“The Problem is the System that Dispenses the Services” (Part II)


(Continued from 9/20)

The Medicaid recipient has to apply for Medicaid transportation and be approved in general, then each specific ride has to be approved individually.  Why has the approval process been dumped from Medicaid and put in the hands of 911, which does not vet rides for their “appropriateness?”  911 says “What is your emergency?”  It does not say, “Do you have a primary care or managed care?”  And it most certainly does not send ambulances to transport to urgent care.  I know because I just called 911 and asked them.  That’s called “research.”  And, by the way, the 911 lady pointed out that urgent care is not open in the middle of the night.  And did anyone from DOH Medicaid ever notify 911’s statewide that they were transferring the decision-making to them?  It wouldn’t be the first time Medicaid has done that.

Seventh, “. . . clearly we did not consider the possibility . . .”  No shit, Sherlock.  There are 22,000 people in Onondaga County who are approved for Medicaid transportation; statewide there are about a bazillion, and I’m willing to bet my life that Tim Perry-Coon, Medicaid and the Dept. of Health did not talk to a single one of them.  Absolutely nothing was done to assess who goes to Emergency Departments, or why.  Oh, I’m sure there are anecdotes of abusive use of Emergency Departments (ED), but there are no equivalent anecdotes about the appropriate use of EDs because people don’t report when the system works as it’s supposed to.

Medicaid users are blamed for inappropriate use of the ED but you know what the greater problem is?  Nurses and doctors.  If you call your primary care physician and he’s not in, then—if your problem just possibly might be serious—the nurse orders you to go to the ED.  I heard a psychiatrist’s nurse order a patient to go the ED after the patient reported that she was short of breath.  The patient also reported that she’d been short of breath for three weeks and she was working with a pulmonary specialist to diagnose the problem.  The patient should have been redirected to her pulmonologist, not sent to the ED; her problem was chronic, not emergent.  Nurses send you to the ED to cover their butts.

Doctors send you to the ED when they don’t want to deal with your problem, particularly in the middle of the night.  I had not been prescribed the correct equipment for my sleep apnea, consequently I was in crisis in the middle of the night.  I called the doctor and the doctor told me to go to the ED.  In the ED, they only can treat what they can see; they would see me when I was awake and therefore be unable to address the sleep problem.  Patients do what their doctors and nurses tell them to do, no matter how useless or inappropriate, consequently Emergency Departments are full of people who don’t need to be there.  Stop blaming the patient for being “compliant” with the doctor’s orders.

So some dorkheads sitting behind desks in Albany have pulled the plug on transportation to Emergency Departments without any input from the people who actually use the system.  Most people who go to Emergency Departments drive there.  Medicaid patients have the same needs as anybody else, but they are too poor to own cars.  That’s why we have Medicaid transportation.  Let’s say some guy is doing some home repairs late at night (he’s one of the working poor, i.e., he works hard all day but doesn’t earn enough to pay his family’s medical bills so he’s on Medicaid) and he slices his thumb half off.  Clearly, the wound needs stitches.  He’s got to go to the hospital.  Now, under the edict of Tim Perry-Coon’s “we,” he will have to go by ambulance and charge the taxpayers an unnecessary $500.  But the dorkheads who make the rules know nothing about reality.  The people who make policy earn big bucks and hire tradesmen to fix their stuff during the day.  It must be nice.

Eighth, “you should be able to easily secure an ambulette [‘ambulette’ is Medicaid’s made-up word for ‘wheelchair van’] in an urgent situation during business hours.”  Oh yeah?  How’s that, Tim?   You wrote that “Our instructions to . . . prior authorization officials across the state, was to not authorize any transportation to an emergency department” so just how the hell am I going to “easily” get a ride to a place you won’t take me?  (Timmy’s thought processes have always been slovenly and illogical, and drive me crazy.)  Or am I supposed to guess that this policy is only in effect at night?

Ninth, then we come to the real hooker:  there are no wheelchair transport companies operating at night in Onondaga County.  There used to be.  I can remember ten years ago being ambulanced to the ED, then being discharged via wheelchair.  In those days, transportation vendors paid one of their drivers $100 a night (i.e., about $10/hour) to be on-call for emergency transportation.  The vendor could do that because there was enough money in the system that they could absorb the loss—the driver might get paid $100 but only do one ride that brought in about $50.  When the money started to tighten up in the Medicaid system then the vendors weren’t getting paid enough so they cut out night rides.  So now, instead of paying a guy $100 to come out for a night run, we pay an ambulance company $500 to do the trip.  Has anybody looked at usage to see how many unnecessary ambulance rides are being taken, and whether it would be cheaper for the taxpayers to pay one company $100 a night to keep one driver available?  No, I didn’t think so.

Tenth, “which would require you to walk to and from the [taxi].”  Come on, Tim, use your head.  My regular means of transportation is a power wheelchair.  Do you really think that if I am so sick that I need to go to the Emergency Department then that will make me so much better that I can walk?

And a final post script:  when I called Medical Answering Service in the middle of the night, I was answered by Rob, a supervisor, who told me to call 911.  Why are the taxpayers paying a supervisor to work nights?  The only medical service that is open during the night is the Emergency Department, and Medicaid won’t transport there, so what is the supervisor being paid to do at night?  He can be replaced by a tape recording that says, “Call 911” and save the taxpayers about $25,000 a year.

The problem is not service to Medicaid users; the problem is the system that dispenses the services.

About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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