Oxylated: Part 2
    Part 1 being the immediately previous post.
    So, this afternoon Intrepid Hospice Nurse Team Leader (from here on to be abbreviated IHNTL) calls to tell me the following:

• Medicare, she says, reimburses our oxygen company "only" $90/month for my mother's oxygen, regardless of how much she uses (or doesn't use). I use quotations around the word "only" because this is the word she used. Someone at our oxygen company told her that my mother is using "$895" worth of oxygen a month. She goes on to confirm that, supposedly, $805 is the amount our oxygen company has been "eating" on our behalf. "This is prohibitive," she said. I agree; such numbers certainly are prohibitive. Thus, she spoke to our company's "respiratory therapist" who had another suggestion that would help us to reduce the cost of my mother's oxygen. There is a concentrator which also fills tanks with oxygen as it runs. "The tanks aren't as big as the tanks you've been using [we've been using E tanks, lately]," she told me. She also wasn't clear on how many hours of oxygen use at 3/lpm, which is my mother's current level and may or may not be reduced later, depending on a variety of factors, each tank would deliver. She told me, as well, that it takes "2 hours" for a tank to be filled and that the concentrator can only be run at 3/lpm while it is filling tanks.
• I tell her that, allowing for actual facts such as how many tanks we'd need to get through a day, thus, how much time would be spent filling tanks on the concentrator, I would be willing to try such a system, provided we also had, say, four back-up E tanks on hand, just in case. She thanks me profusely, so profusely that I'm prodded into nervousness as the conversation ends.
• The more I think about all this, the more questions float to the surface. I have to tell you, I'm not a quick on-my-feet thinker. I make up for it later, though, and am used to operating successfully in arrears. So, here are the questions that occur to me:
  • We've been with this oxygen company for three and more than a half years, since October of 2004. While it is true that, for the first 2 (at least) years of our relationship my mother didn't use much oxygen, I'm sure it is also true that the company had some clients who use oxygen the way my mother does now. If it is true that this company has been eating oxygen costs left and right, you'd think they'd be close to bankruptcy. Instead, in the years that we've been with them, they've opened up a second office in Prescott Valley. Kind of puts those numbers they fed IHNTL into perspective.
  • I keep all the mailings we get from TriCare regarding what they pay to our providers. One of those providers listed on the payment mailings is, of course, our oxygen company. I'm going to rifle through our "in boxes in my bedroom" filing system over the weekend to find out what Medicare and TriCare is really paying this company. You see, it's possible that Medicare, alone, is reimbursing at the rate of only $90 per month, although you'd think this would be based on the prescription, wouldn't you? However, TriCare pitches in after that. I'm curious to know how much TriCare is paying, as well.
  • Perhaps, at this time, Medicare plus TriCare isn't quite covering the company's costs. However, for at least two years I'm sure that our payments were probably subsidizing other people's oxygen costs.
  • Now, I'm becoming really curious about why it is hard to get any literate information from Hospice employees about how Hospice costs are covered. I mean, is IHNTL leading me to believe that our oxygen company is going to bill them for our Medicare/TriCare overages? This doesn't sound right. If they were going to bill anyone, wouldn't it be us? And, if it is us they've needed to bill for overages, why haven't they been doing this all along?
  • Regarding, now, the new system which involves a concentrator filling oxygen tanks:
    • What happens if my mother needs to use oxygen at 4/lpm, or even 3.5/lpm, which is what the rehab facility often had her on (they also, at times, had her on 2/lpm)? Does that mean that she has no oxygen for the next day? Even though her prescription is written for "2-4/lpm"?
    Say that the tanks provided deliver half of what the E tanks deliver. This means that I'd need to make sure six tanks were filled each day. That's 12 hours of filling time. Now, there are two ways I could do this. Run the concentrator constantly and fill most of the tanks while my mother is up, which would keep me from airing out her bedroom during the day to make sure it doesn't heat up "prohibitively" during her nap time. This would involve, still, filling a few tanks while she was sleeping...maybe one during her nap and possibly a couple others as she sleeps in the morning. Unless, of course, she needs to be on 4/lpm. Otherwise, I could stay up all night filling tanks.
    • In addition, this also means that when I wasn't going nuts monitoring tank filling, I'd be going nuts monitoring tank usage, seeing as how I'd need to switch out tanks twice as often as I do now. As I explained to IHNTL even later in the afternoon when I told her I'd left a message for the respiratory therapist to call me before he brings out the equipment next week, "I am not interested in adding such chores to my already chore-filled schedule." She said she understood.

    "I don't know about you," [a direct quote from my mother when she suspects something funny is going on and is about to confront it] but it sounds to me as though I'm getting a royal runaround...rather as though my mother has been selected to be either our oxygen company's or our Hospice company's scapegoat, or both, over oxygen.
    Not going to happen, people. At least, I hope not. I want to say, at this point, in case anyone out there is connected to any Hospice organization, the time when people need hospice is not the time when you want to present them with impossible choices for which, previous to Hospice entering the picture, there was no need.
    Forgive my heightened suspicions at this point but I've noticed that each Hospice employee with whom we've spoken has made it clear, at least once per employee, sometimes more, that we are always free to sign off Hospice. I didn't, previously, find this odd. Now, I'm beginning to wonder, simply because of the problems we've had with procuring sturdy, usable Durable Medical Equipment and, now, the problem we're having with remaining with our oxygen delivery system, if the reason we are told this so frequently is that part of the Hospice Game Plan is to pummel clients with choices that are designed to make their lives harder, rather than easier, and hope that some of their clients sign off for this reason...thus keeping their costs down.
    I'm sure I'll have more to add to this particular episode in my mother's and my adventure with Hospice. I will label them as "parts" of the "Oxylated" story.
    Mmmm, mmmm, mmmm. Lots to think about.
    I'm going to write yet another short post...
- posted by Gail Rae @ 18:36   email  this post