Occupation:: Psychiatrist

I have practiced psychiatry for more than 40 years and during that time I have cared for numerous patients covered by Medicare. I am now covered by Medicare myself. About two years ago my secretary discovered that all of my Medicare claims were being denied. Each month the company which manages Medicare in Florida had a different explanation for the denial but after correcting whatever they claimed was the problem the claims were denied again the next month. This went on for months until late 2009 when someone at the Medicare management company announced that my Medicare Provider Number had been canceled. The Medical Director later said it was because I had filed no claims in 15 consecutive months. In fact I had filed claims each of those months and each time my claims were denied. I was informed I would have to file a new application. I did and the application was “never received.” In April 2010 I again filed an application for a Medicare Provider number and by then part of the application was done online and only a few pages were printed out to complete manually and mail in. Those I sent certified mail and had proof of receipt. Two months later they contacted me to report that I had failed to write in the seven leading zeros on my checking account number on the electronic fund transfer agreement and even though I had had to include a voided blank check they could not enter them and I would have to fill out the EFT paperwork from scratch, not just add the seven leading zeros but fill out all of the remainder as well. I did so even though they were going to have to manually re-enter those seven leading zeros when they copied the numbers into their computer. A few weeks later they informed me that another problem had existed on the EFT paperwork that I had not been told of when I resubmitted it and I would have to resubmit it all over again. On top of that the form for the EFT had changed between April and June and if I could not come up with a blank copy of the earlier form I would have to resubmit the entire application, both the online and paper portions. Luckily I found a passable blank copy and resubmitted only the EFT and it was finally accepted and my Medicare Provider number was re-issued. That happened one week before my financial costs of maintaining an office without Medicare reimbursement for over a year prompted me to decide to retire. I had been assured through the process that once my number was reissued I could resubmit my claims and those that were not older than a year or so would be paid. Now I am told that I will be paid only for services provided since I regained my Medicare Provider number–by that time I had finished seeing my patients and was making referrals. This constitutes Medicare Fraud as far as I am concerned. Apparently a crooked physician is better prepared to cope with the corrupt Medicare system than the well-intentioned one who tries to provide top quality service to his/her patients. Finally, when I tried to find psychiatrists to whom I could transfer the care of my patients I discovered that no other private psychiatrists in the area would accept Medicare because they would not subject themselves to what I have gone through. This is a simplified version of what happened. In fact the problems I ran into in trying to regain my Medicare Provider number were so numerous and absolutely unbelievable you would have had to experience it. I have spoken to several colleagues who report similar horror stories. Yet no one is doing anything about this kind of Fraud against Medicare providers!

Occupation:: Medical Student

I will be in over $160,000 worth of debt from medical school alone… not including college debt. I will have put in an average of 10 hours of work every day (including weekends) for 4 years. I will have sacrificed my own health and put my life on hold to make it through. When I graduate, I will work for at least 3 years of residency on a salary of less than 2 dollars per hour. If I wanted to be rich, I would have gone into business. Doctors are forced to specialize because most of us will not be able to pay back our loans on the salary of a primary care doc. Yes, the system is definitely screwed up. But remember, if you start cutting salaries, medical students MUST get re-imbursed for their years of loans!!!

Occupation:: Registered Nurse

I grew up in a 2 bedroom home, we always had elderly and/or ill individuals to care for and did a good job of caring for them. I have been a nurse for over 30 year and have seen multiple changes. When I first entered nursing we took care of people, now we take care of paper work. I am assuming overall (I work in a nursing home) there is close to 10 times as much time spent with documentation as there is patient care.

Another issue that really annoys me is to hear commercials encouraging families to file suit of negligence or abuse. I invite any individual to work one day in a nursing home. It takes a very dedicated person to do this type of work. Yes, negligence occurs, yes abuse occurs. For example, you have two workers (CNA’s) and a nurse per hall of 30 plus patients. Baths must be done, (hopefully you have a bath team working today) most patients must be spoon fed, most of them are incontinent, most are confused and angry about being at the nursing home. The worker is daily abused as they struggle to keep from being hit, bit, spit on, pinched, kicked, cursed at and told how much “I hate you, you old……” Yes there is negligence, the two workers on the hall have 4 – 5 call lights blinking, state regulations say these must each be responded to within 5 minutes, or you are negligent, there are approx. 15 – 20 of these patients who have had incontinent episodes and the longer each one has to wait the greater the chance of that patient having skin breakdown. At least 2 – 3 of these patients become impatient because you did not get to them quickly enough and attempt to go to the bathroom alone, and will likely fall and sustain a fracture. (Don’t forget to report all injuries.) State regulations discourage any type of device to keep confused residents from getting up on their own. Oh yeah, and the resident that fell (injury or not) an incident report which takes about an hour to complete must be done and that patient must have complete vital sign and neurological assessment every 15 minutes for a period of time. Families and doctors must be notified (hopefully the family or responsible party still has a valid phone #). In the mean time a new patient is being admitted which requires total assessment and hours of documentation. A few rooms up there is a patient dying and you really need to be at their bedside. One of the other rooms has a patient which has just passed away, a minimum of 2 hours time. Another patient on the hall is turning blue and must be suctioned immediately. Oh, we haven’t had a fire drill on this shift, state requires a certain # of drills. Two confused patients are in an altercation which must be interrupted promptly, oops two more incident reports to do. Mr.____bumped his arm on the door knob and his arm is bleeding and must be attended to, another treatment and incident report to complete. One of the CNA’s has already been working 12 hours because someone called in sick. And mercy forbid you go overtime to get your job done, and you can’t work off the clock, this is a liability issue. You should have left work 4 hours ago but a disgruntled family member doesn’t like the nurse on duty now and they are demanding that YOU hear them out and get the concern resolved. Be sure you chart everything you did, if it’s not charted it’s the same as not done.

Does it matter to surveyors, lawyers, administration if the job gets done as long as it is documented? Oops false documentation. Be real, do these people really think everything that was supposed to be done in 8 hours and everything documented as done, actually was?

Everytime I hear “we are changing__________it will cut down on paper work,” I think “who are you kidding?” Why can’t we take care of people instead of paperwork?

CNA’s can work at fast food restaurants and make as much money as they can working in the nursing home. In addition they wouldn’t have to be worried that before they get off work someone is going to ask them to work another shift. Neither would they have to worry about being called to come in to work on their day off just as they have fallen asleep after working a double shift. Nurse’s, CNA’s, firefighters, policemen, emergency medical personnel have very stressed lives, put their lives and their families lives on hold to sacrifice for others, and for what salary? Our entertainers, ballplayers, moviestars, singers, and many other titles far exceed the salaries of those who sacrifice for others. And although we don’t expect thanks, we do it because we want to help others. The thanks we get is to live every moment of our lives worried about liability. O h h h-the price of liability insurance.

Granted, you do not have a patient die every day you work, a fall, patients in an altercation etc. However, there are more things than you could possible imagine I haven’t mentioned which must be done. Make rounds with the doctor, get to the end of the hall and get paged for a phone call, and multiple, multiple little things. And don’t forget to smile.

Occupation:: Nurse, Quality, Utilization Review

I came across this web-site while looking into resources for people to prevent or resolve health care problems. I have worked in a variety of healthcare services (home health, hospice, correctional institutions, and hospitals) since 1973. I have also personally experienced healthcare services with my parents and other family members. These experienced gave me a totally new insight to what the patients and families have to deal with physically and emotionally. I believe that the majority of healthcare professionals really care about their patients and families but the system has really gotten bogged down with regulations and paperwork. The majority of lay people inherently trust healthcare professionals, which is OK but people need to take responsibility for their or their families care. Research diagnosis, symptoms, medications, etc. Work with your healthcare team. It is not insulting; nurses and physicians are human and generally appreciate your involvement. Billing is very complicated, read the explanation of benefits and your statements before making payments. Make sure there are no mistakes. It is my hope that a forwarded minded individual or business would start an organization or business that is objective (not part of the insurance or payor nor healthcare team providing care) to assist the general public as a liason or consultant with these areas. I would certainly be interested in working for this type of organization, giving hope to resolving healthcare problems.

I work with health care professionals helping them manage their career as their agent, or their health career agent, and I can tell you a shift has occurred. Good health care workers, frustrated with their career, are leaving the field and moving on. Those who remain are able to flourish because they are able to function in the current environment. Meaning, the pure play health care professional ala Florence Nightingale is gone and replaced by a vocation oriented individual.

For many of the health care professionals who stay, it is all about the money. Not that they are jumping up and down and set for life, far from it. More like they are frustrated and stuck in their career in health care, like postal workers who can’t afford to leave because of their paid in retirement.

As an agent for health care professionals, it is seldom about the money today, it is about happiness. What health care workers want is appreciation and the ability to help others. Our current insurance system isn’t allowing it and it is driving the best practitioners away.

“Thank you and may God truly bless you this day! While I am totally blind and on Medicaid, my wife has become indigent thru the loss of her job as a nurse because of injuries sustained at work. We recently moved to NC from SC. We did this primarily because we thought there would be better medical resources for her here. We quickly got our street education on the free care system. You are quite right when you say that we indeed need to be on our knees for this sorry state of American medical affairs. Until you, with no thought of yourself or your own glory, sent [person A] at [place A] this message, I didn’t know how we were going to get my wife’s medicine. We have been unsuccessful so far at getting her into the free care system. We have filed for Medicaid on her behalf but have not received an answer yet. We are currently sitting on $25,000.00 worth of hospital and medical bills because of a fall she took Easter Sunday. I just got her back home with me June first, we have been married 23 years and spent our 23-RD anniversary, May 22-ND; apart due to this incident. Again I hope you will pray for us and may God richly bless you this day!

Quite Sincerely: D…

P.S. Some times, I think we can best learn from what our Lord did not do when confronted with a situation, as in the following example.

When Jesus walked on the Earth, he did his best for every blind beggar he came in contact with; he healed them! What he did not do but could have done was to whip off a loaf of bread and two fishes so the man wouldn’t have to beg for food that day. Instead, he restored his sight! Now, the man could go get a job as a chariot driver or something to support himself.

Please know that you have done your best this day and I love and thank you for it!!! ”

This was the email I sent out & included it here in case someone may find it helpful.

“Hi Everyone,

Please pass this along to anyone you know who may need help paying for prescription medications or anyone who works with people who may need help paying for their medications. This is good for the elderly, working class, people with no medical insurance or no Rx drug coverage or just about anyone. Anyway check it out, save the website in your favorites and pass it along to others.

I hope this will help many folks. Now we need a similar program that helps with medical care & especially something that helps with the medical expenses of treatable conditions that would result in a full recovery. There are too many folks out there needing hip replacements, heart valve replacements, and other surgeries but they have no medical insurance and no job because they either can’t work or told are by their employer they can’t work and consequently they are terminated despite it being morally and legally wrong. What’s wrong with this country that there is no help for folks like this. They talk about on the news that people are going to the emergency room for medical care they should be receiving in the doctor’s office. Well there are too many communities where the “clinics set up to serve the indigent” are refusing to treat them because they charge them for the visit and they have no money. They are told not to come back until they pay their bill and if they need medical care to go to the emergency room. It’s sad but those who work with this population or are among this population know it’s a sad fact. Please pressure your elected officials to act on this and demand something be done about this health care crisis. Please pray for this country. It’s really a sad state the problems in the healthcare system in the US. Something has to be done.”