Florida Dialysis Patients and Medicare Medicaid Issues

[bdpoe]

What has Been you Experience getting Dialysis, Doctors, and Meds in Florida?
Medicare/Medicaid has actually hurt many dialysis patients. How has it been for you?
Is DCF or the ESRD Network helping you? What is your opinion?
I look foreward to your input.
Thanks
...bd

[glitter]

We live in Florida- my husband gets SSD and Medicare, plus we have a private policy we purchased years ago, Medicare is his primary because of a clause that had something to do with how he came to have no kidney.(usually medicare is secondary for three years) I forget what it is. Blue cross is his secondary. and it has no prescription med. benefit.

His kidney center makes a donation to the National Kidney fund every month in his name, then the NKF pays our BCBS premium. (300 dollars)  (ask you socail worker if your center participates)

If you make under 40,000 a year Social Security has an Extra Drug Benefit Program where they pay your premiums and all your prescriptions cost between 2.35 and 5.35 each. There is NO coverage gap.

the kidney center accepts what our two insurances pay and does not bill us for anything. we do have a 1500.00 deductible on the BCBS- but most of the Dr.s don't bill us for very much after medicare. Our kidney center is one of three owned by a local individual.

His nephrologist is AWESOME Dr. Tony Tran out of Melbourne,Fl
His GP is also AWESOME Dr. Melton
His Kidney center is okay- the nurses can be a bit full of themselves in thinking we are too stupid to understand things-arrogant-BUT they are excellent in working out his schedule as needed for surguries etc. They do work with us as much as possible. They do seem to have his interests at heart.


all in all- Despite what I've heard others say about Florida- The Melbourne area seems to be treating one dialysis patient pretty well-

[bdpoe]

Although this is an old article, taken from another posting, it explains the situation that many ESRD and
chronically ill Floridians are facing. I too am caught up in this quagmire.
 
For years, even before my ESRD, I have advocated for health care issues,
the homeless, working poor and various political issues.
 
I have now taken my advocacy for myself and thousands of Floridians
with ESRD who are in similar situations as described in the article below
to various agencies, state and federal legislators with no immediate remedy in sight.
 
It is a slow arduous process that I'd hoped could be resolved rather quickly.
Eventually there may be an opportunity to further educate these people with whom I've contacted of your concerns.
Your input is requested and appreciated.

If you are in Florida, any concerns about your care, Funding, Doctors, Facilities, ect would be greatly appreciated
to help better understand the needs in Florida.
 
Best Wishes
...bd
 
Medicare Part D major disaster for chronically ill
Once able to get help with medical bills, residents now caught in gray area as their health declines

By Liz Freeman

Tuesday, November 28, 2006

They are at wit's end when medical bills arrive in the mail that Medicaid used to pay.

There is no way many of the 38,000 chronically ill Florida residents who once were part of the state's Medically Needy program can pay the bills for their visits to specialists, for laboratory tests or dialysis, given that they struggle to live on disability income of about $800 a month.
With the launch of the Medicare Part D drug program this past Jan. 1 by the federal government, many of the Medically Needy no longer qualified for the state program. That meant the state's Medicaid program quit picking up the tab for their medical expenses.

"We figured a lot of people were going to take a hit but we didn't realize how many," said Karen Paladino, a social worker at dialysis centers in Bonita Springs and Naples owned by Fresenius Medical Care.

When Medicare Part D moves into its second year this coming January, more chronically ill patients now covered by the Medically Needy program will be in the same bind when they are required to have Part D drug plans.

A petition is circulating around the state for patients, their families and any concerned citizens to sign that asks the Florida Legislature to address the life-and-death quagmire that many of the Medically Needy are facing when they lose Medicaid assistance.

"We can't get sick people to Tallahassee but now they can get there on paper (the petition)," said Mary Ellen Ross, executive director of the Florida Transplant Survivors Coalition in Delray Beach. "What we would like to do is open a dialogue with the Florida Legislature and look at Part D and income levels."

At issue is the structure of the Medically Needy program, started in 1986 to provide temporary Medicaid coverage for residents who face a catastrophic medical condition but whose incomes are too high, often by a meager amount, to qualify for traditional Medicaid.

They must qualify every month for Medically Needy coverage by meeting their "share of cost," when their total medical expenses for the month would add up to 75 percent of their monthly income. At that point, Medicaid kicks in for the rest of the month.

Traditionally, the patients would reach their share of cost when they totaled up their monthly drug expenses. They or their social workers would submit their total drug bill for the month to the state. Medicaid then would cover the drug bills and all other medical expenses for the month.

That all changed when Medicare Part D came into being this past Jan. 1. Many of the Medically Needy are "dual eligibles" with Medicare. They were automatically enrolled in Part D plans and that meant they could no longer count their drug expenses toward their share of cost each month.

So they no longer qualified for the Medically Needy program and immediately were left with bills for doctor visits, lab tests or dialysis. Some have reacted by not going to doctors' appointments or for laboratory tests and their health is declining. Others are tapping the compassion of their physicians for free care or for payment plans, Ross said.

"Our illnesses are not getting better," Ross said. "We are not here for a free ride but honestly when you are given a certain amount of money to live on and can't get care, we will be forced into hospitals. Share of cost is a very large issue."

Paladino, with the local dialysis centers, said her Medically Needy patients were facing enough stress in their daily lives because of their illnesses, so the impact of Part D has been tremendous.

"People who were (medically) stable are not stable anymore," she said.

Physicians are helping out by billing them but not actively pursuing payment, she said. Her dialysis centers are not turning the patients away even though the centers know Medicaid isn't picking up the bills anymore, Paladino said.

Lifelink Foundation in Tampa, an organ procurement and transplant program, saw numerous transplant recipients lose their Medically Needy coverage.

"It was unbelievable. The outcry was enormous and justifiably," said Rebecca Arsenault, Lifelink spokeswoman.

Statistics for how many Southwest Florida residents lost their Medically Needy coverage this past January weren't readily available from the state Department of Children and Families. Last November, 776 individuals from Lee County and 338 people from Collier County were in the program.

The petition asks state lawmakers to revise the Medically Needy share of cost by using a sliding scale formula according to federal poverty guidelines. That would help

The petitioners will collect signatures through the end of December. Supporters can sign it at dialysis centers, transplant hospitals or online at www.floridachain.org.

"The more we get the word out, the better we are going to be," said Bette Luksha, another member of the survivor transplant coalition.

At the same time, Luksha realizes that homeowners' insurance reform and immigration are priority issues next spring for the state Legislature.

"I believe we will be coming in with open minds and other options to the sliding scale (proposal)," Ross said. "I would like to see some hearings, to tell people exactly who we are and how by the third week of the month don't have any money to live on."

Lifelink representatives are backing the petition and have met with elected officials from the Tampa region to inform them of what is happening, said Arsenault, of Lifelink.

"It's heartbreaking," she said. "It flies in the face of everything we try to accomplish here."

•••

A grassroots petition in Florida asking the Legislature to restructure the state's Medically Needy program can be seen and signed at www.floridachain.org.

http://www.naplesnews.com/news/2006/nov/28/petition_asks_legislature_look_medically_needy/


 

[bdpoe]

What is your hospital, clinic or facility doing to increase sanitation and
cleanliness? Chances are not much aside from a little lip service.
 
With several states, including Florida, faced with dramatic cuts in social services Healthcare is targeted to take a direct hit which has doctors,
clinics and hospitals worried.
 
In the USA your chances of getting a Hospital-acquired infection (HAI)
are approximately one in 136. But some feel that number is lower
than what it should be as many cases are denied, contested or simply overlooked. Officially the US rate of infection is about half of what it is
in Britain.
 
At issue are dramatic cuts in Medicare and Medicaid at respectively the
state and federal levels. Then, in Florida, Governor Crist's recent mandate
that all agencies cut spending by 10%. That means less monitoring, less inspecting, less staffing while the chronically ill and medically needy suffer a reduction in services. A prescription for suffering.
 
Medical Bills are the #1 cause of bankruptcy and homelessness here in
the USA. Aside from lip service and phony promises, our candidates,
legislators and elected officials seemingly fail to realize the seriousness
of our health care crisis and make the cure a top priority.
...bdpoe
 
Dirty hospitals must clean up, says Brown


Jo Revill, Whitehall editor
Sunday July 1, 2007
The Observer


A drive to slash the rates of MRSA and other hospital infections is being masterminded by Gordon Brown, who is convinced that the public's perception of the NHS has been swayed by concerns over cleanliness on the wards.
Brown has told close colleagues that they will never win 'hearts and minds' over the health service reforms until they can demonstrate that the wards really are cleaner, and that they are cutting the numbers of patients being infected.

 

The Prime Minister and his aides have become alarmed that one in four hospitals is still not meeting the hygiene targets imposed in November 2004 by the then Health Secretary John Reid. Hospital-acquired infections (HAI) now affect some 300,000 people a year, and despite better control measures appear to be epidemic in some areas. The government is unlikely to meet the target it has set itself, of halving the numbers diagnosed with MRSA by next April.
Brown chose to highlight the issue of hospital cleanliness yesterday, on his first visit to a hospital - Kingston, in south-west London - as Prime Minister. A team of experts is being set up within the Department of Health to look at new measures to deal with the problem. The new health minister, the surgeon Professor Ara Darzi, will be asked to devise a new strategy to combat the infections.

Since MRSA first hit British hospitals 10 years ago, it has spread across the country, as an increasing number of people became resistant to antibiotics, coupled with poor cleaning on the wards and the fast turnover of patients.

In recent weeks, Brown has been touring the country listening to Labour supporters and the public. One aide told The Observer that the Prime Minister had been dismayed by the numbers who put MRSA top of their priorities for the NHS. 'We've been thinking that tackling the waiting lists is the number one issue, along with better access to the GP, but we know that dirty hospitals are in the public mind,' the aide said.

The new Health Secretary, Alan Johnson, visited Kingston hospital with Brown yesterday, where they learnt how the hospital had managed to reduce its MRSA rate by 47 per cent.

The hospital imposed a stringent system of hand hygiene compliance and general cleanliness. Posters have been put up urging visitors and staff to wash their hands, and a team goes around the hospital every week and observes staff to give them a hygiene compliance score.

Other hospitals are also tackling the superbug. In the final quarter of last year, 1,542 patients had MRSA infecting their bloodstream, seven per cent fewer than in the previous quarter.