O.C. Woman Tells Congress of Medicare Savings’ Costs

Ever since she was hospitalized for an injury from a fall last October, 82-year-old Alzheimer’s patient Vanja Davidson has been on the move--from nursing home to rehabilitation center to hospital and back again.

Following Medicare’s payment guidelines, doctors and social workers have transferred her to 14 different health care facilities in the past seven months--running up $147,232 in bills to Medicare in the process.

But being bounced around “like a Ping-Pong ball” has only aggravated Davidson’s disorientation and dementia, her daughter told a Senate panel on Tuesday.

“Before October, Alzheimer’s disease had taken some of my mother’s mind and independence. Now Medicare and the disjointed system that moved her around like a piece of cargo has taken the rest,” Orange resident Karina von Behren told the Senate Special Committee on Aging.

Von Behren said her mother’s case illustrates the problem of federally funded health programs that put rigid payment categories ahead of patients’ needs.

She and a host of health care professionals asked the committee to push for federal approval of waivers that would allow states to be more flexible in caring for the elderly and chronically ill and place them in managed care programs.

But William J. Scanlon, director of the General Accounting Office’s health financing division, warned that such managed care programs have not yet proved they are able to take care of high-cost sick and elderly patients, as well as the young and healthy.

Sen. Charles Grassley (R-Iowa), who chairs the committee, said the problem of long-term care becomes even worse for patients who are eligible for both Medicare and Medicaid. Patients are often passed from one treatment facility to the next, as the two programs attempt to lower their own costs, Grassley said.

While the nation’s 6 million “dual eligibles” use up to 30% of the federal health care dollars--an estimated $106 billion per year--the fragmented system has left patients and their families unhappy with their health care, Grassley said.

Grassley said he is waiting to see the results of a pilot program in Massachusetts that won waivers from Medicare and Medicaid spending requirements before trying out a program tailored to the needs of senior citizens.

No such statewide program exists in California, but at least one managed care program, SCAN Health Plan, is testing a “social HMO” which, in addition to regular Medicare benefits, provides long-term care services for disabled or chronically ill patients. It is one of four original social HMOs authorized in Congress in 1982 as an experiment to see how the frail elderly would benefit from access to a broader range of social services.

The plan has enrolled 14,000 patients in Orange, Los Angeles, Riverside and San Bernardino counties, said company Vice President Stuart Byer.

“By providing extra benefits we can avoid institutionalizing patients until it is absolutely necessary,’ Byer said.