Medicaid. Is it being abused? - page 13

Medicaid was a great idea when first introduced to assure that even the very poor could get quality health care. I just wonder when I see someone drive up in a newer car come up to the triage desk... Read More

  1. by   grannynurse FNP student
    Quote from hipab4hands
    s. I just want people to recognize that there are reasons, some of which may be very silly but they are reasons. And it is not anyone's place to judge.
    Grannynurse
    Sorry, but I have to disagree. Whoever is paying for those non emergent visits to the ER , either through public assistance or private insurance, has every right to judge the appropriateness of the visit.

    In the end, all of us pay for these high costs- these services are not "free". We all pay for these visits through higher taxes/ higher insurance premiums/ and cut backs in other benefits or services. Unfortunately, most people have not made this connection.

    I would love to see an Universal health system take place here in the US, but until then, we need to carefully use and monitor the use of our healthcare dollars.[/QUOTE]

    Yes, those that pay for a visit have the responsibility and the right to question an ER visit (SURPRISE). By those who pay, I mean the health insurance provider, not the tax payer, not the nursing staff, not the physicians, not even the facilities business office. And I hate to tell you this but the inappropriate ER visits are not the reason for higher taxes/higher insurance premiums. The rise is do to a number of reasons, including expansion of facilities (yes, captial construction is factored into public expenditures); over proliferation of specialized equipment, such as MRIs and CTs scanners (in the space of two blocks, we have four MRIs-two hospital based, two free standing, and no need for that many); specialized units-such as burn units, trauma that are frequent money losers but look good on the website; to name a few of the other causes.

    As for the tax payers, i.e. the ER nurse responsibility, I have experience in that area as well. I worked in NYC, for the NYS Department of Health, as a fraud and abuse investigator in Medicaid. Do you know who the greatest abusers were? The facilities and individual physicians. A Mom might bring in her littlest one for a temperature but have to also bring the three other off-spring. Before she left, the other three and herself would have been seen, had bloods drawn, x-rays, and all on the bases of referrals from the original physician. And it would have been presented in a manner to make the Mom think there was something wrong with herself and her other three children. Granted, this happen in the 70s but it continued to happen through this past year. I kept in touch with some old co-workers and they continued to make the same complaints about the same abuses, through this past year 2005.

    I also worker as an Administrative Assistant in a major teaching hospital, in NYC. We were fined $5,000,000 for keeping a group of peds patients as acute, when they should have been in chronic care. I was warned, by a former co-worker, that they were looking into the problem. I warned the Chief Administrator. Imagine his surprise when my former peers visited, recommended the fine and it was actually taken out of his operating budget. You see, we were also a state supported insititution, something he thought would stop the fine, but it didn't.

    And the comment about non-emergent visits not being covered, that is slightly incorrect. If an insurance company refuses coverage, which is very infrequent, the facility can still go after the patient for payment. And, in today's climate, they do with a vengeance, go after the patient. At least once a week I get a telephone call from the business office demanding higher payments. I am threaten with it impacting on my credit rating-haha and/or being turned over to a collection agency-I'm really scared They get what I can send them and if they don't want it, that is their problem. I have other bills to pay.

    I too would like to see universal health care but it is highly unlikely to happen. Out health care system is not set up to make it happen. We do not pay for our physicians education, nor our nurses. We do not support a unified health care system or coverage. Our health care facilities wage war on each other to get the monies available.

    Grannynurse
  2. by   MicheleNursStudent
    .
    Last edit by MicheleNursStudent on Mar 21, '06
  3. by   mercyteapot
    Care providers certainly have the "right" (responsibility is a more appropriate word, IMO) to ask an asthmatic if they smoke, etc. when the answer to that question affects treatment in any way. Joe Q Public does NOT have the right to "judge" the appropriateness of a Medicaid recipient's medical visits. What do you think privacy laws are for, anyway? As a taxpayer, you have every right to vent about the cost of Medicaid in general, and to lobby for changes. You don't have the right to know specifics of any particular recipient, though.
  4. by   grannynurse FNP student
    Quote from ednurse17
    Your level of triage would definitely be a level 2, most urgent. I would take you before all the others if you were sitting in my triage area. Unless we're really busy we don't have people sign in, when we do, they do not list their complaint. My triage LPN quietly goes to the patients and assesses their needs. If you are struggling for a breath, you won't even be triaged, you'll be taken straight back to a room, a hall bed, somewhere quickly and treatments will be started. I do understand why some hate to be triaged, for whatever reason, its just important to the doctors that they know what the complaint/problem is so that they can better treat the patient. They need to know what meds you're on, your allergies, your medical conditions. We wouldn't want to jeopardize your health by NOT knowing something. I do understand the need for privacy. I wouldn't want to broadcast to everyone my reasons for being there or at the doctors office. Its the same anywhere you go. When you call your dr. office to make an appt, they ask you why you need to be seen. At least mine does. I would much rather you utilize the ambulance service than someone who uses it for a stumped toe. (yes, I have seen that one too) Your condition warrants it if needed. The others just don't have a ride, out of gas, etc. Yes, times and people have changed alot in 15 yrs. I can only remember one time I ever used the ER. I was 18 and had been vomiting for 2 days. My father couldn't take it anymore, he drove me there, we waited 4 hours to be seen. The same ER I work in now. But times have changed for the better too. We don't make those wait long or at all if we can put them somewhere, get a line started and give them something for their nausea. Next time that you do have to come into your ER for breathing difficulties, tell someone, security, a nurse, a volunteer, anyone. I promise you'll be seen quickly!! Sometimes the triage nurse is busy with someone else and can't look up at the moment you walk in. Trust me. It works!
    The situation you discribe use to happen when the facility had its old ER. But with the new one, which has been in existance for 18 months, I will not seen the traige nurse until she/he calls me. They are in a room with a closed door, not accessible by patients, really. And apparently there have been problems, according to some of the ER staff, with inappropriate delays. Steps are being made to correct the situation or so I am told. I carry a few 3 by 5 cards which lisit all my medications, including PRNs, dose, and frequency, plus relevant medical and surgical history, which I give to the first nurse I see (which reminds me, have to add my newest medication). Once I am taken back, I get the needed treatment, a line put in, bloods drawn, nebulizer treatments, placed on a monitor, chest x-ray, then the long wait for a bed (darn, darn, double darn).:angryfire

    I hate riding in a rescue squad. It brings out all our neighbors.:hatparty: It also brings a rescue squad, the fire truck and at least eight firemen into our rather small house. And it would wake up my three grandkids, something I don't like to do. And it generally takes them 7 to 10 minutes to arrive, by which time I could be half way to the ER. And for some reason, I've always had the luck to get the newest paramedic, who has trouble putting a line in. And I grin and bear it-ouch, ouch, ouch. I know I should call 911 but I will resist unless I am unable to drive.

    Thanks for your comments and thoughts.

    Grannynurse
  5. by   LeahJet
    Quote from grannynurse FNP student
    I use the same ER for all of my medical problems. Since the hospital changed the location of its ER and the doors to the treatment area are locked, unless one arrives via EMS, they must be triaged, after they have signed in and listed their complaint. I hate it.
    Oh, but I love it. Locked doors mean a safer environment for the staff. It means crowd control is no longer a huge issue. I can spend more time giving you the optimal care you deserve............
  6. by   ednurse17
    [QUOTE] have to have sinus surgery soon. I hate to admit, being on Medicaid concerns me. I am honestly scared that I will be treated worse, less pain control, etc.

    I understand that need to vent. I also understand that many Medicaid patients can be annoying.

    Please though, from a nursing student on Medicaid...judge people as individuals, not entire groups.

    Also the tremendous shame that comes with being on Medicaid does contribute to some people delaying treatment. I wish some would think about that before they make snotty comments about Medicaid patients. You have no idea how it may affect those listening. It's like death by a thousand cuts, all the comments
    I certainly would hope that your surgeon/nurses wouldn't withhold pain medication or that the surgeon would do a half a** job on your surgery. In our facility, doctors do the same for a ruptured appendix or a broken bone or a deviated septum regardless of insurance or not. Bottom line, that's their medical license. If someone comes in our ER having a heart attack... we'd do the same protocols, the same treatments regardless of whether you're insured or not. When a patient hits my area, I treat what's going on... if you're an asthmatic, you're gonna get the same nebs, the same solumedrol, the same blood work, same O2. I don't look at their demo sheet except for their name, to go pull meds from the medselect or tell respiratory Mr. so and so needs a blood gas. Being from the south, we're often accused of calling everyone sweetie or honey, well, that's just our nature. Sweetie, speaking for my ER staff, we're not talking about you just cause you have medicaid or even self pay, we're talking about the same ones who come in night after night, with the same problems, who after being referred, had appts set up for ultrasounds, cts, labs, doctors appts, don't follow through on those. We have a local man who has a drinking problem, comes in at least once or twice a week, wants detox. We follow detox protocols, let him sleep off his alcohol, feed him, call mental health for a consult, only for him to wake up, eat and then just disappear out the ambulance door. He does it everytime. He loudly professes to anyone who'll hear, I need detox cause I got medicaid, I need an ambulance, I got medicaid. Well, he's exhausted his privileges with detox, no one will accept him now. The only place we can send him to now is a state facility 1 1/2 hrs away. He doesn't like that place, he tells us, he wants to go to so and so cause they are nice. Well, so and so says he can't come back cause he just leaves once he gets there. That's not our decision, that's theirs. THOSE are the ones that drive us nuts. And I'm here to tell you, you can have the best insurance money can buy and still be a butthead. Broke or rich, attitude is attitude. We had a 80-something little lady come right before christmas, who went into flash pulmonary edema at home, she got to us... she was in v-fib, we started our ACLS protocols, intubated, shocked, meds, we did everything. Finally got her back, worked on her for 1 1/2 hr. In the meantime, a patient came in with a UTI that she said she'd had for the past four days. We put her in a room, started a line, obtained UA and labs and told her that the doctor was in the middle of a very serious code and that he would be with her asap. Her husband came out of the room after about 30 minutes, demanding to see the doctor. The doctor just so happened to be coming out of the family room after talking to the little lady's family and he overheard him demanding. He followed him into his wife's room, and came out after about 5 minutes, face red. We told the husband that the doctor was in the middle of a very traumatic code and he didn't care.... oh did I mention that this man was a preacher? I really wanted to take him back behind the trauma curtain and let him see our ER doc putting in that chest tube cause she had a pneumo, our charge nurse doing compressions, our resp tech bagging, wanted to say, why don't you pray for this lady?? He didn't care. He was more concerned that his wife who had ample opportunity to go see her primary physician in the past 4 days, wasn't see as soon as she hit the door. Hello????? Yes they had insurance, so you see? Which would you rather us have done? The traumatic code or giving some vicodin and pyridium to someone who burns when she pees?
    Last edit by ednurse17 on Jan 7, '06
  7. by   ednurse17
    [quote=ednurse17]
    have to have sinus surgery soon. I hate to admit, being on Medicaid concerns me. I am honestly scared that I will be treated worse, less pain control, etc.

    I understand that need to vent. I also understand that many Medicaid patients can be annoying.

    Please though, from a nursing student on Medicaid...judge people as individuals, not entire groups.

    Also the tremendous shame that comes with being on Medicaid does contribute to some people delaying treatment. I wish some would think about that before they make snotty comments about Medicaid patients. You have no idea how it may affect those listening. It's like death by a thousand cuts, all the comments

    I certainly would hope that your surgeon/nurses wouldn't withhold pain medication or that the surgeon would do a half a** job on your surgery. In our facility, doctors do the same for a ruptured appendix or a broken bone or a deviated septum regardless of insurance or not. Bottom line, that's their medical license. If someone comes in our ER having a heart attack... we'd do the same protocols, the same treatments regardless of whether you're insured or not. When a patient hits my area, I treat what's going on... if you're an asthmatic, you're gonna get the same nebs, the same solumedrol, the same blood work, same O2. I don't look at their demo sheet except for their name, to go pull meds from the medselect or tell respiratory Mr. so and so needs a blood gas. Being from the south, we're often accused of calling everyone sweetie or honey, well, that's just our nature. Sweetie, speaking for my ER staff, we're not talking about you just cause you have medicaid or even self pay, we're talking about the same ones who come in night after night, with the same problems, who after being referred, had appts set up for ultrasounds, cts, labs, doctors appts, don't follow through on those. We have a local man who has a drinking problem, comes in at least once or twice a week, wants detox. We follow detox protocols, let him sleep off his alcohol, feed him, call mental health for a consult, only for him to wake up, eat and then just disappear out the ambulance door. He does it everytime. He loudly professes to anyone who'll hear, I need detox cause I got medicaid, I need an ambulance, I got medicaid. Well, he's exhausted his privileges with detox, no one will accept him now. The only place we can send him to now is a state facility 1 1/2 hrs away. He doesn't like that place, he tells us, he wants to go to so and so cause they are nice. Well, so and so says he can't come back cause he just leaves once he gets there. That's not our decision, that's theirs. THOSE are the ones that drive us nuts. And I'm here to tell you, you can have the best insurance money can buy and still be a butthead. Broke or rich, attitude is attitude. We had a 80-something little lady come right before christmas, who went into flash pulmonary edema at home, she got to us... she was in v-fib, we started our ACLS protocols, intubated, shocked, meds, we did everything. Finally got her back, worked on her for 1 1/2 hr. In the meantime, a patient came in with a UTI that she said she'd had for the past four days. We put her in a room, started a line, obtained UA and labs and told her that the doctor was in the middle of a very serious code and that he would be with her asap. Her husband came out of the room after about 30 minutes, demanding to see the doctor. The doctor just so happened to be coming out of the family room after talking to the little lady's family and he overheard him demanding. He followed him into his wife's room, and came out after about 5 minutes, face red. We told the husband that the doctor was in the middle of a very traumatic code and he didn't care.... oh did I mention that this man was a preacher? I really wanted to take him back behind the trauma curtain and let him see our ER doc putting in that chest tube cause she had a pneumo, our charge nurse doing compressions, our resp tech bagging, wanted to say, why don't you pray for this lady?? He didn't care. He was more concerned that his wife who had ample opportunity to go see her primary physician in the past 4 days, wasn't see as soon as she hit the door. Hello????? Yes they had insurance, so you see? Which would you rather us have done? The traumatic code or giving some vicodin and pyridium to someone who burns when she pees?
  8. by   grannynurse FNP student
    I do understand the need to vent but I do not understand the need to make gross misrepresenttion of those on Medicare. And I appricate the need of staff to take part in a CODE and that patient taking precedence over others. But I also understand the reasons for the patient's husband making his demands. The most important thing to him, is his wife's care. And like it or not, he is unconcerned with the needs of others. And the patient that has burning upon urination, again her problem is her major need and focus. And she has little or no insight or knowledge of the more pressing needs of others. Most patients, despite the preceived notion they are more knowledgable, focus on their own needs. It is only human nature. And it appears to be the part of nursing education that many have forgotten. Many seem to focus on the annoying aspects of patients on Medicaid and neglect the reasons for their annoyance. I guess it is just human nature.

    Grannynurse
  9. by   irishnurse67
    I
    Last edit by irishnurse67 on Apr 17, '06
  10. by   MicheleNursStudent
    Quote from irishnurse67
    I had a pt today who wnted me to get the MD to write a script for a nicotine patch. I told he "Oh no honey, you don't need a script for that-you can buy it over the counter!" She told me she knew this but if the MD gave her a script, then Medicaid would pay for it and it would be free (free for HER, I think she meant!). I told her that the patch would be MUCH cheaper than two packs of cigarettes a day. She didn't ask for the script again. I should've told her to do what I did-quit cold turkey!

    P.S. I know, I know-- I gotta stop calling people honey and sweetie--just can't help it--can't help but form a liking to most of 'em. Gotta admit, for every one we can't stand, there are a bunch we love!
    Well sure she didn't ask for the script again -- you shamed her.

    The federal poverty level for one person is $798 per month. This is the eligibility cutoff for Medicaid. The cost of at OTC item is the world when you live on that.

    I say shame on you. It's not your place to decide you don't want her to have something that her benefits cover. Shame on you.
  11. by   grannynurse FNP student
    Quote from irishnurse67
    I had a pt today who wnted me to get the MD to write a script for a nicotine patch. I told he "Oh no honey, you don't need a script for that-you can buy it over the counter!" She told me she knew this but if the MD gave her a script, then Medicaid would pay for it and it would be free (free for HER, I think she meant!). I told her that the patch would be MUCH cheaper than two packs of cigarettes a day. She didn't ask for the script again. I should've told her to do what I did-quit cold turkey!

    P.S. I know, I know-- I gotta stop calling people honey and sweetie--just can't help it--can't help but form a liking to most of 'em. Gotta admit, for every one we can't stand, there are a bunch we love!
    While you may feel justified in your comment to the smoking patient, I tend to view it as a missed opportunity to help someone take the appropriate step towards quiting her nicotine addiction. And I use the word addiction because it is a physical addiction. I guess to some, it is more important to save a few of the tax payers dollars. It will show up in higher costs, when the patient begins to suffer from COPD or cancer, now will it not?

    Grannynurse
  12. by   grannynurse FNP student
    Quote from MicheleNursStudent
    Well sure she didn't ask for the script again -- you shamed her.

    The federal poverty level for one person is $798 per month. This is the eligibility cutoff for Medicaid. The cost of at OTC item is the world when you live on that.

    I say shame on you. It's not your place to decide you don't want her to have something that her benefits cover. Shame on you.

    I wonder how many of those that begrudge the covered medicaid benefit, use their own health care coverage to obtain their patches? Kind of reminds me of those who question someone else rights to a given service, one which they freely use.

    Grannynurse
  13. by   MicheleNursStudent
    .
    Last edit by MicheleNursStudent on Mar 21, '06

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