Ukiah Daily Journal from Ukiah, California on January 30, 2000 · Page 13
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Ukiah Daily Journal from Ukiah, California · Page 13

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Sunday, January 30, 2000
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Page 13
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THE UKIAH DAILY JOURNAL Health Patients, therapists reeling from Medicare reform By CHRISTOPHER CLARK Associated Press Writer . His speech slowed by stroke and half his body weakened by it, 84-year-old Lewis Williams faced an ugly choice: Was it more important to walk or talk? . As a former salesman who enjoyed Chatting with neighbors near his Gainesville, Fla., apartment, Williams came to depend on his voice just like anyone else. . On Jan. 1, 1999, Williams learned that new Medicare rules would keep the government from paying more than $1,500 a year for his speech and physical therapy combined. He could divide the money between the therapies, or spend the entire amount on one. The decision for Williams — surprised as he was at having to choose — was simple. He wanted control of his speech. Besides, physical therapy had returned some stability to the right side .of his body, so he stopped it. It didn't take long for his doctor to notice. By the end of April, with his mobility stiffening and Medicare therapy money gone, Williams' frail health turned worse. One day, while waiting for a ,'friend to park the car at a restaurant, ;WiIliams fell and broke his hip.' - Doctors wanted to perform surgery, but they had trouble stabilizing his heart rhythm. Two weeks after his fall, Williams died. Those who knew him mourned the ilossof a friend. • Opponents of the Medicare limits that stopped his therapy — put into law under the Balanced Budget Act of 1997 — argued that Williams should never have had to choose between two neces- sary therapies. "He shouldn't have had to worry about making those kind of unconscionable choices," said Sally Brandt, rehabilitation services director at the University of Kansas Medical Center. She once lived next door to Williams in Florida. "He might still be with us." Lewis Williams was one of an estimated 200,000 elderly or disabled people expected to feel the pinch of therapy caps last year. Congress approved the caps in a desperate effort to curb a system whose poor oversight encouraged huge government payouts to therapy companies. Budget-crunchers projected the limits would save Medicare nearly $2 billion over the next five years, under a larger effort to keep the federal health insurance program solvent. Therapists conceded some reform was necessary, but they seethed after Congress agreed on $1,500 caps — by most measures an arbitrary limit, therapists said. Many lawmakers agreed. "It wasn't well thought out when we first did it," said U.S. Sen. Charles Grassley, R-Iowa. "It was kind of an experiment, not a totally wrong experiment, but in areas of Parkinson's, diabetes, diseases like this, well, you just can't rehabilitate with that cap." The fallout was nearly immediate. Just weeks after the caps kicked in, the lucrative rehabilitation industry was suddenly fighting for its life: — Stroke, Parkinson's and Alzheimer's disease patients — among others needing speech, physical or occupational therapy — were cut off, unable to continue treatment after Medicare stopped reimbursing for their care. — Therapy divisions of larger companies were closed, consolidated or downsized, their profitability devastated by the caps and separate but significant limits on reimbursements to nursing homes. — Thousands of speech and physical therapists, who just five years earlier enjoyed some of the brightest career prospects in health care, were laid off. Many left the business altogether, convinced Washington's budget-tightening mood had doomed their trade. Hearing an enormous outcry from the therapy industry, Congress put a two- year moratorium on the caps, effective Jan. 1. Yet therapists still fear the limits could return once the moratoriums expire in 2002. As health care goes, $1,500 isn't a lot of money. For either speech, physical or occupational therapy, practicing therapists estimate $1,500 would last roughly three to five weeks, with about three sessions a week. A recent Department of Health and Human Services report found that between 29 percent and 38 percent of Medicare beneficiaries diagnosed with a stroke would have reached the $1,500 cap in 1998. For William Evans, a 79-year-old stroke victim from Rockville, Md., the money lasted two months in 1999. He had made remarkable progress with his speech, but the Medicare money ran out before physical therapy could do him any good. "They said you're only allowed so many weeks, that's it," said Evans, whose therapy now consists of two one- hour sessions at a free clinic each week. "I speak OK, but I can't walk." Under the cap system, patients like Evans had some options: — $1,500 could be split between speech and physical therapy, and occupational therapy had its own $1,500 cap. — The caps could be avoided by getting treatment at a hospital outpatient clinic, though some fear restrictions are coming to that sector, too. What's more, the hospital option had a catch: a doctor had to prove to Medicare that the patient would benefit, meaning not all patients get approved. — In what some called a lose-lose for both the patient and Medicare, capped- out patients could continue Medicare- covered therapy at a new facility, for another $1,500, before moving on again. Doing so not only circumvented the spirit of the caps, critics said, but also interrupted "continuity of care" — the trust and progress developed between patient and therapist. An initial House Ways and Means Health subcommittee proposal set the limit at $900, following research into the costs of hospital-based therapy, whose expenses run about half of those in nursing homes. Later, it was set at $1,500. The overarching goal, congressional aides said, was a balanced budget. Industry experts suggested that Congress was settling a score, punishing companies for years of alleged over- billing and cases of outright Medicare fraud. "Neither Congress nor the Depart- ment of Health has been accountable for this disruption, and they won't be because there is a hysteria that the system has been gamed," said Laurence Lane, a health care consultant and for-, mer vice president of regulatory affairs for NovaCare Inc., whose rehab division all but collapsed after the caps took affect. Saving money through Medicare cuts/ may have been good to the federal bud^ get, but for care providers the reductions stung. ; Take Lane's old company, NovaCare* which slashed therapists' salaries by 25 percent and laid off more than 5,000 employees. ;. Lifting the caps won't necessarily, mean a dramatic recovery in the therapy industry. Congress and the Health Care: Financing Administration have- promised increased scrutiny of Medicare outpatient therapy payout* over the next two years. ; '• ' It's expected that those payouts wilr act as a basis for congressional action^which could include reinstated caps. •;»;. For now, lifting the limits is good;' news for patients like Dick Waltzi ;at retired Kansas City minister whose* treatments at the Parkinson Outreacrv Program in Overland Park, Ka>.£ stopped when the center shut down last- February. ; • ' The center's parent agency, the National Parkinson Foundation, was! forced to close the. facility and more" than 20 others like it when the limits! kicked in. * ' Waltz, 73, still gets treatment. But ifr i » See MEDICARE, Page B-2 '• ' Government finally says exposure sickened nuclear arms workers By H. JOSEF HEBERT '. Associated Press Writer ; WASHINGTON —Reversing a position held for decades, the government has concluded for • ~the-first-time-that many workers who built America's nuclear weapons likely became ill because of exposure to radiation or toxic chemicals, officials said Saturday. The findings, based on a review of dozens of studies and raw medical data covering an estimated 600,000 workers at 14 . nuclear weapons sites, could lead to compensation to the families of some of the workers. Many were unaware that they were being exposed to such health risks. -'While the draft report of the •studies did not show a direct causal link between workplace exposures and specific illnesses, it found that workers at the plants suffered higher than normal rates Q£ a wide range of cancers and clearly were exposed to cancer- causing radiation and chemicals in the workplace. ' -The studies, reviewed by a special task force, examined health records and other data covering three decades of the Cold War from the late 1940s into the 1960s. An official familiar with the report emphasized it does not relate to workers" conditions today. But the draft report, which President Clinton ordered last July, marks a reversal in the government's long-standing position that no links exist between work conducted at the Cold War-era weapons plants and later illnesses. That argument has stymied numerous lawsuits seeking compensation. While the compensation issue has yet to be resolved, the government now is acknowledging that hundreds — perhaps thousands — of workers may well have been made sick by their working environment. "It does appear that in the DOE complex, there -is a*direct link between exposure and the possibility of contamination," Energy Secretary Bill Richardson said in Davos, Switzerland, where he is accompanying President Clinton at an economic forum. In an interview with The Associated Press, Richardson cautioned that the findings are preliminary and won't be completed for several months. Still, Richardson said, if the findings are borne out, "The honorable thing for the government to do is to protect its workers, past and present," including compensation. The report said elevated rates of 22 categories of cancer were found among workers at 14 facilities in the department's atomic weapons complex. They included leukemia, Hodgkin's lymphoma and cancers of the prostate, kidney, salivary gland and lung. "The exposures we are seeing are in excess" of those in similar population groups, a source familiar with the report said. "We don't know what the cause is, but it's clearly related to exposure there (in the workplace)." President Clinton ordered the review after the Energy Department concluded the government should compensate workers who had developed an incurable lung disease because of exposure to beryllium, a material used in nuclear weapons production. Richardson and the White House wanted to determine if other nuclear weapons plant workers likewise should be com-' pensated because of exposure to Plutonium, uranium and a variety of radioactive or highly toxic substances. The interagency group reviewed dozens of epidemiological studies, raw health data and other documents, many of which jn the pa,st have been dismissed by the government. The draft report makes no conclusion on compensation, which will be examined in the coming months. Recommendations are likely in the final report. One official said compensation most likely would be to families "in the hundreds, not thousands," although the number at this time remains little more than a guess. Clinton will use the final report to develop a recommendation to Congress, which is responsible for providing the money. The draft report's conclusions were first reported Saturday by The New York Times. Daniel J. Guttman, an attorney for the Paper, Allied-Industrial Chemical and Energy Workers Union, told the Times the government turnabout was stunning, because for years the government has marginalized the risks to the thousands of weapons plant workers. The report's findings included workers at plutonium production facilities at Savannah River in South Carolina and Hanford in Washington state; the Rocky Flats plant near Denver, where plutonium was molded into weapons components; uranium enrichment and processing plants at the Oak Ridge, Tenn., complex; the Fernald uranium processing plant near Cincinnati; and the Lawrence Livermore and Los Alamos national laboratories in California and New Mexico, respectively. LAST CHANCE! for reserved Mardi Gras tables with special wines! 7pm • seats 8-10 • $150 ea. 462-3888 Dinner tickets extra MEDICAL TREATMENT For a work injury, your employer has the right to control medical treatment for the first thirty days (unless you have pre designated a doctor), After thirty days you have the right to select your own treating doctor or chiropractor. While you may only have one treating doctor at a time, you may change treating doctors if you wish. FOWLER AND BALL 150 North Pine Street, Ukiah (707)462-1420 bob9fowlerball.com Making a false or fraudulent workers compensation claim Is a felony subject to up to 6 years In prison or a fine of up to $50,000 or double The value of The fraud, whichever Is greater, or by both Imprisonment and fine. Get Fit Today for a Healthier Tomorrow! l UKIAH FITNESS CENTER Fully Equipped Gym 677 North State street 462-1255 SPRING 2000 HEALTH CALENDAR Ukiah Valley Medical Center ^\dventist Health WELLNESS EVENTS: SPACE 1$ LIMITED fOH THE FOLLOWING PROGRAMS. PREREBISTRATIOH is RECOMMENDED. Ongoing Health Groups/Events CARDIAC EDUCATION GROUP This group meets the third Thursday of each month at 12:30 p.m. in the Glenn Miller Conference Center — OB "B" at Ukiah Valley Medical Center, 275 Hospital Drive. The group is free and offers valuable information for people with heart problems and those interested in heart health. Call 463-7400, ext. 1446. UKIAH DIABETES EDUCATION GROUP This group is free and meets the second Tuesday of each month at 7:00 p.m. in the Glenn Miller Conference Center — OB "B" at Ukiah Valley Medical Center, 275 Hospital Drive. Call 463-7400, ext. 2495. for more information. UKIAH VALLEY BLOOD CENTER The center is open Monday through Friday from 8:30 a.m. - 5:00 p.m. (open until 7:00 p.m. on Tuesdays). To make an appointment to donate or to schedule a blood drive at your work place, call 463-7441. DEPRESSIVE MANIC DEPRESSIVE ASSOCIATION (DMDA) This support group is free and meets at 7:00 p.m. each Wednesday of the month in the Main Conference Room at Ukiah Valley Medical Center, 275 Hospital Drive. Call Michelle at 468-9424. RBROMYUGIA SUPPORT GROUP This group discusses issues surrounding Chronic Fatigue, Fibromylagia Syndrome, Myofacial Syndrome. The local group meets the second and fourth Wednesday of each month, 1:00-3:00 p.m., Mendocino County Health Department Annex, 880 N. Street. Call Carolyn at 462-5603, Linda at 462-6725. LIVER SUPPORT GROUP This group educates people with liver problems and those who support them. The group meets the second Tuesday of each month from 6:30 - 8:00 p.m. in the Main Conference Room at 275 Hospital Drive. For more information call Gertrude Lynn at 468-9544 or Buzz Knapp 275-3365. SWEET SUCCESS PROGRAM (The Calif Diabetes and Pregnancy Program) Pregnancy is special for women with diabetes. If you are planning a pregnancy or are pregnant, you will need extra support. Call 463-7349. BETTER BREATHER'S CLUB This support group has been discontinued due to lack of patient participation. Please call the Respiratory Care Services Department at 463-7400 x 1471, for more details. CHILDBIRTH EDUCATION Ukiah Valley Medical Center offers a wide variety of perinatal education classes. Please sign up as early in your pregnancy as possible. For further information and a registration packet, call 463-7564. All classes take place in the Glenn Miller Health Education and Conference Center located in the new Maternity Unit at 275 Hospital Drive, Ukiah. •EARLY/MID PREQNANCV Cuss First Tuesday, every other month, 7:00 p.m. - 9:15p.m. March 7, 2000 & May 2, 2000 •CHILDBIRTH INTENSIVE CLASS (One-day Refresher course) Sundays (Attend one date only) 12:00 noon - 5:00 p.m. March 12, April 9 or May 14 •PREPARED CHILDBIRTH SERIES (Four-week series) All classes are held from 6:30p.m.-9:30 p.m. Wednesday Series: March 8-29, April 5-26 & May 3-24 •INFANT SAFETY/CPR PROGRAM (Six-hour course, two three-hour session, or 1 day Sunday class). Tuesday, April 4 K Wednesday, April 5 (6:30p.m. to 9:30 both days) Sunday, May 7 (10:00a.m. to 4:00p.m.) •EN ESPAAOL - Domingo, Mo.no 5 (10:00am to 4:00p.m.) • SUPER SlTTER COURSE This one-day course prepares caregivers of young children in basic childcare and first aid. Call the Ukiah Adult School for registration and information at 463-5217. Health Seminars If YOU tux 4 Mswurr atoaam tttsoimf MXOUUOIMJVMS, MrrO-WHAT? Heidi Daniel will tell about her Mitochondrial Disease. She will be assisted by her therapist Susan Pollesel. (No fee). Thursday, April 13 at 7:00 p.m. Glenn Miller Conference Room "A", at Ukiah Valley Medical Center, 275 Hospital Drive. MENOPAUSE AND VARIOUS HORMONE REPLACEMENTS (Presented by Dr. Michael Smith) Obstetrician and Gynecologist Michael Smith, M.D. will provide free information about Menopause. Thursday. April 20 at 7:00 p.m. Glenn Miller Conference Room "A", at Ukiah Valley Medical Center, 275 Hospital Drive WATER, WATER, WHY AND WHEN (Presented by Dr. Glenn Miller) Glenn Miller, MD will provide free information on the importance of adequate water intake for good health Thursday. May 25 at 7:00 p.m. Glenn Miller Conference Room "A", at Ukiah Valley Medical Center, 275 Hospital Drive HEART ATTACK COUNTER ATTACK (Presented by Dr. Glenn Miller) Part I: Blood Draw In this program, a blood draw and questionnaire will be used by a physician to evaluate your risk of a heart attack. The blood draw will test for total blood cholesterol, HLD, LD}- VLDL, C/H ratio, glucose, triglyc- . erides and uric acid. Please do not eaj or drink anything but water for 12 to 14 hours prior to the blood draw. Fee is $30 for both sessions. February 7, 2000. 7:00 • 9:00 a.m. Main Conference Room at UVMC, 275 Hospital Drive, Ukiah Part II: Results Session Your results from the blood draw wi . be available along with a presentatio > on/10 coronary risk factors and suggestions on how to lower your risk of heart attack. February 16. 2000 at 7:00 p.m. Main Conference Room at l/VMC, 275 Hospital Drive, Ukiah Preregistration required, call 463-7360

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