Of The News, Knees and Judge Judy

By Larry Teren

The Harris Organization conducted a poll in August that confirmed the growing trend of people abandoning the newspaper for the Internet. 2,307 adults were surveyed and the results showed that of those questioned

10% cite the newspaper as their preferred method for receiving the news

36% mostly use the Internet as their primary source for news while

50% watch television.

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Physical Rehabbing is another Way of Saying “Hurry Up and Wait”

Everyone wants to be healthy and wealthy. If not wealthy, then have enough to at least stay even with the crowd. If not totally healthy, then at least enough to maintain a level of dignity and self-support as much as possible. Such are the dreams of those sleeping the night through in rehab facilities. “Hurry up and Wait” pretty much describes what goes on during physical rehabilitation as a result of injuries or surgery.

The rehab therapist sends an assistant to the patient’s room and rushes him or her via wheelchair to the exercise room despite whatever the beneficiary of the said workout is doing at that moment. Once there, the patient is told to wait while the therapist works with someone else.

The therapist finally focuses his or her attention to the said patient. He or she demonstrates for a moment or two what the patient is expected to do for the next few minutes but runs off to help someone else. After a wait of another few minutes, attention is again returned to quickly demonstrate another task to perform but off goes the therapist once more. Eventually the patient is wheeled out into the hall and told to wait until someone can wheel him or her back to his or her room.

Another type of ‘hurry up and wait’ is for the healing process itself. It can be a long duration depending on the injury to a broken bone and surgery to repair the damage. In Ma’s case, she fell and broke her left hip. That same night she had surgery and six weeks later, she sits in frustration at the rehabilitation facility. The other day she met with her surgeon who told her she was progressing fine but that six weeks was not enough time to heal back to her old self.

For one, older people have an issue with osteoporosis, which is a polite way of saying they suffer from soft bone tissue. Simply put, Ma’s bones break too easily and if she rushes the mending earlier than it should be, she runs the risk of re-breaking the left hip. Seven years prior, she fell and broke her right hip, had surgery and was back to her normal self- whatever that means- after two months. However, the break was not as thorough as this time and she was seven years younger and stronger.

The doctor also said magic words. “Look, Medicare gives you 100 days to get better on their checkbook. Take advantage of it as much as you need.” For her it means two weeks of putting at least 50% pressure down on her left foot whereas up until now it was four weeks of no pressure. She has used a walker during exercise time with the left heel down and her toes up. It is up to Ma to go about her business of proving that this next phase is a piece of cake.

After two weeks, it will be the sixty day mark from the time of the surgery. She will be able to try 100% weighted pressure on her left foot as well as walk stairs. The surgeon said that when she can put 100% pressure down, she can go home but that it would not be wise to do so if she cannot master going up and down stairs.

This obviously generates lots of frustration. She feels better than she did six weeks earlier and can do some things again but she wants total freedom. Who doesn’t? Healthy people take for granted that they can take care of themselves.

When I was sixteen and a half, I did a stupid thing- one of just many in my lifetime- and jumped over a fence that I knew had an eight foot drop to a cement floor. Naturally, I broke a metatarsal bone in my left foot which has never healed properly ’til this day. But, being 16, I was also young and strong enough to ignore the fact that I had done damage. Other than wearing a shoe with a wooden sole to act as a splint and cushion the pounding that walking did to the sensitive break, I went about my normal business. I even went to my high school graduation with that stupid wooden shoe. No cane, walker or crutches. I probably would do the same today. But if this were to happen twenty years from now, I suspect I would be grounded for several days as well as using a walker for a while.

That magic word- Medicare- helps soothe some of the pain for those in the same boat as Ma. American society decided that the age of 65 (or whatever it will be in the future) is the special passport to government financed medical care. The first twenty days after surgery, Medicare pays 100% for her recovery provided she is able to show an effort in cooperating with said recovery. After twenty days, Medicare pays 80% and the Medicare Part B co-insurer pays the other 20%. Ma has up to 100 days in a calendar year from the time of surgery to take advantage of all that Medicare will finance. If Ma stays in a rehab place for sixty days and then goes home, she can still return and use the other 40 days up to the anniversary of the surgery.

Once upon a time- sounds almost like a fairy tale, huh?- retired social security recipients were not asked to pay much at all for Medicare benefits. Now, each monthly payment they receive automatically withholds Medicare Insurance premiums. For some people this can be over $300 per month. That is a lot of money to take away from someone who is ending up with anywhere from $1400 to $2000 a month in social security money. And there are those like Ma who saw their social security money drop 40 percent when Dad passed away as well as lost Dad’s pension. The biggest slap in the face to senior citizens is that for the past couple of years there has been no increase in social security benefits due to the “Economy”. But there has been an increase in Medicare premiums withheld. Beneficiaries in 2010 are receiving less social security money in 2011 than in 2010. The situation does not look any better for 2012.

Rehabbing Medicare

There has been a lot of talk lately about the concern of severely curtailing Medicare benefits. Some of us who are years away from the curse of old age do not appreciate the situation. Medicare takes care of the rehabbing that a senior citizen endures in an authorized facility as long as the patient shows signs of improving.

Knowing this Federal largesse, everyone who recovers from hip or shoulder or knee surgery and bone injuries in general tries to get placed in the best care facility possible.

Ma was no different. She knew about the excellent rehab center three blocks from my condo and we lobbied with the social worker at the hospital to get her placed there. Luckily, there were several bed openings and for at least one week she had the pleasure of having the room to herself.

Another quirk in the Medicare laws apparently is that if one has surgery on the injured bone, Medicare will pay for two therapy sessions a day. Without surgery, the patient receives only one session. When two sessions are involved, one session covers some occupational and not only physical therapy.

Once the patient’s doctor and therapist agree that the person has plateaued, Medicare cuts off funding. At the place that Ma is at, this means that the patient is either sent back to their own residence or to a long term care facility in which chances are they will never be able to leave. This is because there are a percentage of facilities that recognize it is in their own long-term interest to keep the patient, now called a resident, there as long as they can.

Of course, not many people are able to pay the six to seven thousand dollar a month cost to stay at a nursing home. If they do not have long-term care insurance, which most people do not have, then they may have to apply for Medicaid, in which the State agrees to finance their stay but requires the patient to pay down all their assets befre getting assistance. This will include, of course, the sale of the house. Exceptions are made if a spouse is still living in the house.
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Why I Hate Hospital Corporations

Why I Hate Hospitals

I have a modest proposal to reshape the health insurance system. It takes away some of the burden from the insurance companies and places it on the individual but also gives the policyholder a saving’s edge. It is based on the idea that the real culprit in all of this are hospitals.

First, here is the plan and then I’ll go into why I believe this is better than the current modus operandi:

Category Age Category Insurance Premium Deductible How it works
Doctor Visits, Simple Tests, Emergency Room visits 35-44

45-54

55-64

1000,00 Dollars

1500.00

2000.00

(Self-insurance in a Health Savings Account

zero Individual uses up to the value of his or her premium for all outpatient visits by paying out of the HSA approved checking account. Once the HSA is exhausted, the Major Medical policy kicks in. The individual is then obligated to spend up to deductible until it is used up and then only pays 20% up to one million for the year.

If during the course of the year, the person does not use any or all of the HSA money, he or she may apply it to the next year, thereby saving them the need to again put aside extra money each year. They are rewarded for being fortunate enough to stay healthy.

Insurance companies lose out but also gain with not having to deal with the paperwork on the majority of medical visits.

Major Medical- Surgery, Expensive Tests, Procedures 35-49

50-64

2000.00 (paid to an Insurance Company)

3000,00

1000.00

1500.00

Individual is obligated to pay up to the major medical deductible and 20% afterward for all bills up to one million dollar cap for the year. At cap, insurance company pays 100%.

Hospital organizations must also be required to drastically lower billing amounts. It is outrageous and way out of line. They do a lot of unneeded extra testing and then charge an outrageous amount for little time spent taking the tests.

Not too long ago my doctor insisted that I take a CAT scan. Correction- two cat scans, because the area of the body being scanned required two passes. I spent a total of twenty minutes going through the doughnut . The insurance company was billed over six thousand dollars for these twenty minutes of service.

The dye that they made me drink to prep for the test cost five hundred dollars! The insurance company thought that this was fair. Each scan was billed at $2800. The insurance company responded to the bill with, “not so fast! We have a network (translated, a wink and a nod) agreement where you accept our negotiated rate. This brought the price down to $1400 each. Big deal! After using up my $1000 deductible for the year, I was still stuck with paying over one thousand four hundred dollars for an outpatient visit that took less than a half hour.

I called the hospital and asked to get the price reduced. They said that at best they could do was to lower it by ten percent or ask to fill out a financial aid form. I wasn’t about to be insulted by filling out such a form, so I took the discount but then asked for the right to pay it off in three installments. The customer service agent told me that she would not allow it- either pay the full amount in twelve monthly installments, or take the discount. I told her that the hospital already received a more than thousand dollar check from the insurance company on my behalf. It was not as if they were relying only on my payment to make a profit on the deal. I asked to speak to a supervisor. She transferred me into the voice mail for a higher echelon person. He returned my call on the next business day and was equally hesitant to offer compromise. He finally told me he was doing me a great personal favor to allow me to pay the bill off in three installments while also taking the ten percent discount.

There should be only one price for a procedure regardless if a person has insurance or not or whether they are in the insurance network. Period. And the price should be regulated by an impartial group that is not beholden to the hospitals.

I recognize that some of the dollar figures listed above may need to be adjusted for practicality. Paramount, though, is that we need to put intelligence and incentive back into health care decision-making for all parties involved- the patient, doctors, insurance companies and hospitals. Otherwise, we mind as well close down the hospitals and let the healthiest survive to the next generation. It will cut down on the price of gas as there will be less people who own cars.

Warning: Hospital Bills Can Be Hazardous To Your Health

Not too long ago I was eating a heavy supper at 5:00pm. Being a quick eater, I was sitting in the living room trying to stay awake while reading a book at 5:45pm. As usual, I started to doze off and could not fight it but kept to as much of a sitting position as possible on the sectional sofa. An hour later around 7:00pm I awoke feeling a heavy pain in my stomach and chest area. I attributed it to not allowing the food to digest properly.

I endured the pain laying in bed and reading, eventually falling asleep for the night. The next morning I felt much better. However, that evening the pain came back with a vengeance and lingered over the next couple of days. I informed my doctor who recommended that I come in for an examination. His probing hands confirmed that there must be something wrong but it was not what he initially thought as the pain was centered elsewhere. He therefore recommended a cat scan- two, in fact. I found out later that it was common to do the two as they are very much linked.
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