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There are too many questionnaires and surveys. Furthermore, I question the validity and reliability of most of them. I try to keep off of mailing lists. A questionnaire is a form containing a set of questions, especially one addressed to a statistically significant number of subjects as a way of gathering information for a survey. A survey is a gathering of a sample of data or opinions considered to be representative of a whole.

In April 2014 I received an undated Dear Medicare Beneficiary letter informing me that “In a few days, you will receive a questionnaire in the mail called the “Medicare Provider Satisfaction Survey. …The Centers for Medicare & Medicaid Services (CMS) is the federal agency that administers the Medicare program … The questionnaire…asks about your experiences with health care in the last 6 months. … thinking about your experiences with a named doctor or other health care provider. Your name was selected at random by CMS from among Medicare enrollees. …You help is voluntary…” Sounds OK, if not great.

The questionnaire has arrived. Clearly, its creation and interpretation have been generated by a vendor, the Center for the Study of Services, with whom Medicare has contracted. According to its website, the Center was founded in 1974 as a nonprofit corporation. Its location is a PO Box in Manchester, Connecticut. It appears to [sell?] “offer economical ‘off-the-shelf’ reports as well as customized reporting tools developed in collaboration with you to meet the needs of your target audience.”  

In the interim, I had accumulated a few notes about my experiences with health care in the last 6 months that I considered worth mentioning in my response. But, the 2014 Medicare questionnaire is not designed to provide such an opportunity, let alone encourage response based on senior citizens’ experiences.  

I would have questioned (a few examples) exorbitant amounts charged for post-surgery rehabilitation and ambulance services; physicians who refuse Medi-Medi patients, i.e. patients with Medicare and Medicaid (Med-I-Cal), including those seen in the past; and the failure of Medicare to acknowledge hearing aids as health-related.  

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Research has found a Medicare major payment “gender gap.” Male physicians on average were paid $118,782 in Medicare reimbursements by the federal government in 2012, compared with $63,346 for women doctors.  

According to NerdWallet Health, reasons for this wide gap in total reimbursements included the fact that male doctors on average saw 60% more Medicare patients than their female counterparts. Male doctors on average make 88% percent more in Medicare reimbursements than female physicians. According to an analysis of recently released government data, which suggests that the gender of a medical provider could play a role in the number of services they provide patients.  

The difference is particularly striking because Medicare —the government's health insurance program for people age 65 and older and the single largest payer of health insurance coverage in the US — pays men and women doctors the same amount for the individual services they perform on patients in the same geographic area. The discrepancy was across specialties. (The only specialty where there was no disparity between the number of services provided was among pathologists.)  

NerdWallet points out that factors other than gender could be playing a role in the disparity of payments. A possibility is that male doctors on average may be performing procedures with higher reimbursement rates than their female counterparts. And yet another possibility is the fact that the government, because of privacy concerns, has not released data in cases where fewer than 11 patients were treated by an individual doctor for a certain procedure. If women doctors are more likely than male physicians to have procedures or patient totals in that low-end range, their reimbursement average could be skewed as well. Skew you. 

The analysis was based on a massive set of data, released on April 9, 2014 by the federal Centers for Medicare and Medicaid Services, which contained information about $77 billion in Medicare reimbursements for information for 880,000 medical providers in 2012. It was the first time in 35 years that CMS had released such data about reimbursements to individual providers. 

• "Rx Gender gap! Male MDs earn way more than females in Medicare," by Dan Morgan (CNBC, April 22, 2014).
• "Male Doctors Earn 88 Percent More Through Medicare, New Study Shows," by Napala Pratini (Huffington Post, blog, May 6, 2014).

Compassion & Choices continues to expand its outreach and mobilize supporters toward the goal of establishing death with dignity in 5 years. C&C opened a Los Angeles office in February 2014 to serve as a base for its Southern California team.  

This is about end-of-life choice in California, hospice, justice, “DNR” orders, fear tactics, and elder abuse. I have adapted it from a communication that contends that, if it's legal to arrest a grieving octogenarian at his wife's deathbed, then the law must be changed.  

Bill Bentinck's wife died as she wished: at home, in peace, with her husband by her side. But what happened after her death is a travesty -- and a painful illustration of why end-of-life choice must be brought to California. Lynda Bentinck was 77 years old and dying from emphysema. In chronic pain, she asked her husband to tape her DNR order to their bedroom mirror for all to see, including her hospice team. On July 2, 2012, she decided it was time to let go. She removed her breathing tube, held Bill's hand and waited. "It was a peaceful death…She just went to sleep."  

A few hours later, the police arrived after Bill called Lynda's hospice service. They were unsympathetic to his loss, and treated the couple's home like a crime scene. He was taken away in handcuffs, and for 3 days and nights, locked up like a common criminal ... isolated from his family, given no explanation for his confinement. At one point, the grieving elderly widower was shackled in leg irons. In the second of the 3 jails in which he was held, Bill asked a guard, "What am I in here for?" "Murder."  

Nightmares like this will happen until end-of-life liberty is legal across our country. Bill and Lynda Bentinck knew their rights. They followed California law to the letter. "We talked about it…We both had DNRs.” Imagine the police ransacking your home in their zeal to declare that choice a crime. The local D.A. declined to prosecute, but the kind of inhumanity displayed by the police should be against the law.  

A victory in California would catapult end-of-life issues into the national spotlight. Secure death with dignity in Oregon, Washington, Montana, Vermont and New Mexico. Highly organized opponents with deep pockets think nothing of spreading lies to poison public debate.  

For further information: Barbara Coombs Lee, PA, FNP, JD/ President, Compassion & Choices; Toni Broaddus, California Campaign Manager 

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NEWS  

"Doctor Shares Tips for Preventing Falls Among Seniors," by Robert Preidt (HealthDay News, May 27, 2014). 

"A Walk a Day Keeps Disability at Bay," by Robert Preidt (HealthDay News, May 27, 2014).