Nursing home surprise: Advantage plans may shorten stays to less time than Medicare covers

[Cenla Agent]

Well IT IS YOUR PROBLEM when the nursing homes take advantage of someone on Original Medicare and a Med Sup by running them through rehab like cattle every day. I have seen it myself when my Mother was in the alzheimer's unit. They came daily and wheeled those people out in their wheelchair while their sleeping and 45 minutes later here they come back still with their blanket on and sound asleep. This is part of the reason we see such big increases on Med Sups, no accountability and it's a free for all with Original Medicare. This is a major part of why everyone at SNF and Nursing homes dis Medicare Advantage plans, they don't like being held accountable for anything they do. $$$$$$$$

This.

I’ve known people who were medical professionals who had a SNF stay and who threw out one or more members of the therapist brigade (OT, ST, PT) when they knew they didn’t need them and knew they were just there to bilk Medicare. They’ll glance at the chart and then say they provided treatment. HMOs were created to help crack down on that sort of thing. Needless to say, that hasn’t quite worked as planned.

 

[LostDollar]

This.

I’ve known people who were medical professionals who had a SNF stay and who threw out one or more members of the therapist brigade (OT, ST, PT) when they knew they didn’t need them and knew they were just there to bilk Medicare. They’ll glance at the chart and then say they provided treatment. HMOs were created to help crack down on that sort of thing. Needless to say, that hasn’t quite worked as planned.

Can you do that?

How does a non-medical person know if the particular therapy is necessary or not?

 

[somarco]

Since when does MA (or Medicare) cover nursing home stays? But no wonder everyone confuses a SNF with nursing homes when Fortune and Kaiser Health News don’t seem to know the difference.

News media, including Fortune and KHN, are "reporters", not agents who should know the difference.

Generally, I find KHN to be mostly accurate and mostly balanced, but sometimes the editor (who is supposed to proof the content before publication) misses things.

 

[straightnochaser]

Can you do that?

How does a non-medical person know if the particular therapy is necessary or not?

I think the point being made is it doesn't matter if it is needed or not, the SNF knows medicare will pay so they milk it as much as they can.

 

[somarco]

How does a non-medical person know if the particular therapy is necessary or not?

Same way home office bean counters, who are not medical personnel, can/will likewise make decisions on the type of care you need.

Inexpensive? Give it a thumbs up.

Costly? Keep denying until they give up or post on social media.

 

[Cenla Agent]

Can you do that?

How does a non-medical person know if the particular therapy is necessary or not?

I was referring to medical professionals who were patients. I had edited the post and inadvertently left that part out, but I’ve now put it back in.

 

[Cenla Agent]

News media, including Fortune and KHN, are "reporters", not agents who should know the difference.

Generally, I find KHN to be mostly accurate and mostly balanced, but sometimes the editor (who is supposed to proof the content before publication) misses things.

More people besides agents should know the difference. It is fairly basic. Entities that hold themselves out as experts like KHN (or even Fortune) should know the difference and have a responsibility to be accurate. But raising the specter of grandma (or us) getting thrown out of the “nursing home” gets more clicks.

I think the bottom line is that people in managed care sometimes don’t get enough time in the SNF whereas people on Original Medicare (and especially a supp) sometimes get too much.

 

[LostDollar]

I think the point being made is it doesn't matter if it is needed or not, the SNF knows medicare will pay so they milk it as much as they can.

Caveat, NOT an agent.

I agree, but that was also a serious question.

I had a hip replacement this summer. In recovery, I received visits from a physical therapist and an occupational therapist. These visits were in the surgery facility, not an SNF.

When I look at the MEOB's for services, I think the PT may have been stretched a bit, but overall I still see it as necessary for evaluation of my surgery, preparation to leave the surgery facility, and preparation for accomodation to the new part in my body.

The OT was more iffy. I have slept since then, but I think it went something like
Demonstration of a sock donner
Demonstration of a grabber to pull up socks
Talking about how, and where, I could get a kit that included a grabber, sock donner, and something else
How I should wipe my butt standing up when I couldn't cope with it over the "small hole toilet riser" I got from WalMart.

And demonstration of a technique I could use for exercise on a totally unrelated shoulder condition that came up when I was visiting with the therapist.

The OT's information was new to me and educational. I used a small bit of it during the first two weeks of my recovery. But overall, in retrospect, I don't see any of it, for me at least, as a requisite for recovery. And, for me at least, I see the OT billings to Medicare as having been an unnecessary expense for unnecessary "treatment".

That's what led to the question I asked.

 

[LostDollar]

I was referring to medical professionals who were patients. I had edited the post and inadvertently left that part out, but I’ve now put it back in.

Caveat, not an agent.

Thanks for the reponse

So it probably comes down to a non-medical professional is not going to have any frame of reference to make an adequate "ahead of time" judgement about the appropriateness of a particular therapy.

 

[rousemark]

There is a reason why ice cream comes in chocolate and vanilla . . .

Most folks have been on a managed care plan the last 30 years . . . that doesn't mean they like them, or understand them.

The light bulb went on for me a few months ago when talking with a prospect who had a number of medical conditions. Nothing particularly serious, but chronic, requiring several doc visits per month.

He also likes to travel, domestic and international.

I asked if he would like to hear how original Medicare + supplement works . . . he was open minded, so he agreed.

I explained about the networks and how that type of approach may not be conducive to traveling. He said he had been fighting insurance carriers most of his life, why should Medicare be any different?

Well, since you asked . . .

He opted for the Medigap plan.

The freight train be damned . . .

People talk about the cost of Medigap. At 78 my premium is $311 per month, $3237 per year. Yhe lowest OOP MA plan was $3250 for in network and did not appear to cover any out of network. Home Health had to be preaporved, Speech Therapy had to be preapproved.. SNF coverd for 14 dtterays max. I have come out much better the last three years. BTW, don't know what my HHC toatal bill has been but Manhattan has already paid me around $6K.. Just bought in February. One of the best insurance buys I ever made.