Maggie's Farm

AND, BD, he'll only be 'splainin it to the bureaucrat between the hours of 9AM and 4PM, when all those folks aren't in the ED. Heh-heh, that'll cure those long wait times . . . and maybe that's part of the plan.

Had chats with a GI surgeon and a durable medical goods manufacturer today, neither of whom could understand any of the applause for The Annointed One's speech before the AMA yesterday (The doc doesn't belong to the org). All I've been hearing is, "If you think it's bad now, just wait!"

So, in parting, here's my favorite story of the week (and it's only Tuesday here in CT, USA: A man complains of abdominal pain, starts to vomit blood, off to the ED and hospital for a one week stay. Upon discharge, the man will be covered by Medicare (His care had been covered by Medicaid, up to that point, including homecare, hemodialysis, therapy for a stroke, etc.). The doc writes an order for Protonix (a stomach medicine, of which there are several similar ones available). The man goes home, daughter brings the prescription to the local pharmacy, and is told that the insurer (Medicare Part D) won't cover it. Now the man could find the service phone number on the back of the card and call and ask for the list of drugs that the insurer covers, but the card is missing. The pharmacist (Actually, several pharmacists from two different outlets tried) can't go into the computer and tell which one will be covered without triggering an order. The original prescriber is off duty, the covering attending MD hasn't returned calls or faxes. No one has responded with a prior authorization for this prescription, which might have to be repeated anyway on a monthly basis. The primary care doc will do anything he can to get the med to the man, but no one can tell him what to order (I finally solved similar problem for another pt by asking for three different prescriptions - it took almost two months.) Several days go by . . . The man is complaining of the pain again, so the daughter (A very poor family, I might add, with a chronically ill child = not much extra money) goes to the pharmacy and buys an over-the-counter, lower strength, similar product. Two days go by, the man is rehospitalized. You can't blame the original prescriber, because she has no idea who the insurer is, or what they will cover, without the magic card, probably lost years ago. Maybe this time they can try another med and hope that it is on the approved list. Oh, I forgot to mention: the Medicare Part D provider isn't the only one in on the act; it turns out that the State Medicaid office got involved and also refused the prescription. Wonder what the second hospitalization cost the taxpayers. Also, do you wonder what the price difference between Protonix and its competitors was? Surely, there isn't any cost involved in the many faxes, and phone calls between all the parties in the last week; after all, the docs and nurses and pharmacists have nothing else to do all day. I'll find out tomorrow what the man feels about all this (never mind, I know) - he feels trapped. None of us can wait for Obamacare, including the "public option."

I should blog these Medicaid/Medicare follies on a weekly basis, but I won't.

To follow on my earlier post to this topic, last week's winner (I need a name for this prize) was this:

One of our seasoned citizens had a broken down electric wheelchair, that stranded him outside last fall, at night, in a slight rain storm. No cell phone, no other traffic on the private sidewalk he was using to return from the store, oh, and no legs.

Managed to get Medicaid to pay for a new battery (a partial fix), asked a physical therapist for an evaluation, who then ordered a nice new chair for him. Six months later, in March, it arrived. It was defective, and very difficult to control, the vendor tried earnestly to fix it, it's being picked up to be returned to the manufacturer. Guess what the chair cost . . . the last one I saw a bill for was about $5K; this one was billed to the taxpayers at a little shy of $35,000!!

Not the end of the story. At the same time, the gentleman had complained that when he transfers from the chair to his daughter's car, only about one inch of the board rests on the car seat. He is a big, rugged, brave guy, but felt nervous because if he fell in a parking lot somewhere, his daughter couldn't help him up. Current board is 24 X 7 inches, so everyone agreed that a 35 inch long board would be just the ticket for car-to-chair surfing. The doc is poised pen in hand to write the order, only . . .

Medicaid won't pay for it. It costs $100. He can't afford it.

The safety specs for this piece of plywood are published, and if I turn my head just so, I can catch a whiff of non-skid wood finish drying, along with the nice homey odor of fresh sawdust (smells like safety to me) Maybe a nice new board will fall off the back of the truck at this man's apartment sometime soon, and the hell with the lawyers, Medicaid/Medicare, and the effin gummint.

Now what do you think would look good stenciled on the bottom of this thing?