Medicare System Lacking

Medicare System Lacking

By ANJETTA McQUEEN
The Associated Press
August 13, 2001

WASHINGTON (AP) - Endless busy signals. Mere slaps on the wrist for errant doctors. Cases settled without phone calls to patients. These are among the troubles affecting a system designed to help Medicare patients complain about poor health care, said a federal report released Monday.

The Health and Human Services Inspector General, an internal watchdog for the federal agency, found:

	Patients have to jump through too many hoops to file complaints.
	The system rarely holds doctors or hospitals responsible for their actions.
	Responses to complaining patients are limited, leaving them frustrated and unsatisfied.

Medicare, the federal health insurance program for 40 million elderly and disabled Americans, pays dozens of private reviewers to handle complaints and recommend punishments if needed. But the new report has found major shortcomings in the system, which began in the late 1980s.

A 1995 watchdog report laid out similar concerns. The new report recommended that the federal agency that runs Medicare either fix the current system, or find others who can.

``We found the complaint process to be an ineffective safety valve that has changed little since our inquiry 5 years ago,'' said Michael F. Mangano, the acting inspector general, in a letter to the Centers for Medicare & Medicaid Services. He added that the current contract with the private reviewers ``treats complaints as a minor activity.''

CMS officials said Monday that the report ``points out the kinds of challenges and problems we seek to address under the new CMS structure.''

Federal officials have said privacy laws that protect doctors or patients make it hard for them to share some progress reports.

The report examined reviews of thousands of complaints made from August 1997 to July 1999. Patient complaints included some serious problems such as missed medication or treatment delays.

For instance, a patient complained that after suffering complications during bladder surgery at an outpatient clinic, he was wheeled six blocks away to the hospital while he was still dressed in the hospital gown with his family following him.

Another patient said he had used all of his lifetime benefits for hospital-based mental health care because doctors in detox, psychiatric and emergency room units had improperly treated him.

Despite such complaints, the inspectors found that private reviewers recommended just six doctors and other medical officials for punishments in the last five years, with no such recommendations in the last two years.

The report said reviewers rarely interview the parties involved in the complaints, instead relying on specific medical records requested when the complaints are filed.

The reviewers ``do little beyond the medical record review to investigate complaints, and are not expected to do more,'' the report said.

The report also faulted the agency for not getting the word out to patients on their right to complain and how they should go about it.

``A review process, no matter how good, will not lead to better quality of care unless beneficiaries use it,'' AARP, the largest lobbying organization for older Americans, said in response to the report.

Since 1995, the Medicare agency has made some improvements, such as reducing the maximum number of days in which a complaint should be handled from 250 days to 165 days, the report said.

Source: The report can be found at http://www.hhs.gov/oig/oei/reports/oei-01-00-00060.htm

By the way, the Bazelon Center for Mental Health Law released the following call to action alert yesterday for those interested in improving the Medicare mental health benefit:

MODERNIZING MEDICARE'S MENTAL HEALTH BENEFIT

Bills have been introduced to expand mental health services and end practices that discriminate against people with mental illnesses in the Medicare program. The most comprehensive is the Medicare Mental Health Modernization Act of 2001 (S. 690/H.R. 1522), introduced by Senator Paul Wellstone (D-MN), and Representative Pete Stark (D-CA).

The bills would:

	Create parity for outpatient mental health services. S. 690 and H.R. 1522 would end the disparity between mental health and medical coverage by making Medicare responsible for 80 percent (rather than 50 percent, as now) of the cost of outpatient mental health services-the same percentage as for general medical costs.
	Expand outpatient benefits by covering "intensive community-based services," including psychiatric rehabilitation, assertive community treatment, intensive case management and day treatment.
	Improve access to a broader range of mental health services, including those provided by clinical social workers, marriage and family therapists and mental health counselors, and allow these providers to bill Medicare directly.
	Expand coverage of intensive residential treatment in detox centers, crisis programs, therapeutic or group treatment homes and centers for addiction treatment.
	Eliminate the 190-day lifetime inpatient limit on mental health service utilization. Senators Olympia Snowe (R-ME) and John Kerry (D-MA), sponsors of the Medicare Mental Illness Nondiscrimination Act of 2001 (S. 841) and Representative Marge Roukema (R-NJ), author of the House companion bill (H.R. 599), also seek to eliminate the discriminatory co-payment rates for outpatient mental health services.

However, these bills do not include any of the other provisions to expand mental health coverage for Medicare beneficiaries. Source: http://www.bazelon.org/801update.html

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