Within the confines of our current state at my work-place, the patients of the program for which I work can only have Medicaid. Once they receive Medicare, we have been forced to cut them loose, the lucky ones over 65 making their way into our program for that population. But at times, some fall through the cracks, and then comes Medicare Part D, otherwise known as Medicare Part Duh. And all hell can break loose.
When someone becomes eligible for Medicare, we all now know that they must sign up for a Medicare Part D drug plan or face financial penalties. The Feds seem to enjoy creating these labyrinthine and ludicrous scenarios which penalize and confuse the huddled masses. The United States of Sadism.
As a case in point, just today a patient rolled into my office in his electric wheelchair. Physically disabled, with major depression and a anxiety disorder, this kind and soft-spoken gentleman needed my assistance. The fact that he is no longer "my patient" on paper means nothing to him, and just as little to me. He explains that he understands that he has new drug coverage and demonstrates this by showing me his new Medicare Part D Prescription Drug Plan card from a company which shall remain anonymous (to protect the guilty). He continued to explain that the pharmacy where he always fills his prescriptions has informed him that he now must pay $74.85 for his one-month supply of BuSpar, a medication for anxiety that he has taken for years. I look at the 1-800 number on the card and sprint to my desk.
"Customer Service, may I help you?"
"Yes, one of my patients is being denied a crucial medication and cannot afford the $85 to pay for it. If you don't help me, I'll reach through these phone lines all the way to California and strangle you." (I paraphrase here, obviously.)
"Well, I'm sorry to hear that, but this patient, or should I say 'member', has a $250 deductible which he must meet before we will may for any prescriptions. He will then have a monthly premium and co-pays for each prescription. Is there anything else I can help you with today?"
"Do you mean that this 65-year-old man who worked all his life and now lives on a fixed income in subsidized housing must come up with $250 to make a deductible which is impossible for him to budget for?"
"Uh, yes, I'm afraid it does." Then an uncomfortable silence on the other end of the line until he says, "Is there anything else I can help you with today?" (As if he had truly helped me with anything.)
"Yes, please give me your home address and phone number so that I know where to direct the hate mail." (I didn't really say that, folks. I just hung up on the heartless managed care bastard who seemed to lack an ounce of compassion.)
Hanging up and putting my head in my hands, wondering how to explain all of this to my patient, a small nightlight-sized bulb went off in my head. As of the 1st of November, my dear patient who is currrenty in Managed Care Purgatory would be eligible for coverage under our program for people over 65 with Medicare! We would essentially become his payor and our nurses would then make all of the decisions about his coverage and medications, with no premiums or copays! (Sounds like a Communist conspiracy to me, Senator McCarthy.) Relief flushed through my veins like so much Bombay Sapphire Gin on a warm summer evening.
Shaking off the thought of a gin and tonic, I rummaged through the meds which I keep in a locked drawer for some of my patients, successfully "borrowing" fourteen 30mg BuSpar tablets from another patient. ("She'll never miss 'em!") But seriously, this gentleman will pay her back, so to speak, when he gets his next supply, and no one will be injured by the transaction. Another flush of relief. Shall we have another drink?
I press the small bottle of BuSpar into my patient's hands, his eyes smiling, my anxious perspiration drying, and we both take a deep breath knowing that we have subverted the dominant paradigm of Medicare Part D(uh) once again. Like my patient who was denied a walker by Medicare because he already has a wheelchair (did you hear that, Orwell?), this patient's only hope of skirting these insane rules and regulations is to seek shelter in our little program which ducks those guidelines and gives the people what they want at a price they can afford, and we have great clinical and economic outcomes, to boot. What more could a Medicare actuary ask for? (Well, deductibles and co-pays, for one, not not mention pricey premiums......)
Folks, I wish I could share with you the secret to what we're doing, the address of my company, and how this practice can be replicated throughout the land, but we just aren't there yet and I must still remain "geographically anonymous". But rest assured, this new breed of "managed care" certainly has a future, and if those actuaries would just get out of our way, maybe we'd be able to fulfill our mission and roll this new model of care out to the rest of you. Until then, keep fighting the good fight, and know that in many corners of this country and the world, brilliant minds are strategizing and conjuring ways to continue to stand this government's duplicitous and worthless schemes on their head. Millions suffer due to their incompetence, and until we think outside of the box---or forget the box altogether---we're trapped in a world we never made.
Gin and tonic, anyone?