I got a copy of the billing that Hospice charge for services to Medicare and Medicare paid on DW behalf. RN - $100/ 15 minutes twice a week to check blood pressure Aide $50 a day for bathing Case worker $60 / 15 minute and I have never talked to Social Worker $60 / 15 minutes which came once or twice in the month but bills every week
For one Month they paid out $4500.00 to Hospice.
That seems like a lot of money given they are only here maybe 30 minutes each day. A nursing home would be about the same or a little more.
I think it all boils down to Hospice costing less than a NH. People are approved for a specific timeframe and if they don't decline, their eligibility is terminated. Once someone goes into a NH, they can be there for years and years, regardless of their rate of decline.
I'm just now geting a crash course in who pays what. Medicare pays for medical care, not room and board. Hospice provides medical care and support. Medicare does pay for some NH care--medically related and for a limited time.
I don't know about anywhere else but Medicare will not pay for home health care even though they will pay for hospice. Home health care only takes Medicaid. I guess there is no reason for that either!
The focus of home healthcare is probably looked at the same way room and board, and custodial care activities are--not mediucal care , is what I've been told.
I think those charges from Hospice are outrageous! Clearly, they are billing for some services they are not providing. As a taxpayer, that really bothers me. There are so many people and agencies out there just ready to pounce on poor people who are having medical problems, particularly the elderly because they can be easily duped. When my dh was first dx I looked into everything privately that was recommended by the "experts". I soon found out that they were all making needless trips to my house and billing me for more time than they stayed, etc. I itemized the bill they sent me and revised the total and fired them. Really got my blood pressure up. What good is it to have a Case Worker or Social Worker (btw, what's the difference, anyway?), if they never discuss anything with you, the spouse. I really wouldn't like that at all, not knowing what was going on with my spouse with these people - grrrrrrrrr.
It seems like Hospice has the opportunity to Bill so much, they know what the Medicare limit is and they do thier best to hit the Max. DW does not have high blood pressure, why send a Nurse twice per week to check it? I figure DW has gotten about 24 hours of 1 on 1 care in a month. That seems to be a very expensive solution. Medicare people have to know what is going on and they sit back and let it happen. The people in government just do not do their job, everyone just goes with the flow. If I say anything do you think Hospice Agency will like it? How will that effect the care for DW?
You all have hit the nail on the head. When my dh had hospice about a year ago (when I knew he didn't need it yet), I was floored at what they were charging medicare and our insurance company. I called our insurance company and medicare. They responded with what I thought was: "So....that is what we pay why are you complaining you didn't have to pay anything for for the service"...I responded "because it was a crime for what they charged and he didn't need it seems to me like it is scam". I just gave up and I am still disgusted.
I don't know why the hospice service I have is so different than you all describe. Aides come 7 days a week to bathe and shave dh. Nurses come 2 - 3 times a week and check vitals and sit with me and discuss dh care or whatever we end of talking about. Nurse is here as much as 3 hrs depending on dh's condition. Some meds are at no charge and they have up-graded diapers to a good quality, enough that I don't have expense of buying anymore. I do not use there "respite" as I was not happy with treatment of dh upon his arrival home. Even the ambulance ride home was paid.I am very happy with services provided - this is non-profit hospice, maybe that is difference. This is in Missippi.we have had them since FEb. Wish you all could have hospice like dh has.nellie
I didn't know that there is a non-profit Hospice and a tax-paid Hospice. How does one know which they are getting and how do they differ? If people like us are dissatisfied with the overcharging going on (even though we do not personally pay it out of pocket), and, in some cases, the actual care as Nellie above said, why doesn't the government do something about it. All this just reinforces my opinion that whatever government runs is inefficient and below standard. Where is John Galt?
Haven't you paid attention to what Washington DC is saying: they need another panel/czar and the people to go after the Medicare and Medicaid fraud. They know it exist but they need to add more government to the payroll before they can go looking for it. I know this is partly a political statement, but it is also the truth of how the process and thinking is - both government and medical community. In the meantime people are being denied the help they need because of the fraud of others.
With the money they are making, they should provide the depends brand or what ever for free. This guys are making a killing. Nellie do you see what the non profit charges Medicare for their services? I am sure that the non profits are paying decent wages to staff, so I am not sure what the difference would be. It sounds like they spend more time on visits. I do not like to see the government being overcharged. It seem like there ought to be some incentive Hospice to keep the time down. It is the other people who are not really providing the care that are making all the $$. I have never even seen the case manager, or spoken to the doctor and the social worker is useless as far as I can tell from my talking to her, but she puts in time every week.
Oh I feel so sorry for those of you who feel Hospice is a rip off. I also wondered why we needed a Social Worker, in fact it made me angry when she would come. As my husband progressed I soon found out how valuable she was to us. She is the one who made the transition to the Nursing Home as quick as it was, she is the one who still comes to the Nursing Home to make sure he gets the Social care he needs. Just this week I told her I was afraid they would move him to the Alzheimer Unit just to make a point to me ( I am one who is after The Nursing facility all the time and they don't like it.) The Hospice Social Worker told me that is when she would step in and make sure it did not happen as he is chair bed bound and unable to defend himself. She makes sure the Nursing Home does not pull anything over on us.
As for the Nurse, yes she comes weekly, you have to remember being on Hospice means that the loved one has a prognosis of 6 months if the disease takes its normal expected course. (No one can really know but those are the rules.) believe me if your loved one has progressed to that point you will be more than glad to have Hospice on your side and in your home.
As for the CNA, she came twice weekly to our home for bath time for my husband. I was thankful to have her. She comes twice weekly to the facility, thus allowing my husband (4) baths weekly rather than only the two that the Nursing Home gives. She washes his hair, which would mean it would only get washed twice weekly without her.
If you feel you are being ripped off, just remember you signed on to them wanting them and it is your option to sign out at anytime. You could really be abusing the system by keeping them if you feel the need is not there.
There I said it, guess I made everyone angry but that is the way it is.
Moorsb, we have seen hospice doctor twice and she examined dh frm head to toes. I know medicare is charged lots of money for this service but if I didn't have hospice I would not be able to keep dh at home due to hoyer lift, hospital bed, diapers, guards, body wash, and cost of prescriptions. I feel hospice is worth every penney and you know we all paid in taxes and still paying. I cannot do this alone even with the helper I pay 7days week. I'm sorry you haven't received good care from your hospice.nellie
How right you are bluedaze, just like a Doctor or Hospital, they all bill much above what Medicare actually pays in order to get Medicare to even pay a reasonable amount, that is the way the system works and Medicare knows that.
The prescriptions alone in most cases are worth the price that Hospice bills, Medicare does not pay Hospice for the medication, that is absorbed by Hospice.
I am just like Nellie says, I could not make it at all without Hospice and just knowing I have them makes all the difference in my husbands care. Those who travel this journey to the end will know what I mean. They are a big blessing in so many ways.
I guess, like email, things can be miss understood. I like Hospice, it is the only way to keep DW at home at this point. I am not happy with the cost to the taxpayers.
moorsb, I understand what you mean, believe me I do. The thing we have to remember is that we all pay taxes and there are many things we don't like that the government chooses to use our money for, Medicare payments are a big chuck of it. When you stop and think of it in the whole scheme of things, Doctors, Health Care etc are way out of control with costs, but then we also have to stop and think we can't put a price on life, and that is what it affords us, quality of life and when we get to the point of the actual dying process, then I am very happy with the cost to the taxpayers, myself included as I have paid taxes many years, I am happy that Medicare has chosen to allow Hospice benefits to be added to the many other benefits of health care that they pay for.
If it makes you feel any better, I myself had the same feelings you have in the beginning of our journey. The charges seemed way out of the range that I thought they should charge, then as we progressed in the disease process I saw the whole benefit package and what it did to help us, and I soon changed my mind.
Jane: I know I had to give approval before they came, but the doctor said your dh has 2 termial illnesses and needs to be seen by hospice. Even when the dr. came I told him I didn't think the service was needed. I told them from the beginning I didn't think they were needed. But, they kept saying..."well we need to evaulate him". I had no problem with their actual service...it was that they just kept coming when they could see they had nothing to do to him except take his BP, temp. etc. They ordered ox..which I told them he didn't need. We got it anyway and never used it as well as a shower bench. We were going on a two week cruise and then they said they would not come back after our vacation.
JudithKB You still had the option NOT to sign on with them. It works both ways. Of course you were following what your Doctor told you to do but many times we know our situation more than the Doctor and that is when we need to be our own advocate. If I felt Hospice was not needed I would be the first to either not sign with them or discharge them. We all also have to remember when we sign with Hospice we are giving up the part A Hospital benefit and that means not taking our loved one to the hospital unless we sign off Hospice. Taking a terminal ill patient to the Hospital with one visit would cost much more than a charge from Hospice.
Again it all comes down to us making the decision, sign on, sign off or never go on Hospice in the first place. Sometimes it is hard to know what to do, we do the best we can.
I have had many people have the same situation with home health when coming home from the hospital. The physical therapy will come and stay until the Medicare runs out, then they will leave. I would tell them I did not need them in the first place, that is what I did when I almost died last month with blood clots in both lungs, blood pressure dropped to 50/26 and I almost did not make it home. When they discharged me I flat told the home health I did not need them and I did not sign for them to come, otherwise they would have been here until my Medicare ran out. We have to take control ourselves with any of this type thing.
Jane: Thank you so much for that last post. I didn't know that if you sign with hospice you couldn't send them to the hospital, etc. which you explained. I thought hospice also would come to the hospital if needed. How does that work?
I also didn't know that "medicare" can run out....I just assumed it was forever if you needed it. My dh retired from the Fed. Gov. and we also have one of their best Blue Cross/Blue Shield plans which also helped pay for the hospice. He also has 70% VA disability and has applied for 100% so that medical care should also be helpful to us if need.
Sorry for your problems with the blood clots. Several years ago my dh had the same problem with clots in both lungs. His COPD and heart condition along with his Alz. makes his condition very tricky.
JudithKB--just to clarify about hospice and hospital stays: last summer, my husband was approved for hospice. Then it became apparent that he needed an impatient stay for medication adjustment (in a geripsych ward--Part A of Medicare would cover). The social worker from the hospice came to my house, I signed a paper to withdraw him from hospice and that day he was admitted to the geripsych ward. Medicare covered the stay with no problems; when he was released and I moved him to the ALF, he went right back on hospice. All was handled seamlessly (what a surprise), with no issues.
Here's my experience with hospice services that are given "too soon" in the AD process--my husband was approved due to weight loss (late stage 6). I enrolled him because I honestly thought they would make a meaningful contribution to his care. He was still living at home, late stage 6, needing help with all the ADL's. However, they insisted sending their aides early in the a.m., which was the time of day he would never cooperate with care--i.e., bathing was out of the question until late afternoon. I told them this and requested their aide come later in the day, but I was told that wasn't possible. They arrange their schedules to their convenience, rather than based on the patient's needs. Although a social worker, nurse and the aide visited our home multiple times, I can honestly say there was really no benefit. Pretty much the same after I moved my husband to the ALF, when he was discharged from hospice because of no further deterioration in his condition. They did not cover his only non-generic medication (Namenda); they didn't supply pullups, etc. It is too soon for a hospital bed and I already had a commode from another relative.
I agree that the taxpayers footed a large bill in this case that was unnecessary. But it was a learning curve for me; now I know that he needs to be much more advanced in the disease before I'll call them back in. I truly believe they will be a huge help at that point.
Jane, so sorry to hear about your illness. I hope you're feeling a lot better now.
JudithKB I did not mean to confuse you about Medicare running out. I was speaking of the home health skilled care. You are only allowed so many physical therapy visits per benefit period. It is tricky but they will use it till it runs out for that benefit period.
Also many people do not realize that Medicare has what they call life time days, this is when you have reached your 90 continuous days of care in an in patient setting and still need care, you then have an additional 60 days that can be used but that is only 60 in a life time, these life time days do not start over with each new benefit period. folks need to read the Medicare handbook and understand that. I worked in a hospital billing Medicare and we had patient's who reached the limit and even dipped into the life time days. It happens. I had many bills that I had to drop into the system and bill at the end of each day when a person was near the end of the 90 day period and embarking on the life time days.
This is why it is so important to have a Medicare supplemental Insurance plan in place.
Each time you are discharged you start another benefit period if you stay out of the hospital and have no skilled nursing services in a rehab facility for at least 60 continuous days, you will then start a new benefit period for another 90 days.