The Daily Background
| The Institute of Medicine agrees with me on Medicare complaints
by Arlen Parsa
Three days ago, I blasted the Administration’s handling of Medicare complaints.
Today, the Institute of Medicine has announced they agree with me. Well not that they agree with me, but we both have the same conclusion. The Administration’s current handling of Medicare complaints is woefully inadequate. The problem is, the Administration contracts out handling of Medicare complaints to private groups (some of them for-profit) in all 50 states. These private entities are called QIOs, or Quality “Improvement” Organizations. I have to put the word “Improvement” in quotes because I haven’t seen an evidence that they improve the quality of service provided with Medicare. The Washington Post reports:
Private contractors hired by Medicare to improve quality and investigate complaints have failed to promote patients’ rights, and face conflicts of interest that may lead them to favor doctors and hospitals over beneficiaries, a federal advisory group reported yesterday.
[…]
“The evidence indicates that QIOs have not publicized beneficiary rights effectively and have issued fewer provider sanctions in recent years,” the group said in its report. “This may be the result of inherent conflicts of interest: QIOs consider providers, not beneficiaries, to be their primary clients, and a QIO may not want to antagonize the providers” with which it works.Medicare pays 53 QIOs about $300 million a year to measure quality, work with hospitals and physicians to improve care, and to investigate patient complaints. There are contractors in every state plus one each in the District, Puerto Rico and the U.S. Virgin Islands. Most are set up as nonprofit organizations.
Almost like one of those “your tax money goes to” segments I do frequently, no? Medicare spokesmen have apparently said they agree with the Institute of Medicine’s findings, while the “American Health Quality Association” seems to be getting ready to fight for the QIOs. We’ll see what happens on this issue.
My mother died unnessarily on Feb. 14, 2004, due to the wrongful administration of a drug that even a layman can understand the effect on her, based on her history of renal failer - under dialysys treatment. I know health care rules and regulations of Medicare/ Medicaid CMS from my past 30 years of experience. I have held positions as Controller, CFO, VP Finance (HFMA Advanced Member) for many health care Providers for the past 30 years. I follow the appeal process, TO THE LETTER, when a gross incident happens so that the Medicare/ Medicaid medical delivery system can enforce the proper sanctions to maintain Healthcare Quality Improvement Organizations that CARE about professional quality delivery! YOUR MEDICARE/ MEDICAID QIO GETS AN “F” FOR FAILURE!! YOUR appointed QIO called ‘PROxx’ (xx for State) looms over the issue by stating “Please note this notice contains confidential information concerning the physician. Under Federal regulations, [..my add: no section of regulation cited..] you are not allowed to give out confidential information, which identifies the physician without his/her consent.” Letter from MD dated 9/9/2004. I documented and filed the complaint with the PROxx. The PRO or QIO as they call themselves now, investigated the issue and gave me the following response: “We have carefully examined your concerns and conducted a thorough review of the medical records regarding the services your mother received. The services that were the subject of your complaint did not meet all applicable professionally recognized standards of healthcare. We share your concern about the quality of services your mother received and have initiated appropriate action as warranted by our review findings.” So try and understand that. WHAT APPROPRIATE ACTION DID ?THEY? TAKE? My guess is NOTHING! I know for a fact that no action was taken since the appeal to CMS for wrongful denial of Medicare/ Medicaid SNF benefits (The appeal decision is: Unfavorable”) SNF bill to my mother’s estate WAS DENIED BY SOME CMS CONTRACTOR CALLED RIVERBEND GOVERNMENT BENEFITS ADMINISTRATOR that I believe is in thier best interest to agree with the physician and claim that services are not covered by Medicare. I was there (SNF) with my mother, I know what they did not do, that is another story with 20 chapters. MY POINT? I AM A BABY BOOMER - WILL WE GET THE SAME MEDICARE/ MEDICAID BENEFITS THAT WERE GIVEN TO OUR PARENTS - ALL BE IT FLAWED ?? I WILL TELL YOU … NO! IF MORE BABY BOOMERS KNEW ABOUT THE MEDICARE CMS SYSTEM FAULTS, IF MORE LEGISLATURE KNEW HOW MEDICARE WORKS NOW, MAYBE SOMETHING COULD BE DONE. I HOPE SOMEONE WITH SIMILAR ISSUES WITH CMS READS THIS! I WILL NOT LET IT GO. LET ME KNOW IF THE US CITIZEN IN YOU WANTS TO MAKE A DIFFERENCE. OUR CHILDREN, GRAND CHILDREN AND THEIR CHILDREN SHOULD NOT HAVE TO BE MISSING HEALTH CARE BENEFITS WHEN THEY NEED THEM!!.