Dennis Liotta

Fri, Jul 19, 2024 11:39AM 29:06

SUMMARY KEYWORDS

medicare, hospitals, patient, program, part, order, waiver program, plan, person, educate, government, transitions, long term care, services, years, medicaid, people, advanced directive, doctor, family

SPEAKERS

Dennis Liotta, Julie Soukup

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Julie Soukup 00:00

Hi, thank you so much for joining again, our podcast, take one patient where we talk about patient communication, and meet with experts in the field in the space. My name is Julie Sukup. I work with medical memory. And I'm very excited to talk to Dr. Dennis Liotta. He's really here with a background in independent living, transitions of care and all these things, but why don't you start by actually introducing yourself a little bit of your background and kind of where your, your journey has, has kind of gotten you to in the medical space? Okay, so, um, basically, all of that could come under the heading of long term care. And, you know, I've been in this space for a number of years, I've been a physician for over 40 years, internist, and also did a fellowship in age management medicine. And so I got involved on the managed care side,

Dennis Liotta 00:57

about 30, some odd years ago. Now a little bit longer than that, yeah, probably 35 years ago. And you may 14 really was the involvement of both commercial and government programs. But I really took on the role of really getting into the government space, which means Medicare and Medicaid. And that really is a major part of what is out there in the managed care environment. We tend not to believe that our country is, you know, believes in socialized medicine, but Medicare and Medicaid are social programs, the VA benefit is social program. There are other also benefits that are associated with social benefits. Meaning that there's greater than 50, close to 60% of the population that is in a government program, meaning that we have a socialized medicine plan in the majority. So hard to believe, right, and we keep fighting over this over, you know, 40% of the population. So, but in that whole learning process, you know, I was involved in being one of the being part of a health plan, back in the late 1990s, when the Part C, Medicare Part C Act came into being to be in a health plan, that was one of the 15. Plans to actually get a contract with CMS, for the Part C program. And for those people who don't understand what the Part C is don't know about it. That's a health plan. That's a commercial health plan that submits its application to CMS in order to get a contract to do Medicare work. So you know, right now, you know, and you see and people don't realize sometimes that at night, you mana United Health Care, you know, all of these companies out there that talk about Medicare and you know, get your Medicare, you know, they do the enrollment in between

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October and December of every year, and they're always looking for people to get in. You know, that's Medicare Part C, and they cover part original part A and B. And they also cover part D. And they usually are anywhere from dope deductible, no coinsurance, no anything to other plans that have deductibles and have Co Co insurances and things along those lines. And people, you know, seek the best benefit out now a lot of people sit there and say, oh, you know, like I don't want to go into a Part C plan because I lose a lot of my freedom that I have in a Medicare Standard plan where I just getting it from fee for service Medicare or Original Medicare. So the background there that's just my husband will come by we both work from home. And so so you know, people don't understand that you can find the right plan that's suitable for you. And you know, really limit down the cost exposure to you. So where does all this come in? And why should you know about all of these different things is because it's really important that if you are sick, do have needs special kinds of needs. Apart see posts program could really be of added benefit to you over having just a standard Medicare plan because the Part C plan can help you in In order to define certain things and what you need, and then also look, if you qualify for other services that are outside of the scope of Medicare, which could be just a benefits that are in your community, as part of a county, or state benefit, or even going as far as saying that the qualify to have Medicaid as a supplement to your Medicare, and then also your eligibility, if you are a candidate for long term care services and supports under the 1915 C waiver program, that supply both home and community based services, as well as nursing home benefits as well to under that program, for those that have more extensive needs. So that's what I've been focused on for the last umpteen number of years. And, you know, it's, it's not an easy thing, a lot of people think that oh, you know, it is an easy thing, it's not, when you get involved with the government on anything, and that's why I think a lot of people don't seem to, like, you know, government health care, is there are a lot of things that you have to know about. But the wonderful thing that I have found out about all these years, really is that the government is very consistent. So if you know, these certain things, and you know, your, you learn about them, they will be consistent for years to come, the government really doesn't change very much. So that's the one thing that I've really liked about government programs is that, you know, they are consistent, commercial programs aren't consistent, because they go with the flow of the people that are buying them. And so people want this, or they want that, if you want other, it kind of changes. The government, you know, and especially more so with Medicare and Medicaid.

Julie Soukup 07:12

So for and correct me if I'm wrong, because even in our communication, you know, this is a lot that I had learned about it, and a lot was it because I didn't qualify for for more for them. But even having my parents that are not aging and going through spine surgery and health challenges, you know, how, how are a lot of these, like patients that now qualify for Medicaid and qualify for these programs? Like, how are they educated about what they should or shouldn't be doing? Or is it just their responsibility? The hospitals responsibility? I mean, what what kind of mechanisms are used to communicate and those aspects? Well,

Dennis Liotta 07:51

the first thing I will tell you is, don't ask your doctor, okay? Because they have no clue, none whatsoever, go into any office, and they have no clue, okay, they will refer you out to a social worker or something or even the hospital sometimes, you know, hospitals are, you know,

supposed to be well versed on, you know, on all of this, you know, as being one of those transitions of care of places, you know, so they are much better at it, you know, they the best thing to do I tell people is to call, you know, your local Department of elderly affairs, that would be in your community or in the state to give you more information. You know, on it, there are, you know, agency of agencies for the elderly and aging, usually, that go by county in just about every state, you know, some counties join forces together, and, you know, it comes together in order to address these needs. Because they may be in rural settings versus in urban settings. So, that's where you really need to go because you do need help on all of this, this is not gonna come magically to you unless you're in the hospital. And, you know, you're just in bad shape. And, you know, you have your Medicare and you're laying in the bed and there's no family around whatever a social worker comes in, they figure out all these different things, and that's the person that is the squeaky wheel that gets the grease. Everybody else is out there on their own. Okay. And the other thing that is very, very important for people to understand, and I get this question a lot from people, and is that the Medicaid program, the long term care program, around the country as part of the waiver program, are all income based. Okay, So you have to be at the poverty level or below, in order to qualify, if you were above $1 or above, okay, you don't qualify. Alright, that's it. And so, you know, where do you go for services? And a lot of people will sit there and say, Well, I don't know, I've worked all these years, I don't understand this guy down the street is getting services, but I'm not getting any services. And it's just based on the fact that he or she's got no money. And I've got $15 more a month coming in. I mean, you know, how just is that? You know, I, I've been fighting this whole thing for many years, and sitting there and saying that the waiver program does not serve the state very, very well. But the problem with the waiver program is that it's limited, it goes state by state, unlike Medicare, Medicaid is a state run, you know, in association with Medicare is state run, and every state has a different level of the 1915 C waiver program for long term care, or any of its programs are separate and distinct. They have some similarities, but they're not the same. Some states, you know, are, they have the ability of 562 1000 people in their long term care program, here in Florida and the state that I am in, there's only 120 People that are allowed in the program in any year. Okay, and there are about 70,000 people on the waiting list, and the waiting list grows every year. So people are literally dying to get, you know, in order to get in, they have to wait for somebody to die in order to come in there. So that's very, you know, very, very problematic. And, you know, we really have to understand because with a growing population, especially with the baby boomer boomers coming into this and growing very fast, okay. You know, it's going to take, you know, what do you do with people who, you know, make over that poverty but need help? What do you do with them? Because those people reflect a significant costs going into the Medicare system by going into the hospital? Because they don't have anybody in the home setting in order to take care of it. They can't afford it. Yeah, right. So what do we do? So that's where the community services. Now, again, that's only going to serve as a very, very small percentage of the population. But families need to get together and help their family members. Because if you're waiting on the government, in order to do that, you're waiting for Medicare to do that. It's not going to come on Medicare is been resistant in doing this for a very, very long time. But we need services and you know, services, like what you provided medical memory is really something that, you know, can help people, you know, and if it's affordable in any of these programs, if it's affordable, people will do what they can, you know, in order to, you know, make it happen, families, you know, we'll get together. But, you know, there's, there's nothing else that you know, you can do, you know, you can't get the government to make these payments. So did you anything else, you know, unless people in advocacy groups, go back to the government and, you know, start advocating and lobbying to state legislators?

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Julie Soukup 13:34

Sure. Well, I think that's one of the interesting things that we spoke about with this. And and I'd love to hear more also about you were talking a little bit about the advanced directive acts and how that's communicated. And so I have two kinds of questions with this. First is, you know, definitely, as you spoke about, I think one of the power of powers and medical memory, the
tool that we use, where you can record, you know, that social worker coming in and talking to that patient, you can record some of these things and hope that you're getting some collaboration, some family some some support around these patients who they might not understand maybe someone in their family who understands, or at least, this is a way to be an advocate for the patient to be able to communicate more eloquently about it. But with that, you were saying, you know, the, the caseworker comes in the squeaky wheel gets the grease. So Where where are usually the doctors don't know. But where is the responsibility of a hospital or anyone to kind of educate a patient about these things that are available? Is it just a social worker, or even the things that they have to which is one of the things you were talking to me about was that advanced directive law where they have to make sure that all these patients have at least this and that's mandatory, but not explaining the other thing? So how, whose responsibility is that and where, where can that communication be bridged if you will?

Dennis Liotta 14:55

Technically it's supposed to be in the primary care provider's office where it should be in every office. Because every every provider is a, a point in transitions of care. So, but it should be in the primary care office, but they're not well educated on it at all, a lot of people don't even know, you know, about certain pieces of legislation that are out there that they're responsible for. And that's because there has been no penalty that's associated with people who are non compliant. Right. So, you know, one of those things, you know, is the, the, the patient self Administration Act, okay, which sits there and says, Every patient is, is in need of information coming from their primary care provider, or any transition point where things are absent. And
in this particular case, it speaks directly to the advanced directive. And the Advanced Directives are all of those things that are talking about, you know, your living will and, you know, determinations that if you are incapacitated, physically, mentally, both, uh, you know, who is going to step in for you, and all that other kind of stuff are really is really very, very important. Now, Medicare, the CMS, you know, said that they did not want to be responsible for this, this was not in their bailiwick in order to do so Congress enacted and sit there and said, well, everybody else involved except Medicare, okay, will, will be responsible. So the doctor's office will responsible hospitals will be responsible. Part C plans will be responsible hospice agencies, long term care facilities, you know, just about everybody you can think of is responsible, okay, from for educating people on the Advanced Directive and other things that they need, you know, to have in their medical record. And but that doesn't go on. And I, you know, I sometimes asked doctors and said, you know, are you talking to people about their advanced directives as part of your intake? At any time, it's your staff do it or anything like that? And they look at me, like, I am speaking some foreign language, okay. Then when I show them the documents and say, did you know about this, and they know, okay, but you're a large group practice, you bring in $30 million a year, you did not know this? Don't we did not know this. Okay. And hospitals do the same thing. You know, hospitals will ask everybody, do you have a living? Well, no, okay, it'll check off the box. No, that's it. But the Act says they have to give them information about that, and try to get them to sign off on it. Right, so that they can actually do it, because it's very important, okay, because if somebody comes into the hospital unconscious, okay, they have to do whatever they can in order to do the best for that particular patient. And then if they

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call a relative, and they say, well, we need to do this, or this or this, or they need to go into, you know, rehab, or they need to do this, but they're not cognitively available, right? That the hospital can ask the son or the daughter or anybody else, because the person never signed anything. So that means that the son or the daughter has to go and get it has to go to court and get the documents, okay, as part of emergency standard. Now, hospitals can do that as well too, and to be a proxy for that for that person. Okay, and act as proxy for that person. In certain situations, not in all situations. So it's very difficult. So hospitals are the leading ones that go after that kind of advanced directive. But the one thing I can tell you about hospitals, ones like this one, you know, 30 seconds here is I would love if the hospitals could record on the discharge planning. Okay, there people are giving the discharge planning information,

okay, where it's on a recording, they can, you know, they go online bum that the Son, the daughter, the cousin, the neighbor, whoever can, can go and listen to it because a lot of the time the document that the discharge sheet, okay, you know, may have gone via email to the doctor to their PCP, but the doctor doesn't read it to three weeks later. And the family doesn't know what medications you're on. What do you got here? What you got there when he got the IV and try and get that done? Charge plan and pull you back. Okay, because mom, dad and Esther, you know, they lost the document between the hospital and going home? Yeah,

Julie Soukup 20:12

well, I'm, that's one of the things, you know, some of our top hospitals, they are doing that right now and they're recording that, but even going to your previous point is a lot of these hospitals will actually pre record a lot of this information that gets sent with every patient. So any patient that even would go through the process, get the discharge data automatically get another video from the hospital that could include this, this bit of information and, and, and, and in hopes so that they I mean, of course, what's in it for me as a hospital? Well, now I'm not going to get my fines or whatever it is by not having it. But it's such an easy, easy thing to educate and automate with like two clicks to all of your patients, and a mechanism they can understand, which is the power of video so that they have it, they can share it, you know, the paperwork, the reading, it's one person has it, no one can support them. And I think that's what we're starting to see, just as you said in that discharge, but it's a lot of it. Well, what's all what are these other pieces of education that we have to have, you know, recorded? We have to make sure these patients have the information? How can we just make it be a click, click Go, every patient now has it now is is the is the advance directive law was that the first time that patient education in some aspect was mandated meaning mandated meaning, you know, the hospital gets fined. Is that right? Is that that first time? Yeah.

Dennis Liotta 21:45

It never happens, okay, never happens. All right. Hospitals will have, like I said, on the intake sheet, they will have yes or no, and all of that kind of stuff. And they will minimally follow it. But they don't aggressively look to follow it unless they're in a precarious situation, where they don't know where to move next, or, you know, in, in the care and treatment of that person, you know, that has any kind of urgent or emergent needs, or in their discharge, okay, and where they gotta get the person out of the bed. All right. And so that's when everything kind of comes to full steam ahead, let's do this where, you know, where's the next of kin, let's get that, you know, let them go to court, let's do this, whatever that whatever it is, they're going to look to get that personnel because, you know, they've already sent out the notice, you know, the

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Medicare that the person needs to vacate that bed. And if that person doesn't vacate that bed, they're going to get charged for each day that they're there. Right, so there's there are penalties to the patient, their, you know, their penalties in a different manner to the hospital for not moving that person out as expeditiously as possible. So there's a lot of things here. So, you know, the the system is, is broken in many places. And all you've got is a gorilla glue and duct tape holding it all together. So pretty

Julie Soukup 23:24

much, sir. And that's I think, where everyone's saying like educate, educate, educate, and it's like, okay, great, let's make another flyer like somebody another, apparently, you know, here's another packet and I think it's, that's one of the things that we are really advocating for is, well, how do we not just educate this patient, but their continuum of care, everyone's getting older, you know, my generation is probably one of the first that's really really needed to take care of their parents and their kids, you know, at the same time and has the means and education to do so. You know, and so I think it's becoming more we I'll do whatever it is, if I know what's going on, and I can't always be there, you know, so, I think it's becoming an interesting place. Well, a lot of these pieces can get, you know, automated these information even just these are your options for transitions of care, you could go here, here here, this is what it's gonna look like this is what all those pieces would help improve streamlining that without without making it you know, record every time it's like here's information for everybody in our facility that's in this genre you know, that makes it trackable, shareable to family and really simple. So,

Dennis Liotta 24:34

what would I like to see is I'd like to see like in every you know, the the offices today, they've got the the video screens, you know, in their waiting room, the video screens in their, in their actual exam rooms where you know, people are ushered in from the waiting room into the exam room, and then wait, you know, another three days there before the doctor whoever is going to come in to see them and You know, so while in there, they can easily just put on a video that sits there and talks about, you know, the the, the advanced directives, right. So like your company would sit there and say, here's the here's a series of videos about the advanced directive and the need for the advanced directive. And play it for the for the people, right? When they see it enough times every time they go into the office. Okay, they may turn around, and you don't start to ask questions or when, when either the the the aide comes in medical assistant comes in, you know, did you watch the video? Yes, I watched a video that's the 14th time I watched the video, you know, and okay, all right. So I guess I really need to do this. Right. Yeah. Because sooner or later, it's going to sink in. Right? Right. Yeah. And

Julie Soukup 25:52

that's a little bit of that power, too, is okay. Well, maybe my my kid knows how to do it. Can you share it with her? Great now, I'm also accountable to you to make sure that we're taking care of these things that I wouldn't even know were needed. You know, or, or, or just as you said, what if you know, you know, someone's in my unconscious, you know, somewhere, they don't even they don't even know where we are like all those pieces that should be lined up so that they are being cared for in the right and proper way that we would won. And I think that's some of it

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is, as you're saying baby boomers are getting older, or you know, their, their kids, their family, they want to support them, they want to help the healthcare burden, but also don't know always all the things and the resources and can't be there for the 10 minutes the case workers walking by so or every appointment. So I think a lot of these things go beyond just here's the information about your specific case. But here's information about you know, health care and what you're accountable to and eligible for across the board, you know, so Right, right, right. Awesome. Well, thank you so much. I so enjoyed our conversation, I show enjoyed our first conversation where I learned a lot of these spaces and did not understand it at all. And I've been in medical sales forever. And I was like, wait a minute, I don't even know these things. I appreciate, like, you know, the new perspective and a lot of the things to start looking and digging into just, you know, to be more effective, and in communicating and educating and supporting, you know, the patients, you know, whether, you know, through through the funded programs are not, you know, it's it's incredibly important. So I appreciate your time. Is there anything else that you'd like to add? Yeah,

Dennis Liotta 27:30

I just wanted to, you know, because I advocate here, definitely for the elderly. Because I think that a lot of people have gotten the short end of the stick, so to speak. And I really want people to go and understand their Medicare rights, understand what they're entitled to. No matter what your health plan says, there's always more, there's always something else that you can do. If you get denied for something, you have the right to appeal. You know, I'd like to make sure that people if they need services, are active out there in their, you know, calling their community, the Department of Health, the State Department of elderly affairs, you know, that IT department of family, children and families, depending on which state you live in, I really think that this is so important, because so many people are need, and there are things out there for them and that they should not have to suffer or go without. If there is something out there for them. There's not going to be out there for everyone. But you know, unfortunately, we don't live in a society like that. But you know, if we can help, you know, 123 You know, every week, then we're doing something

Julie Soukup 28:52
for sure. No, I appreciate that. Awesome. Well, thank you so much for joining us, and we look

forward to hearing more maybe from you down the road.

29:01

Thank you so much. I appreciate it.

Julie Soukup 29:04 Thank you