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Posts from the ‘general’ Category

Sep 21

7 Comments

Through the Eyes of a Nurse

 

hospice hands

What would you hold in your hands if you were asked to hold something that told the world all about you?

Elaine Zelker is a photographer who was working as a hospice nurse a couple of years ago and began to ask hospice patients and residents of long term care facilities that very question and photographed the responses.  I found one her photos on another website and immediately stopped everything to find out more about her.

The pictures are amazing.

I contacted her and asked if I could share on the blog and she graciously agreed.  She didn’t make it easy though.  Click here  and on the top you will see a link to her galleries.   As  you run your mouse over ‘galleries’, six options will appear.  The last one is ‘these hands….’.  Click it and sit back and be inspired.

After you have done that, come back here and tell us all, what would you hold in your hands that best described you.  Better yet, take a pic and email it.  I’ll post it.

Elaine is going to publish a book with this collection around the holiday season.  I will keep you posted on her progress.  I don’t know who would appreciate it more – a nurse working with the elderly or better yet, a non-nurse who doesn’t always understand a nurse’s devotion.

Kind of interesting that I just posted an entire blog about the work of someone I didn’t even know existed until a couple of hours ago.

NOTE:  I found the above photograph on another site.  I noted that Elaine’s photographs were protected and not downloadable which is a good thing for a professional photographer.  I was the one who put the tacky watermark smack in the middle of the photo.  Her website is free and clear of tackiness. 

May 14

11 Comments

The VA’s Dirty Little Secret List

A couple of years ago, I was in a client’s agency when a woman came in to ask about her father’s home visit schedule.  The case manager was confused because the gentleman had been sent to the VA hospital in Texas a few days prior and the agency had no idea he had returned home.

I pulled his chart while they were talking.  The nursing notes described a stasis ulcer to the lower extremity with wound care for almost a year.  The wound continued to deteriorate.  The patient had a physician at the VA clinic in Alexandria who took excellent care of the patient and worked together with the nurses to get the leg to heal.  It did not heal.  In fact, it continued to deteriorate.  The odor of rotting flesh was so bad that the nurses had to ensure that the windows were opened for their visits.  The doctor referred him to the VA hospital in Texas for an amputation.  After less than 24 hours, the patient was discharged because he had less than an ‘honorable discharge’.

The daughter explained that she finally found out that when father returned home from Viet Nam, he did not return a rental car in Washington DC.  He left it at the airport but forgot to turn in the keys.  Pardon me for being overly cynical, but I figured there was more to the story.  The case manager placed a call to the VA’s office in Alexandria and confirmed the story.  It didn’t seem to matter that he had been receiving VA benefits for years and did not apply for Medicaid when he was eligible because he was a vet and he trusted the VA system.  It did not matter that he had been disabled for years but he would not be eligible for Medicare until he had been on Medicaid for two years.

He was just a vet – a sick and damaged individual no longer of use to the country he served.

The hospital wheeled him out to the sidewalk and luckily he had a niece in Texas who came and picked him up and took him to her house until his daughter could make the six hour ride to Houston in a truck that did not start very often.

We called The Department of Health in TX and left a message.  The immediately returned my call but explained that they did not have the authority to survey VA hospitals.  She gave me a number to call and I called it numerous times for about a week.  I left messages.  The agency did the same thing.  Nobody was interested in the vet with the necrotic leg.

Now they have a secret waiting list that shows that veterans are waiting months for appointments but they altered their data to show that patients are being seen within the guidelines.  The wait time is horrible in itself.  The complicated steps to hide the list and create the appearance of compliance with the VA rules is nothing short of immoral.  My clients would be accused of fraud if they altered any records and I would be in the courtroom testifying against them if they allowed people to die and hid the evidence.

This type of disrespect for our veterans of war could only be the result of a culture that fires anyone who presents a problem.  Only in a system where individuals know that nothing they can do will ever make a change would this sort of thing happen.

Secretary Eric Shinseki has failed as a leader.  He has created a culture where it somehow makes sense to lie, cover up and let people die rather than report the truth about how our veterans are treated.  If this were one hospital or a dozen patients, I could believe it was hidden to him.  He had a responsibility to know about 40 deaths on his watch.  If he didn’t, it was because he chose not to know.

In spite of that, I do not want Secretary Eric Shinseki to resign.  I want to see him fired.  He does not deserve the dignity of being allowed to resign.   If the President wants to show any conviction regarding the state of our VA hospitals, he needs to step up to the plate and get rid of Shinseki loudly and publicly.

It isn’t enough for Eric Shinseki  that we send these young men and women to battle fields to risk their lives for our freedom.  It doesn’t matter to Eric Shinseki that a good many of these same men and women who make it back home are permanently scarred or broken because of the battles they fought for him.  The only thing that matters to Eric Shinseki is that he doesn’t look bad in the press.  He fires a couple of people and assumes the situation will go away because that is how narcissists handle problems.  They blame everyone else and sever ties with those that do not reinforce their inflated self image.  I would have had so much more respect for the man if he was as horrified as I was about the delays and set about working towards a solution instead of defending his image.  He should have stuck with making bad decisions about army fashion.

The toll-free number for the Veterans’ Benefits Office is 1-800-827-1000.

You can also go here to contact your elected officials and most government agencies.   I am running very short on time this week but I will take the time to email everyone I can about this.  I hope you do, too, because the who have been tasked with taking care of our veterans are an embarrassment to the United States.

Your comments are most welcome.  Please feel free to include a link to this post in your correspondence if you agree with it.  If you know anything that I don’t know, please share.

Jan 18

8 Comments

Your Rights as a Provider

It is not my desire to create drama but then again, I am not the one who took away your rights as a provider.

Your contract with Medicare is simple.  It states that you are qualified to perform services for home health and hospice patients and Medicare will pay you according to an agreed schedule.  Occasionally, they review clinical records and refuse to pay based on their assessment of your chart.  If you agree with their decision as is sometimes appropriate, so be it.  If you feel as though you disagree with their decision, you can appeal.

Sort of…..

Last week, I heard a rumor started by the National Association of Home Care and Hospice that the ALJ’s weren’t going to be docketing any more cases from home health and hospice providers.  I knew this could not be the case so I emailed Mr. Dombi at NAHC and he responded by sending a scanned copy of a letter from the Chief Administrative Law Judge, Nancy Griswold confirming this complete and utter lunacy.

For those of you who do not work in the world of appeals and do more important things like take care of sick people in their homes, let me explain this to you.

Imagine you did something else for a living.  Humour me and pretend that you are a roofer.  My insurance company who supplies 95 percent of your business  agreed to pay you to put a roof on my house and you did a fine job.   You shingled my home with materials that will withstand a category 5 hurricane and then you sent a bill and my insurance company politely declined to pay it.   Since the services were covered under your contract, the advance Roof Recipient Notice won’t protect you and I am held harmless while enjoying the sound of the rain on my new Cat 5 roof.

You take your complaint to the board of insurance and they tell you that you are right!  You did install at Cat 5 roof on my house but it doesn’t matter.  No payment is forthcoming.  Their reasoning is that in order to begin work, they had you sign a 30 page contract and on page 27, halfway down, it said that in order to be paid, you must initial the bottom of every page of the contract.  You only initialed 15 pages.

You decide the whole world of roofers and contractors has gone crazy and decide to take the insurance company to court.  The problem is there is no judge to hear your case.

So, I get the roof.  You get nothing and you have no rights.  The insurance company who signed a contract agreeing to pay you is sitting pretty with another satisfied customer under a Cat 5 roof and all you can do is work harder and faster to make up for the lost dollars.

That is exactly what is happening with Medicare appeals right now.  Payment is being refused for up to half of all claims at some MACs (e.g. Palmetto GBA, NGS, CGS) and you do not have any right to appeal denials past a certain point.  There is no person that you can talk to and you are completely unsure if anyone is actually looking at your records before rubber stamping  ‘denied’ on your claim. In short, they don’t give a flying flip that you had to pay your nurses or cover supplies.

When I work appeals, most of my work is done with the ALJ in mind.  If it’s good enough for them, it should satisfy the lower levels of appeals but often it does not.  The ALJ is the first human being that you can plead with to be reasonable. Except in desperate and extreme cases, the appeals process ends there.

Ms. Griswold confidently speaks to the increase in the number of denials being appealed but she does not speak at all to the increase in denials that are fully appealable or the rate of denials being overturned by Administrative Law Judges for the first two levels of appeal.   If the first two levels of appeals were performed competently, the workload at the ALJ would naturally fall as a byproduct of efficient, ethical and fair clinical reviews.

She makes a very valid point that the number of cases has increased overwhelming the ALJ’s but instead of addressing the huge percentage of denials that should have never been, she asks for ‘indulgence’.  It’s like pouring salt into a wound.

How dare Ms. Griswold ask for indulgence when almost half of the claims for home health have been denied by some MACs for grammatical errors relating to the F2F encounter documentation?   She wants to thank us in advance even though she has the responsibility to be well aware that her staff is ultimately overwhelmed due to the enormous increase in unfair denials.

I beg for your indulgence when I say that someone in Washington, starting with Ms. Griswold needs to have the courage to stand up for the good providers and quit playing political games with the healthcare needs of our elderly.

According to the HHS website, Ms. Griswold can be reached at:

OMHA Headquarters
1700 N. Moore St., Suite 1800
Arlington, VA 22209

Phone: 703-235-0635;   Fax: 703-235-0700

E-mail: Medicare.Appeals@hhs.gov

Make use of this information.  If you don’t speak up now, you may not be able to later.

Thanks to NAHC for sharing this information freely without regard to membership status. The content and sentiment in this post are mine alone and should not be attributed to NAHC or any other entity or person. 

Dec 18

2 Comments

The Best Christmas Present EVER!!!

Choosing the perfect Christmas present for a 13 year old girl can be a challenge.  One minute they want mascara and designer jeans and two hours later they want a new Barbie doll.  Ponies are always nice but not an option for most families and very difficult to wrap.   Still, most parents will go to the end of the earth and back to find that perfect gift for their daughters because they live for the shrieks of joy and overplayed excitement that consume a happy 13 year old girl.

Yesterday, one family arranged for their daughter the best Christmas present on the planet.  It is also the last present that they will ever give to their daughter and they will be without her on Christmas morning.  I don’t know anything else about this child or her family.  I wouldn’t have even known she existed until a friend updated her status on Facebook last night.

Liver.  Tonight.

My friend is married to the love of her life and has been watching him die a slow, lingering death of liver failure and knew that she would lose him if a transplant did not become available soon.

Three hours later:  ‘Surgery going well’.

Wanna know something funny?  I  have ever spent a lot of time with my friend except on Facebook and other social media.  And yet, somehow I wanted the liver to be perfect.  I have no dog in this race but I wanted a win more than anything.  This is not about me and somehow, it felt like it was.  All I know is that I was desperate for the liver to be a perfect fit.

Two hours pass.  ‘Surgery finished. New liver working wonderfully. Going to ICU now’.

Okay, I admit it.  I actually shed a tear or two but it was late and I don’t cry if anyone asks.  I was also a little confused and overwhelmed by how much someone else’s  liver transplant affected me.  That’s when I realized my FaceBook friend was wrong.  Nobody got a ‘new’ liver last night.  It was a slightly used model.

The used liver had the blood of a teenage girl coursing through it yesterday and for the last 13 years.  As plans are being made to lay her to rest, another family gets a fresh start.  Could anything be greater than a parent’s love for a child?  Could a parent love their child enough to set their grief aside for a minute to impart even more meaning the abbreviated life of their child?

You tell me.

A 13 year old girl received the gift of having the value of her short life multiplied countless times as her parents allowed her liver to go to another patient who has a family who loves him as much they love their daughter.

Earlier this morning:  He is slowly waking up

Merry Christmas, Baby.  Open your hearts and eyes and see that there is such a thing as boundless love and our gift from the parents of an anonymous donor is being awestruck if only for a minute by their infinite love for their daughter as she is laid to rest.

Please put a note on the thirteenth day of the next thirteen months to remember and honor this child and her parents.

Oct 16

10 Comments

Homecare vs Homecare

There is much philosophical talk about being divisive in our healthcare.  I don’t have a problem with being divisive.  This is my website and I can write what I want.  I am the senior editor – make no mistake. 

I do hold myself to certain standards, though and I think I may have fallen short on Monday and understated NAHC’s position on the Caps Limitation bill.   What I wrote was that both NAHC and The Partnership denied involvement regarding the introduction of the bill. 

In a nutshell the facts are:

NAHC – The organization that represents home health care and hospice on a national level has spoken out against the caps.   This is exactly what Bill Dombi of NACH wrote to me:

We do not support the episode cap and, in fact, have actively conveyed our opposition to Senate and House members.

The Partnership – A group of publicly traded homecare companies, plus a few stragglers, originally drafted the language in the bill but denies knowledge of how it was introduced.  This is what Eric Berger of The Partnership wrote in an email to me:

Like others throughout our community, the Partnership views targeted program integrity reform as a preferable alternative to further across-the-board cuts or the reimposition of cost-sharing that would impact innocent beneficiaries and their compliant providers. 

There’s only one sentence but if it were clinical documentation it would result in a denial.  Here are just a few of the questions it raises:

  1. Who are the ‘others’ in our community?
  2. Targeted Program integrity reform is what exactly?  Capping episode limits based on an arbitrary number determined by people who have never laid hands on a patient? 
  3. If there are innocent patients and compliant providers, does that mean that there are guilty beneficiaries?  Is that where the problem lies? 

As I stated in a post last week, there are some people who simply cannot write.  I cannot dance, remember?  The next email I received late Sunday night left no doubt about the position of the Partnership.  Again, from Eric Berger:

As for the Partnership’s plans with respect to this bill, we will not be taking any action on it — our total focus is on the rebasing and face-to-face regulations that pose a significant threat to our community. 

Initially, I was not going to make a big deal about this.  My concern is the bill itself – not The Partnership.  The members of The Partnership pay serious money to be a part of the elite group of companies that pay for lobbying efforts designed to benefit their companies.  Whether you like it or not, I do not believe there is anything illegal about it.   

So while it is very true that both NAHC and The Partnership deny having anything to do with the introduction of the bill, their positions on the bill could not be further apart.  I think that my original post would have been better if I had highlighted these differences.

Because honestly,  while I believe Eric Berger when he says The Partnership had nothing to do with the introduction of the bill, I worry about  his documentation skills.  He’s like a nurse who leaves the vital signs section blank and states the patient is stable.  We assume the nurse forgot to document the vital signs but it may be that the patient is dead.

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