What Should Medicare Do with Patients Who Have No Possibility of Improvement?

Plaintiffs say almost 78 percent of the 46 million or so Medicare beneficiaries have at least one chronic condition, such as multiple sclerosis or Alzheimer’s. Denying them care if they don’t meet the so-called “Improvement Standard,” the advocates argue, can prevent them from performing routine daily activities or even cause their condition to deteriorate – leading to higher costs down the road….  The agency’s claims are processed by private subcontractors, many of whom require improvements in patient conditions and deny coverage to thousands of people every year as a result…

The suit seeks to require Medicare to cover certain types of rehabilitative care even when it likely won’t lead to an “improvement” in patients’ condition.

Full post on the class action lawsuit at The Hill’s Healthwatch Blog.

Comments (4)

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  1. Paul H. says:

    Interesting question. I guess palliative care doen’t count as medical care.

  2. Vicki says:

    I’m not sure what the current rule is but this doesn’t sound good.

  3. Bruce says:

    Maybe the death panels have been with us all along and we just didn’t know it.

  4. Joe Barnett says:

    Many poeple are surprised to learn that Medicare doesn’t cover nursing home care — only rehabilitative care. Those in nursing homes obviously need help with daily activities, but the assistance they need isn’t specifically medical; they need a caretaker. Private LTC insurance, Medicaid, and one’s own resources are the financing options (until the CLASS Act program is operating). Couldn’t this suit lead to Medicare paying for lots of long-term care, putting it deeper into a hole?