Legislated Genocide ?
By Wendy Ford
Having been a student of Dr. Strickler’s for over thirteen years, I am just now coming to a place where I am realizing one of the major things he has been working on with me: it is no longer acceptable to just sit back and observe. My mouth must open and something be said. Action must be taken. Well, here I go.
Dr. Strickler used a phrase one night in class that stunned me and made my blood run cold: Legislated Genocide. My initial reaction was that he was just exaggerating and being a bit melodramatic with his wording, but as he went on to pose questions and make comments the realization struck me as if a physical blow had been made. My God, he is absolutely correct. Dr. Strickler was referencing legislation of programs and processes that normally promote the fabric of public welfare. He really struck a nerve and it has been vibrating deep within me ever since.
Cambridge Advanced Learners Dictionary defines Genocide as: noun 1. The deliberate killing of a whole nation or people. Thesaurus: slaughter, massacre, extermination, mass killing, ethnocide.
How does an action that we know in our very core as a Human Being to be wrong come to find its way into our legislative system?
It cannot just happen by itself. Initially an individual has to become aware of the thoughts in their head then work with the thoughts internally until they become a concept or idea. The individual then brings that concept or idea into manifestation by taking the action of spoken voice and/or writing words on paper or striking keys on a keyboard. The concept must then be discussed among many other individuals fine tuning and sharing ideas until coming to a conceptual agreement. A policy, written or unwritten, is then formulated. This policy is taken to the next step of being used with consent and knowledge to be applied as an accepted course of action. Power is wielded. To be written into policy and guidelines on the federal level takes time, perseverance and commitment to purpose, application of power. It cannot happen through the action of only one individual. For a policy to come into federal legislation requires action and consent of those who we have elected to act on our behalf.
Having entered the healthcare profession in 1973 a certain perspective has been gained as to the huge gap that exists between legislation and the effects and consequences generated by legislative acts.
Almost everyone knows of the existence of the Medicare health insurance system and the radical changes that have been in the news over the past year. Unfortunately all the hype and frenzied goings on leading up to the recent political elections have eclipsed a most important fact requiring the utmost urgency of action by the American public.
Without definitive congressional action by mid-December, the “exceptions process” for the Medicare Outpatient Therapy Cap will no longer be in effect. Come January 1, 2007 there will be a “no exceptions” $1780 cap on Occupational Therapy and a $1780 cap on Physical and Speech Therapies combined.
Medicare Part B pays 80% of allowable fees (they have their own fee schedules) with most secondary insurances picking up the 20%. However, and here’s the tricky part, since the secondary insurances pick up the 20% of the allowable fee accepted by Medicare if Medicare pays zero there is NO reimbursement by the secondary insurance company. Should some other illness or injury require skilled therapy intervention the individual would pay 100% of the costs out of pocket. Very few could even afford to entertain the idea of such costs.
Bottom line: a patient with a catastrophic illness or a degenerative disease process will only be allowed a maximum of $3560 PER CALENDAR YEAR for outpatient rehabilitative services. Period. No exceptions. Let’s use a very conservative cost for an hour of outpatient therapy to be $150. That would come to about 11 Physical/ Speech Therapy and about 11 Occupational Therapy outpatient visits available to an individual for the entire year. Not “per occurrence” but for the ENTIRE YEAR. What might some consequences be? Here are several hypothetical but very realistic and simplistic scenarios.
Most patients with an acute injury or single joint replacement do very nicely with 6 to 8 outpatient therapy visits. But what happens if an individual has a total knee replacement in January (using 6 PT visits) then needs to have the second knee replaced in March (using the last available 5-6 PT visits)? That individual has NO remaining Medicare monies for outpatient rehabilitative services available until January of the NEXT calendar year. It won’t matter what additional medical problems or injuries befall that individual.
Take for example the 65-year-old office worker who develops carpal tunnel syndrome of the hand requiring surgical intervention followed by outpatient hand therapy from an occupational therapist (using 6 visits). She has a successful recovery and returns to work but 6 months later develops the problem in the other hand. Her surgeon recommends therapy to relieve the symptoms and possibly postpone the need for surgical intervention but the patient is reluctant since surgery seems inevitable and she knows she only has 5 sessions left for the entire year. Instead of therapy, the patient and surgeon opt for surgical intervention. This time there is a complication of a wound infection delaying progress with her therapy but only having 5 visits left and not being able to afford to cover continued costs out of her pocket the office worker returns to work. She goes back to work before her hand is ready with only partial use of her hand and fingers so she is unable to fully perform her duties efficiently and without a great deal of pain. By the time her Medicare benefits kick back in the scar tissue will be permanently formed and it will be too late further rehabilitation. Because of continued pain she will be unable to continue in her office position requiring extensive keyboard use and will go on disability that will subsequently lead to early retirement with loss of full retirement benefits. She still will not be pain free and only have partial use of her hand.
One last example: On New Years Day a 66-year-old gentleman suffers a stroke while playing tennis at his winter home. It leaves him with cognitive impairments more than motor so he is able to move about fairly well using a cane, feed and dress himself. However, his motor planning and problem solving skills are impaired to the point where it is not safe to leave him alone. He only can have 6 Speech Therapy visits because Physical Therapy needed 5 visits to teach him how to use the cane, strengthen his leg and improve his balance so he can be independent with moving about his home. The first two visits of his allotted Speech Therapy monies are spent with exhaustive batteries of tests to identify his problem areas of function. Now there are 4 visits left to teach him coping strategies that need to be refined as healing takes place and the brain is trying to “rewire” and “reroute” around the injured areas. The healing process is very individualized and unpredictable and is measured in months, not days and weeks like a broken leg. These processes take time and patience to learn. It takes the Speech Therapist’s knowledge and expertise to help the patient learn and compensate for deficits. Four visits are not enough to accomplish this. Although the very real potential exists for this man to be guided through the healing process and through exercises and tasks that challenge the healing areas to learn strategies that would enable him to be independent and safe to be alone in his own home he will never be afforded that opportunity. Waiting until he has more visits available in another YEAR will be too late. Never again will his wife be able to leave him alone while she goes shopping or to play cards with her friends. They won’t be able to travel anymore because she won’t be able to let him walk into a Men’s room alone.
Not being a politician I know my brain thinks a little differently than one. But come on, folks. Would SOMEONE please explain how this is of any benefit to anyone, INCLUDING Medicare?
The Cap is already in effect but there is currently an “exceptions process” available for physicians to document the need for continued or additional services for an individual. This covers individuals who require ongoing skilled intervention to either recover from an illness or injury or who have chronic debilitating disease that benefit from ongoing therapy to retain function or slow the progress of deterioration. It also takes into account multiple things may happen to an elderly individual over the course of a year. Many folks over the age of 65 have more than one disease process going on any one of which can flare at any time.
Journals and publications are filled with studies that have shown the efficacy of rehabilitation intervention for a variety or disease processes. For example it has been shown that individuals with Parkinson’s disease are able to better retain functional ambulation and self-care skills for longer periods of time when their medications are combined with intermittent sessions of skilled Physical and Occupational Therapy intervention. Folks with arthritis are better able to mange pain and retain functional ambulation and mobility skills prolonging the time for joint replacement surgery when skilled therapy is used as part of the medical management program.
My professional organization has been very active with Congress and Medicare over the past 5 years regarding the Therapy Cap. Through much diligent lobbying by the American Physical Therapy Association, AARP, and many other healthcare organizations representing Parkinson’s disease, heart disease, and arthritis just to name a few, Congress came to recognize the potential for tragic consequences and put a moratorium on the Therapy Cap delaying it even going into effect for several years. However, the moratorium ran out and Congress did not act. The Cap went into effect. Congress was still encouraged to listen and open their eyes that there needed to be some way around this for particular individuals so the “exceptions process” was enacted. The “exceptions process” will expire at midnight 12-31-06.
With so many new faces entering the corridors of Congress and so little time left in this year, it is with utmost urgency that as many of us as possible make sure these new members of Congress are brought up to speed and made to realize the gravity of this situation. Returning members need to be reminded about this critical issue. Here are 2 links that may be of assistance.
www.apta.org search APTA’s Patient Action Center
Consequences? Potentially hundreds of thousands or millions or our elderly will be unable to access adequate rehabilitation outpatient services. They may run out of funds or perhaps more tragically delay seeking intervention for fear of using their allowable funds and not have any left “if” something happens.
The Therapy Cap was put into effect in an effort to save Medicare money and cut costs. Well, my friends its effect will be quite the opposite. In the first place, rehabilitation is NOT the biggest source of Medicare costs, but anyone with more than two brain cells to rub together can’t help but see that this is not the answer. It does raise many more questions:
What will happen when a stroke patient is not allowed to reach a functional level that would allow him to live independently again? Who will care for him? Where will he live when he can’t stay alone because he was never given the opportunity to become mobile and self-sufficient again? Who will take care of an ill spouse when the other can no longer use their walker because the arthritis has become so bad they can’t walk and they had exhausted funding for the therapy that was providing pain relief and joint mobility? Who will come in and push liquid through the old woman’s feeding tube three to four times a day now that she has to be tube fed because there were no funds to cover a Speech Therapist long enough to accomplish teaching her how to swallow without choking or for an Occupational Therapist to teach her strategies to enable her to perform many activities one handed?
Where will all the public monies come from to care for the increasing number of elderly who will require custodial care because they could not receive adequate therapies necessary to remain independent? Folks who might have been able to return to the workforce had they been afforded adequate lengths of rehabilitation or retraining following an illness or accident may be forced to take early retirement. Who will replace those tax dollars lost? Where is Medicare going to find the monies for the potential increase in the number of people applying for disability?
Where is Medicare going to find the additional monies required when more acute hospitalizations are required because of pneumonia or blood clots in the legs or bed sores caused by inactivity caused by the inability to move around safely after a fractured hip or stroke or joint replacement because no outpatient monies were available to restore independent and safe mobility skills?
This does not sound like a money saving policy to me. Does it to you?
There just might need to be an extra department within the Bureau of Statistics: the one that will be needed to keep track of the premature deaths of many of our elderly. But then again, if there are deaths, Medicare won’t have to pay any more for their care will it? Maybe at the end of the day the intended hidden agenda will have been carried out.
I am compelled to speak out, to make as many aware of this as I possibly can. Many of the frail elderly need a voice. This issue isn’t in the headlines. It is tucked very quietly out of sight and under the radar of the American Public. Those of us in the healthcare professions are acutely aware of it. Time is running out. With the many serious issues facing our leaders today this is one we can’t afford to let slide by unnoticed for there will be dire consequences for us all.
There already is a crisis in healthcare as our population ages. Maybe some feel this is one way to deal with an aging population. Maybe the ones in power and behind the scenes are acting with full knowledge and intent. Maybe they are counting on our ignorance, inaction and silence. But silence in the face of knowledge gives implied consent. Please, speak up. Now that you have knowledge, withdraw your consent.
As usual, Dr. Strickler hits the bull’s eye: Legislated Genocide.
Legislated Genocide: the ultimate result of the extent to which our society has been molded and brain washed with the philosophical underpinning and foundation of Sophistry. It certainly appears many have indeed sold their souls to the God of Economics and Opportunity. Anything to boost the immediate bottom line without a moment’s twinge of conscience about the long-term effects and consequences.
May the Lord of Life provide you with the ability to see beyond legislative rhetoric, to uncover and recognize truth and give you the courage to open your mouth and speak up for many that are unable to speak for themselves. You might even find you are speaking for your own benefit and survival.