It may not be fraud, but it sure is inefficiency and waste and it exists because nobody cares. Each link in the health care chain adds to the cost of Medicare, but who cares?

2013

The picture you see here is cases of supplies for a therapy system for wound care. My wife was given these supplies to take home because she is using the system to help heal a wound the size of a quarter on her leg as a result of surgery to remove a basal cell carcinoma. The location makes it more difficult the heal.

“Is that all for us?” I asked the nurse when she carried it in. “You probably won’t need it all with the type of wound, but it comes with the machine.” She said. “But we are coming here to the wound center to have the dressing changed.” “I know, but we don’t store the supplies so you have to bring what you need when you come.” She replied. “What happens to what’s left.” I asked.

“We’ll they used to pick it up from the patient, but they don’t do that anymore, so you can either throw it away or maybe donate it to the hospital.”

At this juncture no one knows how long my wife will use these supplies and no doubt some patients will use this amount and more. However, given each box contains supplies for two weeks, wouldn’t it be more logical to distribute them as needed? Logical maybe, but not as profitable for the supplier and possibly the facility. This is like giving a patient a six months supply of a new medication before it is determined the drug will used that long.

Who cares about all this? Apparently not the hospital who participates in the process, certainly not the nurse or doctor or device manufacturer who wants to rent the equipment and sell supplies. What about me, do I care? If I was not the curmudgeon writing this blog, I likely would not care, I would not even think about it. Hey, Medicare is footing the bill and my supplemental coverage is paying my 20%.

One of the keys to better managing costs is to get all the people involved to care. I suppose you could do that through more regulation, but who likes regulation? Perhaps tighter controls on reimbursement procedures or by making the patient really pay a good portion of the cost is the answer, but then how does the patient affect change by the other people who still don’t care?

Do you care? Does the 1.45% Medicare tax that comes out of your paycheck make you care? What about the Medicare Part B premium you may pay, does that make you care? Or how about the income tax you pay on your Social Security benefit that goes to the Medicare Trust, does that make you care?

I’ll tell you who does care, Medicare Advantage Plans that are trying to make money care (Note: private insurers of non-Medicare patients also care). Their incentive is inverse to that of the equipment supplier. Both want a profit; one by selling and the other by buying as efficiently as possible. Is there a lesson here? Probably not; we don’t want profit motives coming between the patient and their doctor do we?

I suspect too that somewhere in the depths of the Medicare bureaucracy someone cares, but they are overwhelmed by the political desire to provide “high quality, affordable” health care to us seniors and the lobbying efforts that go with it.

So, here is your chance to care, tell us how to get everyone affected to care, really care about costs and inefficiency.