BY: Karlene Stefanakos, M.A., CCC-SLP on Wednesday, 25 January 2012. Posted in All, Dementia, Speech Pathology

From all parts of this country of ours I hear the frustrations of chaos as the Medicare reforms are rolled out. Human oxidative stress levels are rising, company productivity levels are encouraging therapist fraud, and the patient is paying the freight with less patient care. The simple question is, “Can’t we ever transition change without chaos?” The answer is a resounding “No, because too many people believe in greed.” Not to be outdone on the bottom line profit margin, after an 11% cut in Medicare, the “healthcare business” is working the frontline professionals to unheard of stress levels, and then expecting perfection  in the  human endeavor of patient care.

So, here’s what is going on in rehabilitation areas across many companies.  Productivity levels are at insane rates of 97.5 – 100% . This means that in many companies, the therapist is “suppose” to be providing billable patient treatment units,  maximizing  reimbursement to their companies. Since documentation takes time, more and more therapists are documenting in the presence of the patient so they can bill this “patient treatment time”. The result is the patient receives less treatment. Physicians do this also. How many times have you gone to a physician’s appointment, and the doctor writes his notes in front of you, on his high tech computer, while you sit and wait, twiddling your thumbs? I remember the days when the doctor examined you, treated you, told you “you’re doing fine,” and opened the door for you to leave.  Then, he had a civilized amount of time to reflect and write a coherent summary. These productivity levels generate fraud in documentation since the productivity goal is impossible for the therapist.

Directors of Rehab (DORs) are in the squeeze position where they not only have to attend to their normal patient care meetings, budget meetings, interdisciplinary meetings, and therapist activities. Now, some of the companies have eliminated their rehab techs, so now the DORs are now doing clerk filing of daily reports, cleaning rehab departments, patient treatments, “justification” letters for denials (another form added in the reforms). Also, in too many companies the DORs are now being “Executively Micromanaged” on purchases of items required by rehab departments. No longer does the DOR have the right to order rehab supplies for their therapists without corporate interference and clearance on each order. Educated professionals now have to be micro-managed like children, or intimidated for corporate control.

Medicare B audits are increasing across the nation. Some companies feel that Medicare Part B denials “seem” to be automatic, since the swiftness of denials after submission of claims has significantly increased.  Some companies feel that RAC teams, who are not government employees, but non-medical accounting companies, are the major benefactors of these kind of practices since they  receive a percentage of the reimbursement funds they “return” to the government. I remember the days (and the movie) when HMO’s had an automatic denial system in place for their own financial benefit.

But, if therapists and nursing staff become nervous over service on a Part B chronic care patient, what does this mean for the patient – especially the  dementia patient?  If Part B claims remain a treacherous financial endeavor, this means that chronic care patients’ evaluations and treatments may start to decrease across the nation. This means that the most vulnerable elderly population of our nation may be compromised in the Medicare guideline areas of safety and quality of life.  Then, there’s just the daily hassle of daily schedule chaos – since no day is automated and standardized.

You know it’s always the little things - like a patient who soils themselves and then the therapist has to wait for nursing care, it’s a patient whose not finished with her meal, so you have to run around to find another person quickly to keep the productivity up, it’s how slow the patient moves, it’s a family visit requesting you return at another time, it’s a non-compliant patient. It’s a thousand “human” things that go awry while you are trying to keep a tight schedule to satisfy the RUG level minute requirements, or maintain your productivity level. It’s miscommunication between therapeutic disciplines because there is no time to communicate! Stress is up from the job, and then you go home to a family that needs a cooked meal, help on homework, baths, and then you drop into the bed only to get up to another battle the next day. Some days you wonder what  a real life is like. I travel to other European countries and see the peace of professionals on the job. I’m not a visitor to these hospitals and clinics, I’m working in these arenas. The contrast is like night and day.  When I come back to the U.S. it’s always a mindbender with the “newest regulations” which always seem to make things incrementally harder and worse for the patient, and all healthcare professionals. Sometimes I wonder if there isn’t an hidden agenda, or if we just don’t have anyone in Washington, D.C. that knows what they are doing? If you can answer this question for me, let me know. I wish you a non-junk food diet every other day, and more exercise to get through this battle called a “humanitarian job.”

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