Daily Observer
Mandatory Monthly Medicaid Visits Are a Chronic Waste
I barged in, after
slamming the door shut.
“You seem vexed,
Harry,” S.Q. Lapius muttered pleasantly.
“What makes you think
that, Simon? The manner in which I
slammed the door shut?”
“Not at all dear
boy. It was the way the windows rattled
after you had slammed the door shut that clued me in. Difficult case, I suppose?”
“Not really. No as a matter of fact it was an easy day,” I
said leaning back on the stuffed chair and stretching my legs full length. “As a matter of fact I spent a good part of
it going over the Medicaid cases at the nursing home.”
“No insoluble problems
there, I should imagine,” Lapius remarked
absently. He was starting to busy
himself with the newspaper.
“Of course not. Chronic disease medicine is a housekeeping
problem by and large. But, instead of
having the nursing home call me when the patients become acutely ill, Medicaid demands
that I see each of them once a month.
It’s a waste of my time, and incidentally is costly to them. I don’t see why Medicaid should make an
arbitrary ruling like that. There’s no
point in passing a stethoscope over the chest of these patients or poking them
in the belly unless they feel sick. The
ruling is capricious. It cost Medicaid
thousands of dollars that could be better spent elsewhere. Medicaid has somehow arrived at the
conclusion that if one of their patients is in a nursing home, they are sick
enough to be seen once a month. Not once
a week, not once a year, but once a month. I wonder how they arrived at that
figure?”
“Suppose I put up the
coffee. You’ll feel better,” Lapius said soothingly.
“Well don’t you think
that’s dumb, Simon,” I persisted.
“No.”
“You don’t?”
“Not really. The state is paying the medical bills for
these patients. It has the right as
guardian, to call in the patient’s doctor whenever it chooses. If a private family hired you to look after
one of its members in a nursing home, and suggested that you look in once a
month, you’d do it wouldn’t you?”
“What for. Why drop in unless the patient is sick?”
“But if they really
wanted you to do this and offered you an exorbitant fee, then you would do it
without complaint, right?”
“Of course, if they
made it worth my while.”
“So it’s not the
principle of the thing, Harry, it’s the fee.”
“Not entirely. A
private family who is willing to pay a large fee for a monthly visit will go
along with all my recommendations regardless of cost. Here is where Medicaid differs. They hold back in some area. In other words, you don’t have carte
blanche.”
“Harry,” Lapius laughed.
“Where does anyone have carte blanche?
Unless they carry an American Express card or some such thing.”
“The thing that bothers
me isn’t so much the monthly visit, Simon.
But it’s meaningless. Actually,
the best way to monitor patients in a nursing home is to have a survey of
laboratory tests done automatically on a quarterly or semi-annually basis.
I can’t tell on my
monthly visit whether the patient is starting to get an anemia, urinary
infection, or whether some other insidious metabolic problem is
developing. The better way of spending
the Medicaid monies, rather than the useless monthly visit, would be a
laboratory survey, with the proviso that the doctor is informed of the results
of the testing. As a matter of fact,
with all the hubbub about Health Maintenance Organizations, it’s the nursing
homes that would lend themselves best to medical health screening. A lot of time and money could be saved.”
“Harry, you’re
discarding the mystique of the doctor in a very cavalier way. It’s comforting for these patients to know
that their doctor is looking in on them, even if it serves no other purpose, at
frequent intervals. It gives the patient
a sense of security. There’s nothing
wrong with the chemistry survey, but I don’t think that the doctors’ visits
should be stopped.”
I wasn’t
convinced. “I’m going for a walk,” I
told Simon, standing up and heading for the door vestibule.
“Harry,” he commanded,
“Just a minute,” he barged ahead of me.
“What’s the trouble?”
“Nothing. I just want to open and close the door for
you.”