The Social Security Administration adopted new digestive system listings last October. The liver is part of the digestive system and is covered in the new listings. One of the ways to meet the liver listings is something labeled as the "SSA CLD" (Social Security Administration Chronic Liver Disease) score. This is computed using a complicated formula. The SSA CLD formula is the same as what is generally known in medicine as the MELD (Model for End-Stage Liver Disease) score.
I have wondered why Social Security wanted to avoid using the term MELD. My guess is that they did not want people thinking that one had to be in "End-Stage Liver Disease" to meet the listing. That just sounds so extreme.
The listing requires a SSA CLD (or MELD) score of 22 or higher to meet the listing. A recent issue of the New England Journal of Medicine has an article on liver disease. You can only read the abstract online, but the whole article includes a table showing that the median MELD score for those on the waiting list for a liver transplant is 15. One short quote from the article: "On average, the risk of death increased by 21% ... per unit increase in the MELD score." Not only must one be in end-stage liver disease to meet the listing on the MELD score; one must be well into end-stage liver disease and at great risk of death.
Where did the listing requirement of a MELD score of 22 come from? Why not 20 or 18 or 15? Did someone try to figure out how many more people would qualify if the MELD score requirement were lower and how much that would cost? Did someone try to figure out how many more expensive liver transplants Medicare would have to pay for if a lower MELD score was used? As it is now, people in end stage liver disease under age 65 are unlikely to live long enough to qualify for Medicare. Was the Office of Management and Budget involved in setting the MELD score requirement? Was someone thinking "Oh, the hell with them. Most of them are alcoholics anyway." You have to wonder how comfortable the physicans involved in creating this listing are with the requirement of a MELD score of 22.
I have wondered why Social Security wanted to avoid using the term MELD. My guess is that they did not want people thinking that one had to be in "End-Stage Liver Disease" to meet the listing. That just sounds so extreme.
The listing requires a SSA CLD (or MELD) score of 22 or higher to meet the listing. A recent issue of the New England Journal of Medicine has an article on liver disease. You can only read the abstract online, but the whole article includes a table showing that the median MELD score for those on the waiting list for a liver transplant is 15. One short quote from the article: "On average, the risk of death increased by 21% ... per unit increase in the MELD score." Not only must one be in end-stage liver disease to meet the listing on the MELD score; one must be well into end-stage liver disease and at great risk of death.
Where did the listing requirement of a MELD score of 22 come from? Why not 20 or 18 or 15? Did someone try to figure out how many more people would qualify if the MELD score requirement were lower and how much that would cost? Did someone try to figure out how many more expensive liver transplants Medicare would have to pay for if a lower MELD score was used? As it is now, people in end stage liver disease under age 65 are unlikely to live long enough to qualify for Medicare. Was the Office of Management and Budget involved in setting the MELD score requirement? Was someone thinking "Oh, the hell with them. Most of them are alcoholics anyway." You have to wonder how comfortable the physicans involved in creating this listing are with the requirement of a MELD score of 22.
2 comments:
Oh what the hell you would think our government would be a great help for some of us that paid their wages would be in debt to help!well just a thought maybe it will be there time in life when it's done to the ones who makes the decisions.
Doesn’t shock me at all your statement doesn’t even include the massive amount of conditions a end stage liver disease spawns like diabetes. Rarely does a patient needing liver transplant just have cirrhosis. Yes of course someone factored a score to eliminate 85-90 percent of patients. Yes SSDI has a let them die attitude. The whole separate scoring is all about letting many die of sepsis, some of bleeds, others diabetes. Somehow you must stage yourself in their perfect window of very critical yet not dead. Meanwhile someone a little coco bird or of the right race gets rubber stamped. Maybe the solution is sacrifice your sight through cirrhosis induced diabetes that’s a rubber stamp. Think of it blind at 22 at get SSDI for 40 years. The system is whack because it’s got massive overhead look at your local metro chances are it has 8-10 local offices, 5-6 region offices per state. Various adjusters and outside resources for medical and psychological evaluations. Figure they take 40-50 percent of taxes a year. That leaves 50 percent to the masses and interest groups minorities and women. They know exactly what their doing that’s why you need an attorney to take it before a judge that tells these selfish penny pinchers your paying. I’m sure many an administrative judge has seen very sick people whose mere yellow appearance makes them want to throw the gable down that moment. SSDI is filled with tons of government butt kissing bureaucrats who have cos much as seen the patient their saying no to.This is why once challenged they fold up and walk away with their 26-27% denied.
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