Hospice Patients Alliance – Physicians, nurses and other staff patient advocates? #motels

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When any individual seeks health care, he expects that the physicians, nurses, social workers and other professionals will provide the very best of care in accordance with the most modern standards in the health care industry. Whether it is surgery or medical management of a disease, the expectation never changes. Most people trust their physician and the nurses who care for them. They trust their counselors and therapists. Health care professionals are quite often perceived as quite dedicated individuals who do their very best in caring for their patients.

Hospice is no different from any other aspect of the health care industry in terms of the degree of competence and integrity that is expected by the general public. However, hospice patients and their families are less likely to know when they’re being exploited, because it is less likely that they would know about the standards of care for end-of-life care. Even if they do know the standards, hospice patients and their families are less likely to complain, because of their fatigue, the overwhelming intensity of involvement in caring for their loved one (often around the clock), and their intense grief.

Physicians, nurses, social workers, professional counselors and therapists are licensed in each State to provide health care services. Each State has standards of care for all health care professionals, and each professional organization has published its own Code of Ethics and standards of care. Any licensed health care professional has a duty under the law to maintain professional competence, abide by the Code of Ethics, and actually provide care that meets the standards of care. Most health care professionals take pride in being competent at their work, staying up-to-date, and doing the best for their patient. There is a natural bond between health care professionals and their patients. Many will fight for their patients to protect the patients’ interests. That is what patients expect and what they often receive.

However, with the changes in the health care industry, constantly rising costs of providing services, and stiff competition among health care agencies, hospitals, nursing homes, and hospices, the business of running a health care agency or hospice has taken over in terms of controlling what directives management gives to its staff. No longer can you safely assume that the agency or hospice will necessarily do what’s right or according to the standard of care. Cutting corners has become commonplace in health care. This places terrible strain on the health care staff, who are pulled in mutually exclusive directions by their different obligations under their license and to their employer.

Health care professionals’ first obligation under the law and their license is to the patient: to abide by the Code of Ethics for their profession, maintain professional competence and actually provide the care that meets the standards of care for their line of work. The second obligation health care professionals may feel heavily weighing on their shoulders is to their employer; if the employer directs the health care professional to violate the standards of care (in order to save the employer money), he or she must choose between pleasing the employer (and keeping a job) and doing what’s right for the patient.

Physicians, nurses, social workers and others routinely confront these conflicting obligations and try to find a compromise between the two that is acceptable to both obligations. However, when the policy of the employer is clearly in violation of the standards, the health care professional must choose between right and wrong. There is no middle ground when health care fraud is directed and intentionally committed at the administrative level.

Hospice is fertile ground for health care fraud. There are many ways of exploiting the patients, families and the reimbursement source, whether Medicare, Medicaid, private insurance, or the patients and families own money. Federal investigators have struggled with attempting to stop the flood of health care fraud violations occurring. When the U.S. Office of Inspector General started its Fraud Hotline, they were flooded with thousands of calls about health care fraud. Some career criminals have even been quoted as saying that it was easier to make fortunes defrauding Medicare than through the sales of illegal drugs.

If you are receiving care from health care professionals, you can expect that most of them are very dedicated, and honest individuals. That does not mean that fraud might not occur. Some honest individuals do not have the courage to fight the system and simply decide to choose to ignore violations which are occurring, trying to stay uninvolved and just do their jobs. The financial incentive to the agency/health care institution is to commit fraud in order to bolster their bottom line. The financial incentive to the health care professional to keep quiet arises out of their need to keep their paycheck coming to support their family. Challenging one’s employer’s policies is a sure method of becoming very unpopular at work. Management does not look favorably on employees who expose their white-collar crime! Even co-employees may avoid a health care professional who makes a complaint against the employer. they simply don’t want to have their own jobs threatened.

For the hospice patient and families, you can expect that some of the physicians, nurses, social workers or other staff will definitely speak up on your behalf if they think that improper decisions regarding health care occurring. The best thing you can do to help these health care professionals is to listen closely to what they may say to you. Remember their comments if any problem arises, if you are having difficulty getting proper services. By listening to what some of the hospice staff may tell you, you can glean extremely important clues to what you should be receiving, but may not be receiving. or you may learn of problems which you did not even know existed.

Remember, if you don’t know the standards in hospice, how can you know when you’re being exploited? If you determine that any of the services you are receiving are inadequate or improper, your complaint directly made to the hospice management will be much more powerful than any complaint made by an employee. If you have questions about the care being provided, ask one of the staff who you seem to have a stronger, closer relationship, who you trust. If you’re still unsure, you can contact other hospices, health care professionals you may know or call us at the Hospice Patients Alliance.

While all health care professionals are required to be advocates for the patients under their care, the reality is that some health care professionals choose to look the other way and keep quiet, to save their own job. Health care fraud, under-serving patients and outright violations of standards of care does occur. You can help stop it from continuing by listening closely to the staff you meet, by learning as much as you can about the standards of care (that’s one of the reasons for the Hospice Patients Alliance. to help inform you and protect you), read the contracts and literature provided by the hospice, and be willing to ask probing questions of the hospice staff who work with you. Some hospice staff do not know the full meaning of the standards of care and have been misled by their hospice employers. If you have doubts about what you are told, look up the law for yourself in the Section on Federal Laws Governing Hospice: the Uniform Standards of Care. We will be happy to explain the standards to you if you call.

Primary Care Doctor Shortage – How Does the Health Care Law Address


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How to Beat the Doctor Shortage

En español l For years, Marcia Andrews visited the same internist in Washington, D.C. Then she turned 65, got her Medicare card and had to find a new doctor: Her internist was not accepting Medicare patients. Primary care doctors are in such demand now that they can choose not to accept Medicare, whose reimbursements to physicians are lower than private insurance rates.

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More and more people, especially Medicare patients, are having trouble finding a doctor.

The doctor shortage is worse than most people think, says Steven Berk, M.D. dean of the School of Medicine at Texas Tech University. The population is getting older, so there’s a greater need for primary care physicians. At the same time, physicians are getting older, too, and they’re retiring earlier, Berk says. And graying doctors — nearly half the nation’s 830,000 physicians are over age 50 — are seeing fewer patients than they did four years ago, a 2012 Physicians Foundation survey reported.

Soon, this fraying primary care network will face another huge challenge: Under the Affordable Care Act. millions of formerly uninsured men and women will have access to health care.

We need to absorb these 30 million people, and that’s going to be a strain, says Russell Phillips, M.D. director of Harvard Medical School’s new Center for Primary Care.

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A fundamental change

The approach most favored by experts at Harvard and elsewhere is to reshape traditional primary care: from a stream of patients waiting to see one harried doctor to a more efficient team practice in which patients with routine problems are seen by nurse-practitioners and physician assistants — trained specialists with master’s degrees. The team frees the doctor to spend more time with patients with more serious complaints.This change could be as fundamental as the one that took place when most family doctors stopped making Marcus Welby-like house calls.

The Affordable Care Act encourages such a sea change, with provisions that aim to shore up and expand the country’s ailing primary care system while still reducing costs.

The ACA authorizes money to increase the primary care workforce by training more doctors, nurses, nurse-practitioners and physician assistants. It includes more graduate medical education training positions, with priorities for primary care and general surgery, and more money for scholarships and loans for all health professionals. The law expands the number of patients seen at community health centers in areas with too few doctors and increases the number of staffers who work in the centers. It also expands nurse-managed clinics at nursing schools where nurses in training see patients who live in the area.

Another key provision: a 10 percent bonus, through 2015, to primary care doctors who offer services to Medicare patients.

But in these times of shrinking federal budgets, it’s unclear how much ACA primary care money will be available as Congress juggles competing priorities. Congress, for example, already has chopped about $6.25 billion from the ACA’s new $15 billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts catastrophic.

A recent study by the Institute of Medicine and the National Research Council reports that, when compared with citizens of 16 other high-income democracies, including those of Western Europe, Japan and Canada, Americans not only die younger but have poorer overall health. The researchers traced U.S. health disadvantages to a number of causes, including the fact that Americans have more limited access to primary care.

Where have all the doctors gone?

Today, the United States is short about 16,000 primary care doctors — the very doctors (family practitioners, internists and pediatricians) who offer the treatments and preventive screenings that save lives and head off expensive emergency room visits and hospitalizations.

Why the shortage? It starts with huge medical school debts and ends with a doctor who is often overworked and underpaid. While students may enter medical school wanting to practice primary care medicine, they graduate saddled with heavy debt — $250,000 is not unusual — which prompts them to switch to a more lucrative specialty. The starting salary for a primary care physician is $150,000 to $170,000; a radiologist or gastroenterologist can make two to three times that.

Only one in five graduating internal medicine residents plans to go into primary care medicine, the Journal of the American Medical Association reports.

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Looking for a Doctor?

The best place to start is your state medical association. Many provide doctor directories that often include new doctors just setting up practice.

If you’re a Medicare beneficiary, go to medicare.gov . Under Forms, Help and Resources on the home page, select Find doctors, hospitals and facilities. Type in your ZIP code and you’ll get a drop-down menu of medical specialties, including primary care. The tool provides contact information for doctors according to the criteria you enter — geographic location, specialty, etc. Call the office to check whether the doctor is still taking new patients.

Clay Buchanan, a former lawyer, is one of those graduating in May. At 48, the Little Rock, Ark. resident is older than most medical students. He shadowed a family doctor as part of his training — and was hooked. By noon the first day, I loved it, Buchanan says.

New York University and several other colleges are planning to experiment with a three-year program.

Health clinics offer primary care

Community health centers offer another form of primary care. Nationwide, the centers serve 20 million patients a year using a team approach, and are open to all on a sliding fee scale. Under the ACA, they are expected to double their capacity to 40 million patients by 2015. To entice doctors to work at these centers, the National Health Service Corps repays up to $120,000 in loans for each doctor in return for four years’ service.

Technology, including telemedicine — which could reduce patient trips to the doctor’s office — also should help expand health care.

Another way to increase health services is to give physician extenders — nurses and other medical professionals — more autonomy. Patricia Grady, director of the National Institute of Nursing Research at the National Institutes of Health, supports increasing the role of trained nurses, allowing them to set up independent practices where they could do physical exams and advise patients on exercise and diet.

But that position has met with some resistance. The American Academy of Family Physicians and the American Medical Association (AMA) favor training more physicians and nurses but want to keep nurses in teams led by doctors.

Nurses and foreign doctors

Permitting more foreign doctors to practice here also would increase the pool of primary care providers. Last fall, President Obama signed a three-year extension of a visa waiver program that allows states to place 30 foreign medical school graduates a year in medically underserved areas for three years. Most remain in the communities after they satisfy their commitment. Still, the shortage is so acute, even the AMA is lobbying Congress to increase to 50 the number of foreign-educated doctors each state is allowed.

In the meantime, more Americans are anxiously searching for a primary care doctor — or waiting months to see one. Marcia Andrews, whose Washington doctor refused to take Medicare, finally found a new doctor who does. The search took her 18 months.

Marsha Mercer is a freelance journalist who lives in the Washington, D.C. area.

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