Robbed Of Medical Funds

Ocean County Observer

October 13, 1986

On September 25, Jacqueline Wilson, Deputy Administrator of Region II of the Health Care Finance Administration (HCFA) addressed a group at the Kimball Medical Center.

She described the efforts of the agency to control medical costs. The meeting was sponsored by the local Office Of Aging headed by Philip Rubinstein, and attended by about 50 health care professionals including physicians, administrators, nurses, social workers and members of the fourth estate.

Ms. Wilson finished a 30 minute discourse and then opened the meting to questions and comments. There were more comments than questions. Lost in some critical declamations, I forgot to ask her the one question she was most competent to answer, namely this,: By what morality can HCFA purposefully slow the rate of reimbursement to Medicare recipients in order to enable the government o save $130 million dollars a year? Of course the so-called “savings” is really stealing from the recipients, but it doesn’t seem to arouse the same sense of indignation that results when some character does a little shop-lifting.

A number of critical comments concerned an apparent lack of compassion that seemed to accompany the new restrictions and rigidities imposed by the government to cap health-care costs. But Ms. Wilson ducked behind the claim that she was simply an administrator and had no powers to influence the law. That is quite true. But even administrators have a moral duty to try to rectify conditions they find offensive. At the very least we would hope that she passed on to her superiors and even her congressmen and senators, the sense of displeasure enunciated at the meeting.

Cases were brought to her attention that represented examples of cruelty of the depersonalized regulations. Ms. Wilson admitted that HCFA had no technique to measure the human suffering, up to and including death that it might be causing with its supervisory tactics and committee mandates, all of which are aimed at rationing health care. Charles Kaufman, head of the Ocean County Department of Health, described the case of a 90 year old woman with two broken arms who was declared not to be housebound (probably because she could walk) and thus denied Home Health Care services. Dr. Malta described the frustration and sense of foreboding doctors felt when caring for patients, knowing that remote, anonymous forces were empowered to create the conditions that encouraged doctors to discharge patients prematurely.

Of course the government argues that no one is forcing the doctor to discharge the patient. But that is not true. There is a concentration of intimidating forces that often impels physicians to do things against their better judgment.

James Schuessler, president of the Community Memorial Hospital, stated that by imposing the current cost-saving restrictions, Medicare was delivering a service far beneath the public expectations. The fact is that Medicare regulators, started in 1967 by following guidelines, and then relaxed them in the intervening years, only to tighten the stringency when the coffers shrank.

Schuessler further posed a question most intriguing. It appears that the State of New jersey, which pioneered Diagnosis Related Groups, was able to receive a federal waiver from the national DRG program, and thus divert about 22 million dollars from hospitals to inner city medical care and medical education. Scheussler wanted to know how Medicare could permit the money, which had been dedicated to the care of the elderly to be used for non-medical purposes. No answer from HCFA.

The question is most important particularly since it seems to represent a misdirection of funds by the congress. Schuessler further pointed out that at Community Memorial Hospital alone a $5 million shortage was experienced this year.

Ms. Wilson, apparently missing the point, responded that most hospitals in the country had profited from DRGs.

Schuessler persisted, stating that since the CMH census included about 70 percent Medicare recipients, why should the hospital be deprived of funds specified by congress to be used for that particular population, whereas hospitals in states that had not received a waiver were profitable while treating a population that included many fewer of the aged.

Ms. Wilson couldn’t answer. But Schuessler’s point is valid. The freeholders should follow through to try to get the money back; our legislators in the state senate and assembly should trace the funds and, if possible, reclaim them. Other funds should be allotted for inner city health care and medical education.

We were robbed last year. Knowing this we should not allow our community to be robbed next year.