Sunday, June 25, 2017

Catastrophe is generally unplanned

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 Reimbursement
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.