In innocently mentioning to a friend, who is a Physical
Therapist, the prognosis of a foot thing I have been dealing with, she said to
me “Lesley, do you really want to know why you can’t get a diagnosis on your
foot” Well, of course I do so I said,
“Yes”. She told me it is because they
have to treat all the Medicaid and Medicare patients for about $17.00 a visit. (that
is the PT reimbursement I don’t know what the physician visit is) That in order to make enough money as a
provider, they have to treat more patients, often overlapping visits, and
doctors and therapists don’t have the time to sit with you to determine the
full diagnosis of intermittent and transient symptoms. I said, “My visits cost me a $75 copay as
well as the $200.00 the insurance company paid.” She became adamant and said, it was because
of the Medicaid patients that I had to pay so much. We were at a party, I didn’t want to go into
this any farther and quite frankly, I had to think about this and unpack both
her anger and the facts.
Cost of
I didn’t ask her what her solutions would be so my conjecture
shouldn’t be connected to her. Maybe she
didn’t have a solution, maybe she was just frustrated with the increasing work
load and changing regulations. From what
little research I did, I found the coding and regulations changed the end of
the year and she is right the reimbursement is incredibly low.
I did two physical therapy visits at the previously mentioned
charges ($275). The first visit I was
with the Therapist about 20 minutes and she did some strength and movement
assessments, sent me some exercises by email and gave me an elastic exercise
band. The next appointment I went to the
main exercise room which looked like a small gym. I was instructed to warm up on the exercise
bike for a few minutes while she finished her previous patient. Then we went through some calf stretches, leg
lifts, hip flexor machine, a foot rotating board which she asked me to do while
she attended to a new patient who came in. She got him started on the bike. When she came back to me, I was pretty frustrated
because due to my “issue” I couldn’t do the foot board which she said something
to the effect “oh, just do this…..”
”well, I can’t, that is why I am here…duh”.
I left frustrated and
of course, $75.00 poorer. (which they made me pay up front…smart) None of that visit was satisfactory in any
way. I didn’t go back. I joined a gym. So I have digressed here somewhat. (Plus I
will fully admit that I am sort of a nightmare patient… impatient and skeptical
and a bit of a know-it-all)
I could see that the PT’s where having to balance several
patients. Some patients with far more
serious issues were getting more attention and that was as it should have
been. I don’t know if they got
reimbursed more for higher need patients but from the looks of most of the
people in there…I was definitely paying the most and not a Medicare or Medicaid
patient. I don’t know why we have made
the reimbursements so low, this shouldn’t be acceptable. We, as the American public shouldn’t want
that for our providers.
I mean seriously, if you worked 8 hours and saw 16 patients
you might bring in $272 for the day. That is not enough to keep the lights on. You definitely need me the insurance customer
because you made the same on me as you did the entire caseload for the
day! Actually, I don’t know what the
patient load for the PTs is, it could be even more.
I remember before the ACA a doctor said to me that we were
already rationing health care by cost.
If you didn’t have the money and or insurance you were simply not
getting care until it was an emergency.
I don’t think we want to get back to that because that isn’t ultimately
cost effective. But on the other hand we
can’t expect doctors and therapists to work in areas with low reimbursement due
to poverty when they barely can cover their costs: building, staff, equipment, malpractice
insurance and other health insurance for themselves and staff, and probably for
time, college loans.
So here is probably the “not” news; Our insurance premiums are related to the low
reimbursement of Medicare and Medicaid because those doctor fees the insurance
companies are paying are necessary to offset the losses they are incurring due
to the government squeeze.
We need
to cover everyone equally
I believe that my friend is compassionate and she wants people
to have care if they need it. However,
not at great cost to her.
That is the $64,000 question; “What is great cost to each of
us and how do we compute that?” I will just say that I do not have the ability
to tease that magic needle out of the haystack.
I am just going to list some things I know.
We need affordable healthcare coverage in
what form, I am not sure
When a person
does not have reasonably regular checkups, things get missed.
Things get missed for long enough
they have a tendency to become big things which are more complicated and costly
to take care of.
Shit
happens. Yes, to the young and healthy as
well. Catastrophe generally means
unplanned.
Unlike buying tires, healthcare is a universal need. You can choose to own a car but not your
body. I mean, here is a dystopian novel
concept: People who are injured in auto
accidents and uninsured will simply be taken to a holding center (for sanitary
reasons) until they are either picked up by a family member or die. If there are any unresolved costs to their
care, we can just begin harvesting organs….you only need one kidney, one lung, or
one eye. A slight hyperbole there for
sure but what the heck!
I think there has to be some universal rate system. I believe they do that in other countries
that even have private insurers. This is
a hard problem, one that takes great care and we can’t allow our partisan
division get in the way. It is one of
humanity. Heaven help us.
