Kristie Chapman is a Registered Nurse, Healthcare Advocate, and gifted writer from Charlotte, North Carolina. She will serve as our “local expert” on all things related to Healthcare here at “The Thirsty Quill.” Kristie’s personal blog, “A Scarlet Stethoscope,” is loaded with additional information and resources, which you can find at http://rnadvocate.blogspot.com.

Most notably, Kristie was specifically recruited to speak on Healthcare at the recent Charlotte Independence Day Tea Party. We appreciate Kristie’s contributions, and we look forward to posting more of her work at ‘The Quill’ in the days ahead. You can contact her offline via email at kchapmanrn@gmail.com.

“Getting Informed About Reform”

By: Kristie Chapman, RN (Healthcare Consultant for “The Thirsty Quill”)

Over the next few days, I will be posting information here and on my blog, “A Scarlet Stethoscope,” about different healthcare issues and information that relates to healthcare as we know it right now – the good, the bad, and the downright ugly – what could possibly come with the healthcare reform bill as it stands, and ideas from different folks about other healthcare reform possibilities. My hope is that it will be a resource for you as you communicate with your elected officials about what you feel is best for healthcare reform in the United States. As you research, keep this thought in mind, from a member of Community Oncology Alliance:

“We face dire consequences if we break what is working and do not address what is already broken.” (1)

This week, I attended a staff meeting at the oncology clinic where I work. Our practice administrator shared some information that I had feared would be coming down the pipe very soon (see my June 13th blog about $313 billion more cuts for healthcare reform)…

“The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule for the 2010 Medicare Physician Fee Schedule. Among other provisions are cuts to imaging services, elimination of the consultation payment codes, attempts to reinstate the Competitive Acquisition Program (CAP) for Part B drugs, and the 21.5% cut in payments to all physicians scheduled for 1/1/10 unless Congress acts to overturn this…” (1)

“Community oncology clinics, which treat more than 80 percent of Americans battling cancer, are already struggling to care for Medicare patients. Given that the administration is now discussing an additional $313 billion in cuts to Medicare, in addition to significant cuts already proposed, cancer care in this country is truly in jeopardy…

“The Medicare cuts have now reached the point where cancer-care practices cannot stay in business, and cancer patients often cannot afford necessary treatments. Medicare does not reimburse for essential services required by cancer patients, such as treatment planning and care coordination. Oncologists are often reimbursed at less than the acquisition cost for the expensive cancer drugs. Clinics across the country report a freeze on hiring and the cutting of staff - and some have already been forced to close facilities, especially in rural areas.

“On Florida’s West Coast, our offices may be forced to close our doors to Medicare patients and send them to area hospitals for cancer treatments. This will cause extraordinary hardship on these patients and steeply increase the cost of treatment. This benefits no one, and it definitely will not save Medicare any money. If further Medicare cuts are made, our local cancer-care delivery system will be dismantled in short order.” (2)

As well known as it is within community oncology clinics, the general public often doesn’t realize the hits that private practices are taking with Medicare cuts. Medicare, for some strange reason, has become the “price setter” in insurance reimbursement. Most private insurance companies set their reimbursement rates according to Medicare, often reimbursing a few percentage points higher. Not such a bad thing, if you’re having to deal with Medicare cuts, because you can try to recoup some of those losses through private insurance payments…

That is, until Medicare cuts even more.

What is happening now:

Several different chemotherapy drugs that are being given in oncology clinics are being given at a “break-even” price, and in many cases, at a financial loss to the clinics. CMS is now proposing cuts to “administration codes”, basically, reimbursement for nursing support. That nurse who starts the IV, who checks the dosage on the medication, who monitors the patient while they are receiving the treatment? They don’t want to reimburse for them anymore. As if the drug is going to give itself?

So…as of 2010, if Congress does not act, private practices have to deal with already existing cuts in the cost of drugs that they give, and then figure out where they are going to produce the overhead to pay the nurses that they desperately need to administer these drugs and care for the patients. Moreover, physician reimbursement will be slashed, so the doctors responsible for ordering treatments for a growing number of people battling cancer will be hit even worse.

Please keep this in mind: this is totally unrelated to the huge firestorm that is looming with the healthcare reform bill being debated in Congress right now. This is just the mess we’re already dealing with.

It’s a small piece of a huge issue that is snowballing. Hospitals get a different level of reimbursement, but they are being hit as well. Medicare even proposed not paying for charges related to hospital-acquired problems such as decubitus ulcers, citing that they were completely preventable: “…hospital-acquired conditions which could have reasonably been avoided through the application of evidence based guidelines and would be subject to the adjustment in payment…the rate of growth in health care costs has made it necessary for payers of health care services to examine every avenue available to conserve health care dollars.” (3)

Now…I’ll be the first to say that being in the hospital is often the LAST place someone needs to be in order to get well. But in order to have access to all of the resources someone needs with many illnesses, the hospitals are the only available option - that’s just reality.

But there’s another reality. Sometimes things just can’t be avoided. And “sometimes” is more like “often” in the kinds of cases that many hospitals see on a daily basis.

Let’s take the chronically ill patient with poor circulation, decreased mobility, and multiple medical conditions – paired with multiple medications needed to manage their conditions. Top that with the side effects of these medications, just to make the problems of the medical conditions worse. Now put that patient in the hospital, in a hospital bed (that is certainly not a Tempur-Pedic, if you know what I mean!), add in some fever, poor appetite leading to altered nutrition, and what do you get?

A “decubitus ulcer”, or a bedsore.

Now, according to “evidence based guidelines”, frequent position changes and diligent skin care will prevent decubitus ulcers. But if you have a patient that is morbidly obese, unable to control bowel or bladder function, or on medications such as steroids that make the skin very fragile, prevention turns into more of a battle than a practice, and a bedsore can come out of nowhere – and lead to huge problems, and huge costs.

Medicare says, according to this rule, that they won’t pay for it. Period.

So the hospitals have to eat the costs of dressings, nursing care, the whole nine yards.

This is what we have to deal with right now, and those are just small pieces of a huge task that Congress is trying to tackle in a few short weeks. It took years to create this problem. It can’t be solved in a couple of weeks by a group of politicians sequestered in Capitol Hill.

I will have much more information posted here in the coming days (as I’m able to get it organized and typed out!), but hopefully this is a start on helping you learn more about the current healthcare situation and give you a place to start on researching for yourself. My perspective comes from working in private practice and working in close coordination with hospitals. Talk to your friends that work in other types of healthcare organizations to get their perspectives. I would strongly encourage you to stick with people that work in the field…obviously, Barack Obama is no expert on healthcare, but for some reason many Americans are giving him more trust with their health than they do their own doctors. Get information from the people that KNOW, not from politicians.

Again, I can’t emphasize this enough:

“We face dire consequences if we break what is working and do not address what is already broken.”

References:
1. Community Oncology Alliance, http://www.communityoncology.org

2. Tampa Bay Online, Commentary published July 13, 2009 by Scott A. Tetreault: http://www2.tbo.com/content/2009/jul/13/na-harmful-reductions/news-opinion-commentary/

3. The National Conference of State Legislatures: “Medicare Nonpayment for Hospital Acquired Conditions”: http://www.ncsl.org/IssuesResearch/Health/MedicareNonpaymentforHospitalAcquiredConditio/tabid/14747/Default.aspx

Kristie Chapman is a Registered Nurse, Healthcare Advocate, and gifted writer from Charlotte, North Carolina. She will serve as our “local expert” on all things related to Healthcare here at “The Thirsty Quill.” Kristie’s personal blog, “A Scarlet Stethoscope,” is loaded with additional information and resources, which you can find at http://rnadvocate.blogspot.com.

Most notably, Kristie was specifically recruited to speak on Healthcare at the recent Charlotte Independence Day Tea Party. We appreciate Kristie’s contributions, and we look forward to posting more of her work at ‘The Quill’ in the days ahead. You can contact her offline via email at kchapmanrn@gmail.com.