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In September 2020 I had to move my 93 year old mother from her house in VA to my house in NC because she could no longer walk or get up from her chair or bed. I am the only daughter. I have two brothers one of whom is living with my Dad in VA. They could not care for her. I am married and this has been a big adjustment but the alternative- a nursing home - was out of the question due to COVID. I have also witnessed the neglect both my parents experienced in rehab nursing home facilities and feel it is not the best for them. I thought I had a good team set up which included getting her set up with my family doctor. Since she is bedridden he has had to use televisits to see her. That has worked fine. She has Medicare A and B. She arrived at my house from rehab with a small bedsore that I have managed to heal with prescriptions from the doctor. I have aides helping me 6 days a week and the doctor ordered home health care to come for out for wound care and a UTI. My mother is on very little medicine and really has no major health issues aside from her age and physical deterioration. We use a Hoyer lift to get her in a chair almost every day and she assists with changes of diapers in the bed by rolling herself on herside.


She does not have dementia and is oriented except when a UTI is brewing. Most days she can tell you what day it is, what is going on in the news and she . remembers birthdays and the aides names She has been here about 9 months and while hard at times, I am making it work. During televisits, the doctor has sometimes seemed irritated even though we have not had frequent appointments and try not to ask stupid questions. In June, shortly after getting her 2nd COVID vaccine, my mother developed pain under her arm on the same side as the shot. She also had extreme swelling and itching at the site. That went away but the side pain did not. I also noticed she stopped eating and drinking as much. Long story longer, on a Friday evening I finally sent her to the ER. That was the first and only time she has gone to the ER since she has been with me. She was diagnosed with a pulmonary embolism and a UTI. Both were treated and she was released in three days in good condition. She has continued to do well at home. I was told to follow up with her Primary to determine any changes of dosage of the blood thinner. His first words were to tell me I can’t keep sending her to the ER and that she is costing Medicare a lot. He suggested a nursing home “would be better for her”. I informed him that in the past 6 years she has been to the ER exactly 3 times (including thus trip) and one trip in 2015 was because she was knocked down by an automatic door. This was her first ER trip since being with me. Anyone with pain that doesn’t go away can legitimately visit the ER. He failed to address the dosage issue so I had to call back. Today he informed me that Medicare rules prevent him from keeping my mother as a patient because she needs to be seen in the office to certify her as bedridden! What?! He told me to sign her up with Doctors Making House Calls. I tried. The merged with Eventus Home Healthcare and they do not have any providers in my area at this time. My doctor’s response was there is nothing he can do. He has given me 30 days to find a new doctor and then he will discharge her either way. We do not owe him money and he is being paid by insurance- can he do this???? He is leaving my mother with no primary care doctor. What am I supposed to do if she needs a prescription or home health for a condition?

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Try to get a hold of someone through AARP . I know that may sound strange but they are so good about assisting one's with questions and referrals. You can email them and they will respond withing a day or two.
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My mother-in-law is a quadriplegic she's home now and we take the City wheelchair van to appointments it's a pain but sometimes she has to go to the hospital for tests and things and I can't get her in the car anymore on my own and it doesn't cost very much check into that I hope it helps and you can go on the van yourself as her or his caregiver and that doesn't cause anything usually
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Speak to an elder lawyer re a letter to him about fulfilling his duties of care, to the insurance company to see if they want to carry on paying him for any patients if this is how he behaves, and to the authority governing Drs in your state to find out what he can do and when a complaint is suitable. He doesn't see her in his office other times so to be honest he is being an a*******e and jus wants out (probably of all patients who take any time). At the end of the day he is the patient's servant not the other way round. He gets paid to look after patients on his books. It is irresponsible to leave someone with no Primary care - don't take it lying down, kick up stink with anyone who can affect his cosy life.
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I almost hate to post because my experience is so different but my DH aunt, 94, with dementia and now on hospice sees her primary doctor via Telemed, telehealth some call it. When going on HH there is a time frame patient had to have seen the doctor. I think it’s 90 days. We used telehealth with no issue. Further more I just had my annual physical on telehealth. No problem. My doctors office did have to check with their business office to make sure it was still covered by my insurance (original Medicare). It is. I don’t think Medicare is doing away with it. I think it’s the odd doctor who doesn’t want to use it. I love it personally.
DhAunt had a primary several years ago who was always coming up with things he blamed on Medicare. I knew they weren’t correct as my mom had original Medicare and was on HH for years with an annual visit and no problem. This guy wanted her in every 60 days I think it was and then when we were there he gave very poor service. I found her a geriatrician who understood how Medicare worked and got rid of that primary. It’s easy to blame it on the gov when your office staff doesn’t understand it and neither does the doctor. It puts you in a bind but you are better off without him. I’m sorry he was rude to you and how dare he spout off about you wasting Medicare’s money. Your mom has been paying insurance premiums for many years and she didn’t write the programs.

Here is a Medicare link where you can look for providers.


https://www.medicare.gov/care-compare/
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A Doctor can do whatever they want.

IMO those "televisits" were allowed because of COVID. They would not have been allowed by Medicare forever. I think that you were lucky a new doctor would not have wanted to see her personally the first visit. She is not an existing patient. He is correct that he must see a patient face to face. In my State, to refill medications, you must see a doctor every 6 months.

Doctors are hiring more and more Nurse Practitioners. You may want to find a doctor who has NPs and sends them out to homebound patients. Thats what the Visiting doctor does in my area.
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Here's the link from the Medicare Rights Center:

https://www.medicareinteractive.org/get-answers/medicare-covered-services/ambulance-services/scheduled-non-emergency-ambulance-transportation#:~:text=Depending%20on%20your%20circumstances%2C%20Medicare%20may%20cover%20scheduled%2Fregular,no%20earlier%20than%2060%20days%20before%20the%20trip.
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I am horrified by the callousness of the medical/insurance profession. All for the bottom line. My experience was my husband had severe dementia and needed additional meds for a change in condition. I was told I had to bring him into the office, I managed to get him in the car and through the horrible traffic with him distressed the entire time. When we finally got there he threw up and wet his pants for the first time. I turned around and went home and he ended up in hospital.
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Have the doctor write an order for non-emergency medical transport.

If it is a Medicare requirement that she been seen in his/her office, then Medicare will cover it.

We did this with my mom once when her dermatologist insisted that he could only do a biopsy in his office, not at the NH. I belive we discovered that Medicare (not Medicaid) would cover a trip like this for some limited number of times per year.
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Ok - Medicare and most of not all insurance companies will not pay for non-emergency ambulance transport or wheelchair vans. There is an exception on the ambulance transport for dialysis patients who are too ill to ride in a wheelchair van. So, if the doctor must see the patient in their office in order to certify they qualify for home care, then the family has to somehow get their loved one there which may require them to pay out of pocket for the transport. I am prepared to do that and my mother should be able to go by wheelchair van. But what if your loved one truly could not leave their bed? Without a provider to come to the house the patient is just out of luck?
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@Garylee For those of us struggling with this issue, please name one or two of these insurance companies that you are aware of that provide non-emergency ambulance transportation for non-medicaid patients. It would be very helpful for many of us. Thank you
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Why in the world would you want her to continue with him anyway. A doctor is supposed to be helpful not belittling. Find your mom another Dr, and do the best you can.

You can use a wheel chair van service or a stretcher service for her to be seen by a new Dr,, just as you could do now. Most insurances cover this service.
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Hi Jem, normally a lurker - but, I signed up just now to help. Have recently gone through the same issue with my Mom. Her previous Doctor refused any more televisits, (citing Medicare reasons) and said she had to start coming in! Her Doctor said "we need to get her out of bed!!" (As if she could magically walk again.)

To make a long story short ....

I wound up calling a Medical Transport Company and hiring a stretcher and ambulance for her and paid out of pocket.

Her new Doctor set her up with 60 days of Medicare approved Home Health Care visits by a Nurse and PT. And also ordered a Hoyer lift for her which the PT will train me on how to use after it arrives. I'm disabled myself, so this will be a bit more complicated.

For anyone reading further - here's what we tried:
1. Specialized Doctor's office that made home visits. Did not work, as the Doctor was almost a two hour drive - they tried twice and opted out.
2. Called her insurance company and asked for help with this. None given. Called the county transport about their bus, they don't help people out of bed. 3. Called every Home Care Agency in the county. None would lift without a Gait Belt, Hoyer Lift or Slide Board.
3. Finally found a local doctor that agreed to see her once to establish a patient relationship. After that - phone visits are okay.

ALL because her previous Doctor decided that she didn't want to bother anymore with televisits!! I feel your pain!
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Well I have become a student of Medicare rules and it looks like Medicare does in fact require a face to face with the doctor or a PA or Nurse Practitioner in order to “certify” that the patient may need home healthcare services. I understand we are trying to prevent waste and abuse but it defies logic to make a frail, homebound patient in their 90s travel by wheelchair van or ambulance to a doctors office just so they can say they were “seen.” The policies and laws put in place to deter fraud were not meant to prevent legitimate patients from obtaining the honest services they need. My understanding is that some medical providers, like the VA, are now doing most of their routine visits by televisit whether the patient is fully ambulatory or not. A televisit, in conjunction with reports from the home health nurse should be enough. Apparently my mother has 30 days after the hospital stay to be seen or he can’t certify her as homebound. Something needs to be done about this ridiculous logic defying rule!
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this will be of little help, but for what it's worth, our beloved PC was wooed away to private industry and in the same office was the current PC believed to be a good diagnostician but he is a chauvinist pig. We daughters are there to do it all andthen some. Former MD and I keep in touch...sporadically...and he offered some other names and even admitted some other patients had the same complaint as me. The others he suggested are very hard to get an appt with or are not taking on new patients and are also at further distance...This MD (current) refused to sign referral to hospice because he had not seen her (because while not homebound at the time she has become increasingly so due to attitude and incontinennce x2. In the end it was the ER doc who did it, based on her dementia. She has been in hospice just over a month and I was the one who posted about the hospice MD (who is in charge of her care at this point) who prescribed seroquel for her which I object to for the reasons she felt it appropriate. I have since learned from a nurse at the neurologist's office that both local hospital/medical systems have visiting physician programs. My first call I told the office person our circumstances...i..e mom 98 with dementia, dad 104 and deaf, and me approaching 65 and having had a dissection of aorta last fall, and their only caregiver (i.e. no family in town, and limited friends remain for them... It was more than a blessing that the office person offered to contact the medical director and see what they could do, and I was so grateful to learn that while they normally do not see someone if they are in or move to hospice, they are willing to make an exception. All you can do is try, keep trying....all they can do is say no. IF your current MD is part of a "system" you might try going over his thick head and seeing what your alternatives are, what strings you might pull...OF course you won't especially want your mom to continue being his patient as he may be angry if you do that. Regardless, I would not continue with this arrogant, clueless and insensitive individual.
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Who is this guy, Dr Kafka? I've never heard such a rigmarole in all my life.

"Let me stop you there, please, Doctor, I'd just like to clarify - can you tell me how a bedridden patient should attend your office in order to be certified as bedridden, please? How about you explain the process, and I won't call my insurers to make a formal complaint."

Has anything else happened that would have made this doctor so anxious to get rid of not only your mother but presumably also you and your entire family as patients? Is he having a nervous breakdown or something? (I'm not being rude, there genuinely is a lot of it about among primary care providers).
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I had this happen with several homecare clients of mine who were no longer able to get to the doctor's office.
The doctors were also refusing to refill prescriptions if the clients couldn't "come into the office".
Your mother will have to go to the doctor's office by ambulance.
This is what I had to do with all of my homecare clients who were either homebound or bedbound. The paramedics come and they bring the person to the doctor's office. Depending on the ambulance company, some of them will stay too and make sure the person gets into the exam room. They will not however, put a person on the exam table or help them get undressed. All of them said no to that. Pretty much all the doctor did when the paramedics got the clients to the office was listen to their heart/lungs, the blood pressure, temperature, and put the blood ox on their finger. Nothing a visiting nurse service couldn't do at home. Of course these clients were completely out of it with dementia and didn't know what day it was, let alone be able to answer any questions the doctors had.
They have to see them or can't bill it as an office visit. This is why they insist. Any doctor can drop a patient from their service and not give any reason at all. They do it all the time.
As for the UTI's. Well, every time you suspect one you will probably have to call an ambulance and send mom to the ER in order to get antibiotics.
I had one client with an old-school MD who still possessed common sense which is all but extinct in the medical profession.
Anyway, I would call him and explain that the client's urine had a certain smell and was darker than usual. He understood that I'm an expert on every kind of piss and sh*t there is because I've been in elder care for so long. Every time this happened it was a UTI. The client was bedbound and in diapers so he'd prescribe an antibiotic before the next stage of bloody urine showed up with this client. He retired though. With all the others it was a ten or twelve hour visit to the ER. Family would always have to come down and wait with their loved one in the ER when my work hours ended and that was hard on them. Many lived out of town. Or hard on the finances because any hours that ran over my working hours I charged double-time pay.
All you can do is find mom a new doctor and take her by ambulance to appointments unless there's one who will make a house call.
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Does your mother have a Medicare Advantage plan? If so, call the insurance company and ask for assistance finding a new PCP in your area for your mother. It sounds to me that the current doc has some personal issues going on that are not related to your mom.
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Yes that is what I want. Keep her comfortable and treat issues that cause discomfort if possible to do so with non-invasive treatment. She is not hospice eligible right now.
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Just doesn't pass the common sense test does it?

Can Dr No make a referral for Geriatrician instead?

Someone who specialises in elder issues may be better for Mom? In my limited experience, they can be more maintenance orientated, rather than curative: more holistic & big picture, less pills, less scans/tests, less 'must fix'.

Depends if this is the direction you want.
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