Over the years I have seen a number of changes in our healthcare system, as you well may have. I must say early in my career I was so naive about the ins and outs of business and medicine, it is not surprising my eyes were closed to the reality. But then most peoples eyes were closed.

Early in my career, insurance companies, and Medicare gave cart blanc to the healthcare industry. Little was ever said about payment. A bill was submitted by a doctor or hospital and there was never a question from the payer source. The length of stay in acute care was never questioned, nor was it questioned for skilled nursing facilities (convalescent hospitals). In so doing, the patient was usually taken out of the home, and care for the duration of their illness in a professional setting.

Then in the mid 70’ came something called DRG’s. Diagnosis Related Groups. This was Medicare’s first capping of reimbursement to acute care facilities. The government said that this is the average cost of care for a specific diagnosis. Medicare will pay you this money, no more, no less. If the hospital was able to make money on that sum, so be it, if not, it was not the government’s problem.

Hospitals needed to work smarter. Shorten length of stay in their facilities in order to make their institutions profitable. Services that were provided closely looked at, and methods to have patient turn over implemented.

The reaction soon to follow was that if the government could limit reimbursement, then so could private insurance companies. Hence, the birth of the theories behind HMO’s shorten length of stays in hospitals, and physicians becoming more accountable for ordering of tests, and examinations.

As with acute care, the government soon followed suit with skilled nursing facilities, and Medicare approved home care agencies. Regulations were implemented that represented shorter length of stay, and need for documentations by these agencies to prove the care they were providing met strict guidelines.

What does all this have to do with explaining Nurse Case Management/Patient and Family Advocacy? It is very simple. Within the structure of our healthcare continuum, the needs of individuals usually last much longer than the government services that we all hoped would be available for long-term care. It does not allow for long term support by way of custodial care, or skilled nursing services to assist with staying in the home. It does not allow for assistance for making decisions regarding staying in the home or moving to another environment, nor does it provide for assistance in making that transition.

Today there are as many unanswered questions about tomorrow as ever. At Fox and Associates, we may not always have the right answer but we have the right attitude. We are able to research any problem and help families come to decisions.

Fox and Associates can be creative in helping you and your family find solutions to healthcare needs. from medication administration, assistance with selecting caregivers, caregiver over site, telemonitoring, liaison between MD and Patient/Family, care and maintenance of ostomys, IV’s, or family mediation.

We are proud to provide for you, in a way that will help whatever issues that may come forward, to have the highest quality of life possible, for all concerned.

We look forward to serving you soon.

Fox and Associates Wellness Nurse Case Management
Helping you and your family Navigate the Healthcare System

Call: 707.573.0223