Can We Calculate the Price of Human Dignity?

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motor wheelchair
motor wheelchair

I never claimed I was brilliant.  I never bragged that MENSA representatives were knocking on my door and pleading for me to join.  But I am smart enough.  Smart enough to gain admittance to medical school and a residency program.  Savvy enough to own and operate a business.  Lucky enough to be married and have children. Most difficult projects in life require hard work and a certain amount of stubbornness.  And I rejoice that I have been given the mental faculties and vast opportunities to succeed.

I reluctantly admit that I have always found a way around most of the hurdles in my path: I either jumped over, ducked under, or swerved to the left or right.  Occasionally, I turned and ran the other way.  Nothing extraordinary here.

Recently, however, everything changed.  I've met my nemesis.

It takes the form of a colossus of metal, rubber, and a little bit of padding.  One can see it hocked on the Internet and in infomercial-like segments with elderly people cheerily scooting around with smiles on their faces.

Yes, I'm talking about power wheelchairs.

Now, in general, I'm not a fan.  Of the thousands of geriatric patients I take care of, I may have ordered 20 in 10 years of practice.  Occasionally, no matter how much I dislike them, some patients are so disabled that there is no choice.  As their doctor, I want to help these patients.  I want to protect them from falls and increase their mobility.  I want to restore a modicum of dignity through the wonders of lost agility.  

But no matter how I try, every order I have written in the last 6 months has been denied by Medicare. 

It's not that I don't understand.  Fraud happens, and these machines are expensive.  So I get that in order to have this kind of service covered, a face-to-face evaluation of the patient must occur documenting the disability and the reason for the need.  I get it!

Unfortunately, I can longer traverse this process without messing it up.  Either I document too thoroughly or not thoroughly enough.  My review of systems is inadequate or my review of systems is too adequate.  One patient's note did not describe in enough detail the weakness requiring a power chair.  When I addended my note and clarified, I received a denial message saying that the patient was too weak to maneuver the chair.

So this frail, elderly person who has been tripping over her walker because of inadequate strength will not be able to move her hands enough to operate a joystick? Really?

We often use the word draconian to describe the clunky nature of governmental regulation.  The collateral damage of dealing with small amounts of fraud is often greater that the cost savings from such measures.

My unstable octogenarian will not get her power wheelchair.  Instead she'll trip over her walker and land in the hospital with a broken hip.  Instead of a $5000 piece of medical equipment, the bill will likely be more than $50,000.

Let's not forget the cost of a hundred covered days in a nursing home.

And can we calculate the price of human dignity?


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