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Sunday, March 12, 2006

Mugglie on Care Management

Occasional contributor and social worker Cindy Mugglie has some comments that relate to efforts to manage care by means of payment:
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One would expect the ever changing state and federal regulations regarding patient/client care to result in better care for health care consumers, but in my experience the opposite is sometimes true. Extensive paperwork that must be completed within strict time frames often serves to reduce the amount of time spent in caring for patients/clients. This has an even greater impact when regulations are changed frequently because of the time it takes to constantly adjust to the changes and educate staff on their changing responsibilities. I understand that regulations are needed to protect consumers and control costs, but there must be some point where we realize that regulations can do more harm than good. At times they may even seem unethical.

I wonder if any research has been done on this issue and I have 2 examples.

First, I've worked with many nursing home residents who at some point received physical therapy under Medicare. When a resident reaches the maximum physical gain deemed possible, Medicare will no longer pay and the resident is dropped from physical therapy. Once dropped from physical therapy, the resident's physical abilities often decrease and at some point they are allowed more physical therapy. However, they may not see as much improvement as before, and over time their physical ability will show a marked decrease. Wouldn't it make more sense for Medicare to pay for some kind of maintenance physical therapy in order to keep people from losing so much ground over time? Wouldn't it cost less to provide maintenance care, especially when you consider the paperwork that must be completed each time a resident is discharged from physical therapy and each time a resident is re-admitted to physical therapy?

Second, there are instances where people with dementia are admitted to hospice care because of weight loss and other associated problems that, if continued, can at times result in death. Hospice provides the care needed to assist such a patient by increasing their intake of food and liquids. But after a certain amount of time, the weight loss and other problems that indicated a need for hospice care can be reduced so much that the patient will no longer qualify for hospice care under Medicare, and the patient must be discharged from hospice. Once off of hospice care, that patient's weight loss and other problems can re-occur, and the patient may be re-admitted to hospice. Here again, wouldn't it cost less to allow such a person to remain on hospice? More importantly, wouldn't it be better for the patient to prevent a recurrence of the weight loss and other problems associated with dementia?

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