The new year has blown in with an unkind surge. Along with the trite old custom of “New Year Resolutions”, the roll-over of a new Medical Policy renewal period has taken place. That’s right people, brace for impact. Your outrageous and infuriating new year deductibles, copayments, coinsurance, prior authorizations requirements and newly unlisted 3rd Tier prescriptions have sliced into your monthly income. Alert all ERs and Trauma Centers a mass casualty event has occurred due to financial crashes. On second thought don’t bother calling the ERs and Trauma Centers, I can’t afford my ER copayment and deductibles, I will just push my bleeding spleen back in and wrap it up with Duct Tape.
After I try to write down the license plate number of the Congressional truck that ran me down, I am going to file a police report. I can’t do that? Well, why not? I can’t sue Congress for failing the American people? Nope so let me do this instead. Share with you some insider facts, I almost wish I didn’t know most days.
What do you call a collective hive mind in which regular people’s needs are ignored? How would you describe a system of behavior that permits defrauding others of life-sustaining medical treatment? Sad to say that outlines the current state of our Congress’ in the sheets relationship with the corporate medicine, pharmaceutical corporations, and insurance giants. The secret kickbacks and post public office employment offers, slinky black-ops like agreements that create hardship and intentional inflating of prices all to keep the good ole boys comfortable. Much like the bashing of Net Neutrality, designed purely out of greed and artificially developed utility need. They litter our American streets with the desperation of most families struggling with health issues.
What do you truly know about the direction the White House is attempting to take healthcare and their chronic inaction to take down Healthcare Related Industries abusing facets of the business? I typically say, follow the money, all the way to the posh real-estate on a lake somewhere. Follow those dollars to the institutionalized financial waste, layered in broken policies, practices, and indifference to what is best for patients.
If your current health insurance is obtained through your stable employer, then you have experienced premiums and copayments climb, and deductibles increased. Trying to predict, when and how much your premiums and copayments will increase is nearly impossible. But one thing is clear, both will continue to climb fast. Making each of those alarming, difficult to budget, and frustrating to be subject to. There is no sense of fairness or conscience.
In my professional career, I spent hundreds of hours extensively researching the statistics of my hospital’s performance. Endless hours establishing, creating and brainstorming ways to ensure all Joint Commission criteria was meet. Not only met but outperformed. It was and continues to be a sincere passion. But now I also engage in it with the perspective of patient and patients Mom.
During my years I tracked everything from how many babies contracted MRSA in the year, to total numbers of unverified CODES occurring in Fluoroscope procedures. Dozens of everyday outcomes most people care nothing about. But insurance companies, risk management and each health systems CEO and CFO’s do. When I say that 2017 saw all-time highs of directed medical product waste, I mean it.
Let me provide some examples. My son required multiple Port Cath testings. When a central line port appears to fail, have difficulty being accessed or patient reports of unusual pain. The go-to action is order that test. Doing so required heparin locks, basically making sure any hiding clots are destroyed before flushing them directly into the heart. Why is that worth mentioning? Every central line port is done through sterile field procedure. Every item is sterile, needles, mask gloves, and the bottle the sterile needle touches to the sterile bottle of heparin itself. After all, is done, the needle is discarded safely, the nurses are expected to then throw out the entire bottle of heparin. That bottle can hold nearly 100 doses, depending on size.
Into the trash, the useable product goes, still completely sterile, but fat gutted or well-chiseled abs of overpaid CEOs and CFOs tend to focus on how to avoid fines and lawsuits. Not necessarily because they are staying up losing sleep fretting about medical errors costing lives or worried about the micro chance of infection spreading during a port procedure. No, they throw out an $800-$1500 bottle of heparin worried a cross contamination will cut their bonus when unexpected lawsuits go bad… Who absorbs that cost? You, and I do. Oh, the insurance companies whine and complain as if they are victims. Hospitals complain they are being stripped dry of funding due to insurance claims and drug companies. We, the consumers of medical services absolutely are bleeding out salaries as we also are hanging butt out in the radiology department about to drink a third bottle of contrast, too. We are paying to be sick and I am absolutely sick of paying.
Here is a sticking point. If healthcare systems, mainly upper Executive levels, were truly bleeding dry as claimed, they would flood Congress with great urgency, stocked with facts. But even they know a lost cause and instead of wasting energy on unreceptive Congressional staff, they gut services, use crappy products in the hospital, put unreasonable restrictions on medical staff, and hand to the public, twice the price they pay behind doors.
What I can’t figure out. What does not add up, is where is the outrage from our Representatives and Senators. Does Congress care more about their slice of pie? Or are they obsessing about how big the pie is in the first place? Literally a case of them having cake and eating it too. I would love to praise my Congress for taking down greedy pharmaceutical companies that rob Americans. Not as much in the UK, because those countries have greatly shortened those leashes and tied them to very costly poles. I want to celebrate strict policies with accountability attached, forcing Health Systems to reveal their cost versus what they charge. Laws should govern how much they can charge and of what quality of products should be used on patients.
Here is something that should make you angry. When my children are in the hospital. Very rarely does the inpatient pharmacy carry their actually prescribed medications. At a time when my children are already in crisis, they want to start swapping out drugs with unequal substitutes. It’s a big deal to do that because generics are not necessarily as effective and have different bonders than name brands typically do. Such shortfalls have immediate affects and complications. If your child developed inpatient complications, are they due to the crisis causing admission or additional ones because drugs were carelessly switched. To avoid potential problems and unnecessary lengthened admission I am forced to bring my home supply of medications to protect against such issues.
But, and this is a huge but. Often the Drs just hurriedly write the orders, with little regard to what is being used from home. Sometimes that’s due to simply repeating what has been a regimen from home, other times its because they already know the hospital will use what is cheapest and it’s not worth a conversation to the family, and sadly, maybe the minority of physicians, there is a disconnectedness to the sensitivities a patient has. Especially if your hospital uses in-patient hospitalists, who know nothing of you outside that one specific admission. Hospitalists physicians employment is a discussion for later, but they are a factor in the larger landscape of how politics, corporate and government affect your care.
In regards to Home medication supply. It must be authorized by an in-hospital pharmacist. Even though one did that at the retail pharmacy you use. After they do their part and reliable your child’s drug. They hand it back to nurse. I advise you not permit the nurses to take a home supply out of room to their dispensers. Why? Well, too many times ours and other patients go missing. You won’t get it back once that happens. And you are out of luck once you get home and need it, as your insurance won’t pay for it again because the hospital lost it. (Pro-tip, if you know this tends to be an issue during admissions, count out only what is needed and leave the rest home. Ask your retail pharmacist for duplicate bottle and label). I also learned, when examining our fees on the bill, charges appear for the drug I supplied in the first place but at nearly 4x the cost. It is straight up fraud.
To avoid that you must make the nurse go into chart system and take off the drug with notice patient supply. If you are tending to sick children, it’s unlikely you will catch all that. And the hospital systems know that. So the drug the physician ordered creates a charge, the system sees it as an ordered prescription. Many nurses do not bother taking the time to notate chart to prevent charges. There are no effective regulations policing such errors, none that stick.
This is where political health could and should be pro-active. Congress and sometimes your local state level, does not force healthcare systems to send or provide proof of inventory used in their billing. In fact, if you ever miss a dose of medication during a stay, or refuse it, that charge should not appear in billing. In NC, at least with Carolinas Healthcare System currently, does not even provide Medicaid patients a bill. Because the patient is not paying for it, they don’t bother communicating charges to you. However, how does state Medicaid know if the charges are valid? You the patient, or parent will be the only source of validity, but you are cut out of the exchanges, fraud is a simple unchecked keystroke. Oh yes, you can demand a bill, but it is a hassle. So much fraud drains the system, lines the pockets of the wealthy and causes the cutting of more expansive services desperately needed by families. For some reason, the bias that Medicaid families are ill-educated or ignorant of how things are done creates supported indifference. If there are regulations intended to prevent this, they absolutely are not being adhered to and no consequences placed upon offenders. Our elected officials should tackle that instead of cutting services incensed about cost created by sick people. There is excessive sickness, not all in the form of suffering patients.
Corporate medicine is a far cry from health services. They are not at all interchangeable in delivery, content nor approaches to care. ANything corporate is indifferent and distant. Forget that and you will pay the price in more ways than one. So I ask, where is the outrage from Congress. The crackdowns they proposed is in sweeping cutbacks when so much cost can be saved by simply forcing the insurance companies and corporate medical systems to prove costs while providing patients the ability to closely examine itemized charges for the entire admission. And when you get a ton of things to sign off during admission often they slip in so many clauses, your rights are given and taken away in the same form. Split billing, multiple agencies that send bills for the admission mean the patient/consumer must be organized and make sure all the charges line up.
There is a very well established political system within corporate medicine. Government officials decide how many hospital beds a hospital can have. It is all scripted into your state law. Did you know that a medical system can’t just build a hospital because they have an overflow of patients needing care? Systems claw and fight each other in State Capitals clamoring for your money and you have little to say about it unless those conversations begin with your elected officials. The public is not informed, educated or even invited to the table. Corporations lobby politicians and politicians make private back room campaign promises to those specific systems, each ensure they get their heaping pile of funds.
Political Health is a big deal and with ObamaCare being endlessly attacked and dismantled, you and I will face greater and more fortified medical systems who secure their well being above ours. Is it any wonder, why co-payment, premiums, and drugs cost are out of control? I remain hopeful with more awareness, the right conversations between the correct parties will happen. As for now, they are not happening and it is a problem.
There is something wrong when I have had to request the entire medical record of an admission to compare to an itemized bill to reconcile what charges are truly legit. Did my children really receive 14 IV infusions, or did they miss dropping the charges for the 4 infusions never given as the pharmacy was so late sending it up through pixis, it was not safe to administer so close to the next scheduled dose? Nurses notes will indicate that, whereas a bill just lists it. It is infuriating and cumbersome to keep the system, hospitals and drug companies honest. Honestly, for one lone Mother, creating accountability is impossible. It will take Congressional powers who care to be involved the right way to rectify these issues.
How do you brace for that type of impact? It’s like a hit and run crime, where your personal medical vehicle is totaled but the offending party takes off without a trace. The crime is there but the only person left to punish ends up being you. In the case of my household, my children and I suffer greatly. These powers fighting over control are not sitting bedside watching the suffering. In fact, recently a doctor I once respected shocked me with expertise in indifference once their decision making was questioned when colleagues did not support clinical decisions being made. All attempts to create awareness of this physicians behavior failed. I was disappointed that open conversations were not engaged and all of the events were kicked off by the State Medicaid system watching medical claims and diagnosis afar not add up. Money and politics touch all of us no matter how hard we try to avoid it. Personalities, shortcomings, and bias bleed their way into how we seek, receive and administer medical services. Just as Government bleeds into how corporate medical systems behave with their patients. Know what is driving the vehicle your in. Its a crime when egos hurt patients and none of us are immune. Not identifying the trends in interactions certainly leads to deceptions on many levels and it starts at the top. So if we can’t get a handle on the politics in healthcare, our bracing for impact becomes harder to do.
Forgiveness should be sought out by many providers who fail to do the right thing because morals lose out to pride and prejudice. I will always fight for what is right even when not a comfortable place to stand. I make no apologies and I am grateful to uncover the truths and for the ability to teach those who are brave enough to face the challenge to embrace humility. Hey, if humility was easy, the world would have no adversaries. So bracing is as much about knowing the truth of people as it is in knowing the true motivations behind decision makers in medical systems.
One thing is painfully clear. Trump intends on dismantling our Nations healthcare one way or another. Recklessly and indifferent, he cares not the price as long as his bank account remain fatted. Its also clear current elected officials are more concerned with being his Twitter fodder than facing those who elected them. Its as if each of those people up on the hill are stashing their personal goods so they can hide out in the post-Trump nuclear fallout, giving up on forming a united front against wronging and the wrongdoer. Let’s get this straight. He is not the first fraud up there to be called Mr. President, sadly won’t be the last. So there is no excuse for cowards to neglect the American public who are creating this nation, who function as its legs and arms and lately, are the only beating feeling heart. Politics will forever be apart of our Nations Medical system and its time the grown-ups, speak up!
So I offer this challenge to our Congress and a guiding light to those wanting action. Protect yourself with your seatbelts when engaging with corporate medicine and corporate pharmaceutical costs. Place pressure back on your employers, your Congress, and contacts who have a hand in the crumbling network of services rendered. By doing that tedious work, being aware of how you are picking up the tab, be the motivation for change. The last thing a medically fragile household needs is more greedy institutionalized practices of the health systems they depend on. Believe it or not, Medicaid can be your friend in the regards to cost. They take reports seriously and are very motivated to work with you. In the end, your plate of medical services to select from widens with each effort, each report and each correct discussion. The lady on the other end of your phone call has no power to fix your bill. You will hear the scripted responses and given many lists of numbers to call. So network with families like yours, educate each other. We are the watchdogs when banded together and in the end, the right parties reap the benefits, even if a long road to walk.
Bracing for the impact of our nations political health is important. Together some good decisions can be made, great conversations are had, and promising improvements made. But without forced accountability and some really fired up patients focused on the right targets. We will all bleed out. First financially, then physically as the life-saving health services vanish.
My focus remains steady and my goals clear. To my fellow families of disabled and medically fragile homes, be encouraged. As hopeless as it seems, we are not powerless. I offer whatever I can to arm you with the knowledge to navigate with success. Survival tactics are well developed and obtaining your very own set possible with some dedication. You are welcome to join any support group, no fees or memberships required. Just a group of families dedicated to making life livable in homes where the challenges are more plentiful than funds.