|Brad Stevens of Londonderry, pictured with wife, Doris, will begin outpatient treatment today at Catholic Medical Center in Manchester instead of having to spend his nights at a nursing home.|
Union Leader Correspondent
LONDONDERRY -- After a “series of unfortunate events” that, according to a Medicare spokesman, should not have happened, it looks as if Brad Stevens will get the care he needs, without having to spend the night at a nursing home for $335 a day.
Last week Brad and Doris Stevens were caught in what they described as a “hostage situation.” Despite repeated calls to Medicare and U.S. Sen. Jeanne Shaheen, no one seemed able to resolve their problem.
Brad Stevens, 75, had been through a nine-month ordeal of surgeries and missed diagnoses. Finally in March, doctors realized that to cure his chronic infection he needed surgery to remove a patch and wires still attached to his heart — remnants of an outated defibrillator that he’d received in the 1990s.
Following his successful surgery last month, Stevens hoped to be discharged from Massachusetts General Hospital and sent home to recuperate. He knew he needed twice-daily intravenous antibiotics, but figured a home care nurse could visit him at his Londonderry home.
Instead, a caseworker from Mass General told Stevens his post-op care would be administered at Hackett Hill in Manchester, a skilled nursing facility.
According to Medicare spokesman Mary Kahn, this is where things likely broke down for Stevens. He should have been advised that Medicare would pay for one of three options for his post-op needs — a stay in a skilled nursing facility, if medically warranted; outpatient delivery of the medication at a hospital; or outpatient care through a physician’s office.
Medicare will not pay for the cost of the antibiotics he needed in a home-care setting unless a patient is homebound, which Stevens was not.
“The question would be how is Massachusetts General Hospital’s discharge planning research done? It seems likely that they rely heavily on Medicare patients, and so it’s astounding to me that the discharge planner wouldn’t have every stitch of discharge information emblazoned on her brain,” Kahn said.
She was adamant that Medicare services are clearly outlined, and that despite what the Stevens may have been told, his being sent to a skilled nursing facility had nothing to do with Medicare.
“The idea that someone told this man he had to go to a skilled nursing facility is beyond me,” Kahn said.
Hospital case manager
A spokesman from Massachusetts General Hospital yesterday declined to speak directly about Stevens’ case, but said the hospital’s case managers are committed to serving the needs of individual patients. “Case managers work collaboratively with patients, their families, patient care teams and insurers, to ensure a safe transition from the hospital to the next setting of care or home. As each patient is unique, case managers always work closely with each patient to identify and communicate all options for post acute care based on each individual’s circumstances and preferences to ensure they receive the highest qual-ity, most cost-effective care possible,” said Nancy Sullivan, executive director of case management for Massachusetts General Hospital.
Given no options
Brad and Doris Stevens maintain that they were given no options upon his release from the hospital.
“They told us to take him to Hackett Hill, so we left the hospital, stopped at home so he could get a decent meal, and then I did what they told me, which was drop my husband off at Hackett Hill. Neither of us could figure out why he had to stay, since he had no restrictions from his doctor. He was supposed to be doing his own physical therapy. All he needed were the antibiotics twice a day,” Doris Stevens said.
Because Stevens’ condition was otherwise good, he was allowed to leave Hackett Hill in the mornings, following his treatment, but was required to return at night for his second round of antibiotics, and to sleep there, at a daily cost of $335.
For the past three weeks Doris Stevens had been making phone calls, going back and forth with a caseworker at the Boston regional Medicare offices, trying to find out why her husband had to sleep away from home.
Worth all the trouble
A story in Friday’s New Hampshire Union Leader detailing their predicament prompted Sen. Jeanne Shaheen’s office to intercede.
Monday, a spokesman from Shaheen’s office called the Stevens to confirm that Medicare would cover the cost of outpatient services at Catholic Medical Center.
“I told them I would like to see it in writing. At this point, I question everything, but what a relief,” said Doris Stevens. “They told me that if we have Medicare B, which we do, then it would be covered on an outpatient basis. Why didn’t someone tell us this three weeks ago?”
On Monday, Doris Stevens tried to find out from CMC how much the outpatient treatment would cost — just out of curiosity.
“They said they couldn’t give me a figure, but I will bet you that it’s less than the $335 a day that Hackett Hill was costing, and that was just the basic room rate; it didn’t even include the antibiotics,” Stevens said.
“When they told me I could pick him up at 7 a.m. from Hackett Hill (Tuesday) and take him for his outpatient treatment to CMC, I was beyond happy. Just to have him home at night, where he belongs, will be worth all of this trouble,” Stevens said.