Grade Your Government: Medicare Part 1

By Taylor Hemness - email

EAST TEXAS (KLTV) - Arlyn Vierkant's mother is 98 years old. She lives and receives much-needed care in Providence Park in Tyler.

"She began to need some help at home, and that's where the home health care agency kicked in, and it was just kind of a seamless process," Vierkant said. "It moved on through this and the hospitalization, and now into the rehabilitation."

Many of the residents at Providence Park are here thanks to the benefits provided by Medicare.

Although Arlyn's mother has been there for four months, administrator Heather Moore says most stays are shorter.

"A big part of our program is short-term rehab," Moore said. "We take advantage of that benefit for our residents. We get them in, get them real intense rehab, and try to get them back out to what they were doing before. Our average length of stay here for medicare is about 56 days."

Medicare covers up to 100 days of skilled services, which includes rehab. At Providence Park, there's a model home, where residents re-learn how to care for themselves. But, the government-run insurance program also works for people who need care in their home.

Greg Ortiz has been in the home health care profession for 25 years, and says the current system allows Medicare patients to have a smoother transition than others when it comes to post-hospital care.

"If we get a patient, in that same scenario, we have to call the insurance company, and talk to a nurse or just a person on the phone, that will say, 'No, that patient doesn't qualify,'" Ortiz said. "The difference is, patients under medicare have access to care, patients under insurance, the way it is today, have no access to care, for home care."

As with anything related to health care, money is a big part of the equation. When it comes to Medicare, some physicians say they are the ones who feel the pinch. Dr. Scott Lieberman with Cardiovascular Associates of East Texas says sometimes, Medicare reimbursement money dries up temporarily and unexpectedly.

"We sometimes have to take out a line of credit from a bank in order to meet salaries and payroll while we wait for medicare to clear their decks and get the faucet turned on again," Lieberman said.

But Medicare patients also have to deal with certain expenses that aren't covered.

One of the most common complaints, the Medicare Part D "donut hole." It kicks in after patients spend about $2,500 on medication. Coverage stops and doesn't pick up again, until costs reach the $5,000 mark.

Dr. Barbara Allen at Trinity Clinic says this a big problem that leads to difficult decisions.

"It is making people in some cases choose between medications and food or light bill, Allen said. "And many patients are afraid to admit that they can't afford the medication."

Both doctors mentioned preventive care as an area where Medicare could do more, so patients who are healthy, stay healthy. But, the problem with that is that preventive care is very expensive, and Dr. Lieberman said that often with preventive care, thousands of dollars are being spent to save one life. That gets very expensive on a national scale.

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