By Douglas Gould, President, Douglas Gould and Company
Medicare has done so much good over the last 50 years, but it needs a tough watchdog to keep it effective in the years to come. Case in point would be the so called “Improvement Standard,” in which care managers and other Medicare decision-makers determined that benefits should be cut off if a beneficiary’s condition was not “improving.” It wasn’t in the law, nor was it in the regulations, and yet it was being enforced. It limited the length and quality of life for hundreds of thousands of people.
I saw this policy misapplied firsthand, when physical therapy was withdrawn for my 88 year-old father after a hospitalization because he wasn’t going to improve. He was however, going to stay active, have better balance, and maybe stay alive a bit longer.
The Center for Medicare Advocacy’s successful “Jimmo” class action lawsuit had the policy removed from Medicare manuals, but the need still exists for a culture change within the Medicare system that incorrectly assumes that denials based on lack of improvement is ok. Without constant vigilance and pressure things will never fully change. The Center for Medicare Advocacy serves as the best watchdog Medicare can have, and it needs to be supported so it can have an even greater impact for the program’s next 50 years.