KOT1 TASK 2

Discuss with Mrs. Zwick’s daughter, based on coverage requirements, which of Mrs. Zwick’s costs will be fully or partially covered.

Mrs. Zwick’s has Medicare A, Medicare B, and Medicare D. According to Medicare’s coverage guidelines, her stay in the hospital and the skilled nursing home stay will be covered by Medicare Part A. The walker that she needs will also be covered by Medicare Part A. All of the doctor’s visits in the hospital and the skilled nursing home will be covered by Medicare Part B. All test done in the nursing home or hospital such as lab test, X-rays, etc. will be covered by Medicare Part B. Any physical therapy needed in the skilled nursing home for rehabilitation will be covered by Medicare Part B. All the medications that Mrs. Zwick is going home on and when hospitalized will be covered by Medicare Part D. The urinary tract infection treatment will not be covered by Medicare. It is considered a hospital acquired infection. Hospital acquired infections in Medicare’s eyes are preventable.

B. Explain how Medicare policies would affect reimbursement for the additional care Mrs. Zwick needed when she developed a hospital-acquired infection.
Discuss the ethical implications of Mrs. Zwick’s incurring costs related to her hospital-acquired condition.

The only thing that will not be covered by Medicare is the treatment of her hospital acquired infection. It is considered a preventable condition, so Medicare refuses to pay for it. Medicare is requiring the hospital to pay for it and not the patient. This policy is called the “Never Event” Policy.

When you are talking about fairness, this policy is pretty fair when you think about it. Ethically, if the patient would of have to pay for it, it will be out right unethical because it is something that could of been prevented with proper infection control techniques. Making the hospital pay for it is the best idea because they should train staff better on how to prevent, track, and treat patients that are at risk for hospital acquired infections. Educating the staff about hospital acquired infections and conducting research studies on their prevention is a must and that is why they are preventable.

Explain how the Consolidated Omnibus Budget Reconciliation Act (COBRA) will allow Mr. Davis to continue his insurance coverage while he is out of work.

COBRA requires most employers with group health plans to offer employees the opportunity to continue temporarily their group healthcare coverage under their employer’s plan if their coverage otherwise would cease due to termination, layoff, or other change in employment status (Unknown, 1999-2012). Mr. Davis will have the opportunity to get COBRA coverage from his former employer if he had group coverage with them. He will have the same group coverage as he had while he was working but will have to pay more per month for the coverage.

D. Discuss two challenges that state or local government face in providing care for patients like Mr. Davis who lack insurance coverage and have long-term, chronic illnesses that require ongoing care. Recommend one step that state or local government could take to address one of the challenges you have discussed.

The first challenge the state and local governments may face is people with chronic illness ten to take more money and resources to take care of than those with acute illnesses. The second challenge is the amount of uninsured people with chronic illnesses that require long term care is rising. One step that the state and local government could take to address the challenge of limited funding and resources for the uninsured patient with chronic illness is invest in more free clinics, health departments, or community clinics. This will help out with cost for the uninsured and get them the medical attention that they need. Doctors and nurses volunteer their time at the free clinics, so the cost is free. Supplies are usually donated or government funded by grants. Community clinics offer a sliding fee scale for families or single patient within a certain income bracket.

Discuss whether it would be better for Mr. Davis if he were a citizen of Great Britain, Japan, Germany, or Switzerland based on his healthcare concerns.

It would be better if Mr. Davis was a citizen of Japan because Japan has universal healthcare. Medications are covered. If a patient has a pre-existing condition, they will still be able to get healthcare. Children, retired patients, and the unemployed will still be able to be covered under the universal healthcare policy. No requirements to get a referral to see a specialist under Japan’s healthcare policy. Germany has a good healthcare policy for its residents. Employees and employers pay into a sickness fund. Pre-existing conditions is covered. Everything is free for kids until they turn 18. Switzerland only provides sickness, old age, and disability insurance. The working class insurance is based on income and employer contributions are mandatory. Great Britain are eligible for care through the NHS at no charge by the government. Patients rarely get to pick their physician. Terminally ill patients may get denied coverage. Those were not a good choice in Mr. Davis’s case.

REFERENCES

Unknown. (Unknown). COBRA Questions & Answers. In COBRA insurance. Retrieved September 19, 2012, from http://www.cobrainsurance.com/COBRA_FAQ.htm.