One of the most avoidable health care challenges that people face is that of a rehospitalization. We have seen this time and time again. A person is discharged from the hospital, many times before they are ready to leave, and end up back at home or in a rehabilitation center. This is seen more frequently with those carrying a Medicare Advantage Plan, or Part C plan. Those medical professionals treating this individual, either at the hospital or at a facility, are no longer able to properly manage their care. This has been transferred to the insurance company getting paid full rates by Medicare and then paying the bill on your behalf with a model to keep as much of that payment as possible.
A person is forcibly discharged by the insurance company, often times by the health care provider receiving a "cut letter", and the appeal process is denied. It does not matter what the covering physician recommends, you either discharge home or begin paying the bill out of pocket.
Right behind these challenges are some more to deal with. Case Managers and Discharge Planners/Social Workers are behind the scenes trying desperately to arrange Home Health services (100% covered by Traditional Medicare) through an agency that is willing to work with your insurance plan/company. There is a problem however....no agency wants to accept you as a patient simply because they are familiar with how these policies (and companies) "manage" your care. They simply limit the services or pay very little, if anything at all. Home Health Agencies do not want to work with these insurance companies and you simply can't blame them. These same health care professionals that are trying to arrange covered services for you at home (if you carried traditional medicare) now face the fact that they must discharge you even though it is not classified as a "safe discharge". You end up at home, with very little to no help, and then have a fall or new health related challenge that sends you right back to the hospital. Often times within 24 hours of getting home. Sure, Private Duty is an option and a great one. If you have the resources to pay $25-$30 per hour and around the clock. Often times this is something that a senior community will insist happens before you come home. Private Duty services must be arranged and for a certain amount of hours and weeks before they authorize your return.
Even when Home Health Services are aligned, they are limited each week and eventually run out. As we see more and more Medicare eligible individuals enrolling in these dangerous plans each year, which is what Medicare wants, these types of important services will become even more limited. To both those carrying Traditional Medicare and one of these Advantage Plans. One option to help offset these issues and concerns is simply Concierge Clinical Visits.
With a physicians order additional monitoring visits can be added and be a very valuable resource to you, even helping reduce the chances of a hospital visit or stay. Visits that may include monitoring your blood pressure or blood sugar. Checking to make sure that a wound or surgical site is still healing properly. Checking again to make sure the correct medications are being taken and no new questions or symptoms have surfaced. Having a simple conversation and checking to see how you are doing, overall. How your caregiver is holding up. And so on.
This service and the benefits in having this available to you or a loved one has never been more obvious than it was during the COVID Pandemic that the entire world faced beginning March of 2020. Here in the middle of 2021 we are still facing it. Many facilities and senior communities had to eliminate visits from family members, friends and loved ones due to the risk of everyone involved and the possibility of exposure. Personally I feel as if those individuals living in Memory Care suffered the most from the lack of interaction and seeing a face they recognize. These visits are so important and we know that, however, the true value in a familiar face and visit has never been so obvious as it has now.
As we work to incorporate these types of necessary visits into your plan remember that this will also bring some comfort to you and those that you love. Additional support, eyes and ears are a very valuable resource. This can be arranged with or without a physicians order and depends on the needs of the individual and requests by those that know and love them.
Click on the Contact Us link above to discuss these options.