Have a Heart, Obey the Rules

An 82-year-old woman in a small Indiana town recently called for an ambulance to take her to the hospital for her dialysis and chemotherapy treatments. She is confined to a wheelchair. The ambulance service — the only one in town that offers wheelchair transport — is threatening not to take the woman because she cannot afford to pay the driver the co-pay at the time of service. The co-pay was $1.

Before you judge and say, "It's just a dollar. Surely she can find that in her couch cushions," know this: The woman is on Medicaid because of her health and financial situation. She is too sick to work.

But more importantly, Medicaid clearly states in its provider manual that a patient cannot be denied services for not having the money at hand. The ambulance service can bill her for the co-pay, which it admits to not having tried.

We understand that ambulance services are for-profit businesses, and we are grateful to all those that provide caring, prompt service in many places throughout Indiana where service otherwise couldn't be obtained.

However, those companies that sign up as Medicaid providers must understand the rules — and follow them. A person's life may be at stake.

Tamra Simpson, Program director
Indiana Senior Medicare Patrol

JoePa and Lessons for Health Care

Re: Bill Santamour's Jan. 24 column in H&HN Daily

I just finished reading your article, "Flaws and All," and as a Penn State grad and a health care professional, I wanted to take a moment to thank you. Not only did you capture the emotions the Penn State community has been experiencing in the last few months and days, but you gave voice to the man who defined a university and career with passion — a passion that has been misconstrued and violated by outsiders.

I didn't think it was possible to tie Joe Paterno into health care, but you succeeded and made great points. Your demand for compassion and communal effort reinforced the ideas I've been brewing over during this tragedy, and reminded me that the world would be a little better if we all tried to live by the lessons and foundations that Joe demonstrated.

Thanks for taking the step to bridge the industry and PSU roots.


Targeting the Triple Aim

Re: "Achieving the Triple Aim With Accountable Care" by Todd Cozzens, H&HN Daily, Jan. 10

The Triple Aim of lowering cost, enhancing quality of care and improving outcomes should be the mission of every hospital every day. There are some hospitals that have been doing this for years.

I worked at a hospital for 10 years that was doing this starting in 1995. It actually prepared them for the ACO model and value-based/bundled payment, etc. Hospitals that spent money on clinical information systems years ago and used the data to meet the Triple Aim are ahead of the curve.

I remember setting up a meeting with a payer in 2004 and trying to receive added payments for controlling costs within the DRG, enhancing quality and improving outcomes. They didn't know how to respond.


IT and Doctor Phobias

Re: "Whiskers and Other Unintended Consequences" by Bill Santamour, H&HN Daily, Jan. 3

My conclusion from the Dartmouth data is not that care provided to an individual patient who dies is bad or misused; it is simply an interesting reflection of the bias we as physicians all demonstrate, either for or against continued treatment of severe illness.

Currently, we only have the artifice of medicine and the feelings of the patient and family to guide us toward more or less treatment in the face of severe illness, especially severe chronic illness. This data is a call for increased care and conversation with patients and their families about their understanding, expectations and desires.

To reward this is not a death panel; merely a recognition of our shared mortality. This is uncomfortable for all of us.

—Michael Lambke