Have we entered a new era of saying no in Medicare?
Have we finally reached a point where special interests do not decide that Medicare will pay for everything under the sun? Have we finally reached a point where economics play some part in the equation? In the last week, Medicare has said no not once, but twice.
First they will not pay for the new warfarin genetic testing. Say bye, bye to the test. If Medicare doesn't pay for it, no one will. And that means nobody will order it. Nobody will pay for it. And nobody will get it.
Good for them. There should be clear evidence of benefit, that is cheaper than currently available therapies before anything is approved and paid for. Just because we have a test does not mean it should be run, nor paid for.
Next up is the virtual colonoscopy, a turf war between the radiologists and the colonoscopists.
Once again, good for them. Just because you have a test does not mean it should be paid for. This is the the current reality. A slow but steady wave of saying no will start to creep into the delivery of your health care by government forces. These are small baby steps that will amount to no significant change in the overall expenditures of the Medicare National Bank.
But look out. Once the bank is insolvent, which is less than a decade a way, you will be seeing lots of nos in everything from no dialysis for anyone over 80 years old to no ICU for those over 80 to no payment for COPD exacerbations in those testing positive for cotinine to no treatment of any kind for lifestyle related diabetics who aren't wellness program members.
The age of rationing is just beginning. Be prepared to take care of yourself before you find yourself shut out from care for which you are deemed unworthy of.
I love it when you get all Logical...
ReplyDeleteYou missed a big un'
"No Treatment for HIV/AIDS/Associated Conditions unless you have documented/notarized proof of catching the Hivie from Blood Transfusion or in Utero..."
Yeah, I didn't include Needle Sticks, too big of a loophole, good reminder to be careful...
Frank, M.D.
Let's start with no treatment for:
ReplyDelete*anything for one month after you go AMA...
coccaine, heroin or methamphetamine induced *organ damage
any injury occuring while committing a felony
*anyone on death row
then we can move on to things that have been worked up a zillion times before and yielded no reasults. Maybe we put a max medical cost on each persson or a max # of ICU days before the pt/family has to pay.
I kind of like a sliding scale copay myself.
The bank is a year or two from insolvency. The decade figures include "drawing down" the "trust fund". Of course the trust fund is made up entirely of government bonds.. apparently magical ones. The day the real insolvency kicks in when the "surplus" is no longer there and the principle and interest from bonds have to be found. Good luck on that.
ReplyDeleteWe opened up pandora's box with the technologies available. I work primarily with the old folks in the hospital and what I see is organ specific treatment. 93 y/0 with dementia and multiple co-morbities with crapped out kidneys (it always seems to be the chfers with their fluid restriction and ace inhibitors yeah EBM!!)who get the renal consults and when the bicarb, gentle hydration and eliminating the ACEI doesn't work here comes the ash cath (can you say sepsis) and dialysis. No matter when all is said and done he will be still be an end stage dementia with co-morbidities. I don't see thoughtfullness with the docs when proceeding with treatment just fix the numbers and eliminate the haze on the xray.Also you have the families who have decided that's mom's last days on earth seems to be the time to finally move forward in repairing a 40 y/o fractured relationship by doing EVERYTHING. Common sense, straight talk and realistic expectations would go a long way with salvaging some of the medicare dollar.
ReplyDeleteMidwest woman... what a great post.
ReplyDelete-Second career nursing student