Yet another problem related to the physician payment rules is that doctors are paid less for taking a patient’s history and performing an examination than for performing a procedure, even if the former takes more time than the latter. Yet, time to describe problems adequately and be counseled about symptoms and the pros and cons of potential treatment options is what family caregivers and their loved ones need. Performing an endoscopy or interpreting an MRI might be more lucrative for a physician. These diagnostic procedures are required from time to time, but they don’t represent the type of care people with chronic illnesses need daily. It would seem that doctors should receive more money to better care for the chronically ill. It would benefit family caregivers, and our loved ones, to have more time with them.
Definition of Homebound and Related Issues
If you haven’t come up against the homebound rule you’ll think I am making this up; unfortunately, I’m not. Medicare says that unless someone literally can’t leave the house without assistance, he or she is not eligible for home-care services. If that individual does leave the house for anything other than a medical reason and this is discovered, the services will be suspended. This was changed slightly some years ago to allow people to go to religious services a few times a month, a graduation, or a funeral, but it has to be clear that these are not everyday events. The home-health services that Medicare will pay for must be considered “medically necessary”—to treat a pressure sore, for example—or be of therapeutic value, and Medicare will only pay for services for a short period of time, not over the long haul. Part of the reason for this, as noted before, is that Medicare was designed as an acute-care system (performing heart surgery, curing ear infections, or saving the life of someone who has been in a car accident, etc.) and has not adjusted to the changing demographics of our society, or the fact that people are now living many years with chronic conditions such as Alzheimer’s, the consequences of stroke, and MS. Regardless of the reasons, it leaves caregiving families in the lurch, having to pay out-of-pocket for help with “activities of daily living” such as transfers and toileting. CMS (the Centers for Medicare and Medicaid Services, the agency that oversees Medicare) is not willing to pay for a power wheelchair for someone to get around outdoors if that person doesn’t need it inside the home. Common sense tells
us that in a house there are walls to hold on to, the distances are not very vast, and many homes don’t have doorways wide enough to accommodate power chairs. Since Medicare provides services for people with disabilities as well as the elderly, this could mean the difference between someone going to work and having to be on welfare. In fact, the disability community is so outraged by this ruling that a coalition was put together just to fight this provision.
