Medicare was never designed to pay for the long-term personal care and therapeutic services that people with chronic conditions need. They just aren’t part of the Medicare package. In fact, Medicare doesn’t even address personal care. It inappropriately, and I think pejoratively, refers to the type of services provided by family caregivers as “custodial care,” and as you and I know, what we do is far more than watch over our loved ones, which is how the dictionary defines the word custodial. But regardless of what words you use to describe the services family caregivers provide, many people assume that Medicare covers them, and therefore they and their families have a rude awakening when they least expect it. It’s worth taking the time to look at Medicare in more depth, not only because it affects millions of caregiving families, but it is a good example of how “un-caregiver friendly” our healthcare system really is.
Physician Time
Some of the rules and regulations that affect us the most have to do with the privacy rulings under the Health Insurance Portability and Accountability Act (HIPAA). These are not part of Medicare, but it is important to mention them here because some physicians are interpreting the privacy rules to mean they are not allowed to talk to family caregivers, and they are being very adamant about it. If a doctor won’t even talk to you, you and your care recipient have a bigger problem than which services the doctor can bill for. Assuming a doctor is open to talking with you, and even sees you as an ally in his patient’s care, there are no CPT codes (the boxes they check on the payment form) that allow a physician to bill for time spent talking with and counseling family caregivers if the patient is not also present. When a doctor is not being paid, there really is only so much time he or she can afford to spend with us. What this regulation is saying in no uncertain terms is that Medicare doesn’t recognize the role of family caregivers.
This is the crux of some other issues as well. In addition to not paying for doctors to talk with us, Medicare also does not allow a physician to bill for time spent coordinating a patient’s care with other doctors. Given that most care recipients are dealing with multiple physicians, this is a serious issue. Lack of care coordination is believed to lead to unnecessary hospitalizations, and to otherwise unnecessary nursing home stays. It is also thought to be one of the primary reasons for a patient to experience an adverse medication reaction. If your loved one’s doctors aren’t communicating with each other, how is each to know what the other is prescribing? The answer is that it becomes your job to tell them. By default, family caregivers are the health system’s care coordinators.
