues. Things take a long time to get done. There often seems to be little logic in the decisions that are made. With my involvement with this issue I can empathisize with our lawmakers. These matters are so complicated and there are so many matters. They are just Men and Women like you and I. They make the best decisions with the information they have. The problem often lies with the information. Large Lobby's dominate our policy makers time and distribute information that is financially beneficial to their organization. Who could make heads or tails of most of these matters. Well, I will tell you this. There is the Energy and Commerce Committe that seem to be on their game.

Tuesday, August 3, 2010

The following is MAMES response to the competitive bidding issue found in the KCStar.
The hidden costs of lowering Medicare costs too far

The Medicare “competitive” bidding program for medical equipment is an ill-conceived scheme for the people who rely on these products and services and the hardworking small businesses that provide them.

A recent Star editorial (“Don’t pass up Medicare bids”) does not clearly explain the cost of doing business in a Medicare system that requires hours of paperwork to be reimbursed and hours of follow-up with the prescribing doctor’s office to ensure the paperwork is complete and accurate to meet Medicare standards.

Suppliers must also employ technicians who are trained and certified to properly deliver and set up home medical equipment and train consumers on safe and proper use of the equipment, as required by Medicare. Additionally, suppliers must provide patients with repair technicians who are available 24-hours-a-day, seven-days-a-week, including holidays.

All these costly and time-consuming Medicare requirements are covered under the single payment amount paid by Medicare — an amount that is paid 45 days later, at best, and only if everything is perfectly executed. Do you really want the lowest bidder — who has been forced to slash delivery frequencies, cut back repair staff and rely on lower-quality equipment just to stay in business — to supply your sick relative with life-sustaining equipment and services? In some cases, the lowest bidder doesn’t even operate in the local Kansas City area! The fact that Congress delayed this program two years ago is testament to how flawed it was then and continues to be today.

Once delayed, providers across the country, not just those in the nine bid areas, were hit with a permanent 9.5 percent across-the-board decrease in Medicare reimbursement rates as a compromise for delaying the program.

The editorial is correct in the statement that Medicare “expects” to pay 28 percent less in the Kansas City market for durable medical equipment.

However, what is going to happen when the desperate providers who have taken these contracts realize that they cannot sustain the rates for the next three years? What is going to happen to access to care when providers in Kansas City go out of business and those that remain can no longer fulfill unsustainable contracts?

What is going to happen to prices in three years when these contracts expire and there are only a few providers left and the competitive market place has been damaged? What Medicare “expects” to see and the reality of what’s to come are completely different things. Suppliers all across the country have worked with congressional leaders to put together a more effective cost-savings solution, HR 3790, (which today has 254 bipartisan co-sponsors), that will preserve high-quality access to care and save billions of dollars over the next 10 years while saving 100,000 jobs.

We are not beseeching Congress to support a costly status quo. We are beseeching Congress to understand and save the very health sector that can be one of the critical pieces of preserving our healthcare system. We are beseeching Congress to force the government to eliminate fraud before it starts by enforcing regulations for accreditation and surety bonds. We are beseeching Congress to recognize that home care, and the equipment and services necessary to preserve it, are the best answer to the long-term cost issues facing our system today.

Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services, lives in Stillwater, Minn.

Saturday, July 3, 2010

This is so relevant to the day’s discussion of fiscal responsibility and HealthCare but in the United States of America the more powerful your lobby the louder your voice. You may have the best solution to Healthcare but without the lobby your voice is a whisper. Home medical equipment and care is already the most cost-effective, slowest-growing portion of Medicare spending, increasing only 0.75 percent per year according to the most recent National Health Expenditures data. That compares to more than 6 percent annual growth for Medicare spending overall. Home medical equipment represents only 1.6 percent of the Medicare budget. However, CMS "Medicare" continues to release stories of Medicare Fraud in the Home Health and Home Medical Equipment Industries. However the CBO or Congressional Budget office says Medicare spending could be cut by 30% by using more conservative approaches to patients with Chronic Diseases. It only makes sense. One visit to the Hospital for a three day stay for a COPD respiratory episode runs in the thousands of dollars. If treated in the home it is only a couple of hundred dollars a month. Home Care can provide almost all treatments that facilities can without the cost and risk of infection. Why is it the same story in the news of a little old lady that was charged $1000.00 dollars for a wheel chair and the same chair can be bought of the internet for $400.00. Who is going to provide the regular service for this internet chair?? They don’t tell you that the wheel chair Provided by the local Home Care Company is rented and if the patient only had it for a few weeks the company providing it would lose money. At an average of $60 dollars a trip, that’s $120.00 round trip Medicare pays rental of 140.32 per month. No extra payments for middle of the night calls, because the brakes are locked or a tire is flat, that is all on the Home Medical Equipment Company. They don’t tell you that those chairs described in the news stories are ultra light weight made of special alloy that allows a heart patient or someone with a stroke the ability to propel themselves. How about the patient, covered in bed sores, that is comfortable in their home with special Alternating Pressure Mattress and Bed for a grand total of 800.00 dollars per month this would be a thousand dollars a day in a facility. How about the people that cant swallow and are allowed to stay home with portable feeding pumps. My daughter was one of the patients. At the age of 4 she was diagnosed with Acute Myeloid Leukemia. She responded well to the chemotherapy but contracted fungal lesions in her lungs. Her physicians said that the longer she was in the hospital the larger the risk of more of these infections. She was allowed to go home with home health services. A nurse came every day and administered the IV drugs that she needed. She received TPN or IV food as well as antifungal and antibiotics. This all cost a fraction of what we were paying for the same treatment in the hospital. Why the sensational news stories of fraud without the common sense success stories of survival and savings. Don’t get me wrong there is fraud in all areas of Healthcare. Doctors, Hospitals, Nursing Homes, Home Health Agencies and Home Medical Equipment Companies all have a few rogues. But why is the value of Home Care never presented in the news and only the few fraud cases. CMS has made several good moves over the past few years running out the criminals. All Home Medical Equipment (HME) companies now have to be accredited. This costs about 16K per location and insures a CMS deemed accreditation body has gone completely through the company to make sure they are operating under a legitimate basis. It’s almost like an IRS audit. About 30,000 companies left the industry when this rule took place. My feeling is they had something to hide and needed to leave, though that may have not been the case with all. That leaves the rest of the HME industry. Despite the reports of gross overpayment we work off thin margins. An example being NBC's report on Home Oxygen Therapy, They reported that a oxygen concentrator can be purchased for around $600.00 but Medicare pays 165.00 per month to providers. So over the 36 month rental cycle the HME provider is paid $5940.00 They don’t tell you that these machines require monthly maintenance, the 120.00 round trip cost we discussed earlier, licensed Respiratory Therapist on staff 24 hrs a day to help patients, Emergency back-up bottles in case of a power failure and regular deliveries of soft goods such as cannula, tubing and connectors. It takes several hundred patients receiving this service from one HME provider before any profit is made. They also don’t tell you that the HME provider is responsible for providing service for the rest of that patients life even after the 36 month rental cycle is over. How much would a nursing home or hospital charge for a lifetime of oxygen? They would be more than $5900.00. Who benefits from the sensational stories, we all know. The Home Care Industry has been the scape goat for Medicare and Congress for too long. Home Care is a sensible, valuable savings for Americans. Many members of Congress have a deep respect for what we do. Usually there respect comes from experience with a family member that has received the services. The family member was able to live through their illness around family in a home setting or allowed to remain independent without burdening the family for constant care. Even the President of the United States has mentioned the value of Home Care after his grandmother’s death in Hawaii. I believe she was receiving oxygen therapy. There are many that benefit from kicking around the smallest recipient of Medicare dollars, but the media should let common sense prevail. The truth will set us free and save us billions of dollars

Michael Isbell