Frustrated With Health Care

Just when I think I’ve gotten it all out of my system and I’m ready to start talking about some positive, constructive stuff another article comes across my desk that I feel compelled to discuss.  This is yet another article that adds to my frustration, and yet, supports my moving forward plans.

The newest article was in this past weekend’s Parade; “Don’t Let the Economy Endanger Your Health”.  This hard-hitting story reports some sobering facts about how people are reacting to the economy relative to their health.  In fact, based upon conversations I’ve had with many other doctors these figures come as no surprise. 

Startling results of a survey from the American Heart Association reveal that 57% of those surveyed report that the economy has affected their ability to take care of their health.  The impact is obviously greater amount those with lower incomes, although 33% of those earning $75,000 or more say that they also feel the squeeze.  People are forgoing lifesaving care; 10% have reportedly stopped or reduced their medication for chronic diseases such as high cholesterol and asthma.  13% have elected to not get a flu shot, while 18% have avoided getting needed exams like mammograms. 

However, in reality the state of our economy may not be completely to blame for this; health care has just gotten to be so freakin’ expensive.  In 1970, Americans spent approximately 7% of their budget on health care.  At 17% for 2008, this represents a 2.4 trillion dollar outlay, which exceeded our spending on housing or food.  The truth is that the U.S. leads the world in advanced specialty care; as such, we spend more money on health care than any other nation in the world, and what do we have to show for it?  In spite of our huge price tag, the World Health Organization reports that the U.S. is ranked 31st in over all health as compared to all other industrialized nations; a very sad commentary!

So, what does the author, George Anders, recommend us to do?  He suggests that prevention must be our priority and that we should find creative efforts to encourage wellness; sound familiar?  To me, this sounds like it is right out of a chiropractor’s mouth, after all, isn’t this what chiropractic is?  All we need to do is demonstrate that our care is wellness orientated and that we are a great health care option; that’s all it should take, right?  Well, actually, I believe that because of the economy another part of this puzzle is to demonstrate affordability and possibly re-think our fees in these tight economic times.

Like most chiropractors my desire has always been to help as many people as possible.  In fact, in my career there have been times where it was not uncommon for me to see upwards of 90-100 patients a day in my practice.  Today, I’m lucky if I see 30-40 a day; clearly a significant drop.  So what happen?  Did these patient’s condition get better?  Do they all-of-a-sudden no longer require my services?  Obviously not!  The solution?  We just have to find newer more modern ways to communicate with our patients to bring them back in.  Lightening bolts in the Yellow Pages doesn’t work.

You know, I really don’t like to beat a dead horse, but I do think that something else needs to be said about the direction our “health care” system is going.  I don’t know, maybe it’s because I’m a chiropractor and I am concerned about how chiropractic services are going to fit into the whole health care picture.  Or, maybe it’s because I see health care continuing along the path of an ever increasing dependence on drugs to cure all our woos. 

It would seem that the push now-a-days is for national health care and what they call “preventative care”; you know, early detection through expensive testing procedures and early intervention through expensive drug regiments.  As previously mentioned, this is sick care and it is LESS cost effective.  Where in this plan is true health care?  Where in this plan do you see chiropractic care fitting in?  As many chiropractors will tell you, it does not!

Back in 1998 chiropractors may have won the battle with the AMA to cease and desist their anti-trust practices, but it would seem that the AMA is getting the final word.  Think about it, what three organizations run the health care industry?  I think you might agree that it is the AMA, the pharmaceutical companies and the health insurance industry.  So, let me ask this, do any of these organizations even consider health care from a wellness point of view?  From a chiropractic point of view?  Not on your life!  It is just not in their best interest!

Medical costs continue to sky rocketed and chiropractic services have been prevented from keeping pace.  Why?  Simple, the allowable fees are also set by the health insurance companies and they do not value chiropractic services.  The result is that with higher overall health care costs the health insurance industry has raised their co-pays, obviously to save money by precluding them from having to deal with what they consider to be nuisance claims; aka, chiropractic services.  One obvious solution is for chiropractors to fight for higher fees, but you know that along with that we would also have to compromise by accepting a cap on care.  OK, great you say, we’ll take $75-$100 per visit with a 12 visit cap.  Then we all know that 12 visits isn’t enough so we’ll just convince our patients to continue care at a cash fee that is much less, right?  Depending on your area getting the full fee might be an unrealistic expectation.  Aaahhhhh, but is it legal to charge less than the established fee schedule?  To answer that let’s take a look at our current model of “national health care”, Medicare.

As a chiropractor in the Medicare system we have three codes that are covered; 98940, 98941, 98942; all chiropractic manipulation codes.  These codes are only covered when there is an active treatment plan with an end result in mind; on going preventative, maintenance care is a non-covered service.  All services, covered or not, are supposed to be properly documented and properly billed.  This means that for all care, covered or not, a claim form must be submitted to Medicare; a special modifier is used to tell Medicare when care is active when it is not.  In either case, your patient is supposed to pay their share, which means that for covered services they pay their co-pay and for non-covered services they are supposed to pay the full fee.  Anything less and you run the risk of having to answer questions of the National Government Services.  It would seem to me that these same rules would apply to any new government plan that comes down the pike.

Now the questions one might have is, why do we need to submit a claim to Medicare for non-covered services?  That’s a good question, but I might speculate that it is because “they” want to keep on eye on us to make sure we are not taking advantage of Medicare patients by convincing them that they require more care than they actually “need”.

The questions abound: Who’s rules are we playing by?  Who says that a patient can’t make their own decisions regarding their need for care?  Since care that is not active is considered a non-covered expense, then why are we bound to the established fee schedule?  Whose to say that we couldn’t give it away for free, and if we did would they still be concerned?

It seems that I am not, and chiropractors in general are not the only healthcare provider frustrated with the healthcare system. 

Just the other day I heard on the radio that across the U.S. something like 35% of Medicare patients could not find a General Practitioner who participates in the Medicare system.  While this is a sad commentary, it is just representative of the bureaucratic nightmare that goes along with taking care of Medicare patients.  Across the board providers are pulling out of Medicare, as well as out of other insurance company provider panels simply because the excessive control prevents them from “being a doctor to their patients”.

Unfortunately at least for Medicare patients and for us as providers is that it doesn’t matter if the provider is Participating or Non-Participating, all the same rules apply.  As a Non-Par provider the only advantage is that you do not have to wait for payment; presumably your patient pays at the time of service.  HOWEVER, as long as you are accepting and careing for Medicare patients, even as a non-par provider, you are still bound by a fee schedule, you still have to bill, code, and document your services and level of care accurately and appropriately, AND you still have to be able to provide this documentation to Medicare upon request; the nightmare continues.

To the best of my knowledge, the only way to avoid this nightmare with Medicare patients is to not accept Medicare patients for care.

And actually, the same would hold true with most other patients who have any type of health insurance.  The only difference is that other insurance companies do not have a non-par fee schedule; presumably you can charge whatever your usual and customary would allow.  But again, if your patient has insurance they are going to want to submit a claim for your services.  As such, as the provider you are required to document and code your services accurately and appropriately, and you must make your records available upon request.

The day of the family doctor where a patient comes in, they get a consultation and examination, you jot down a few notes, give your treatment, and the patient pays . . . , those days are long gone thanks to the controlling eyes of the insurance industry.  Justified???

Just another source of frustration as a healthcare provider.

Hello, and thank you for visiting my blog.  My name is Peter Holst; I am a chiropractor and have been in sole practice in Middletown, NY since December 1986.

This blog is based purely on my experience as a healthcare provider and upon the experiences of other healthcare providers, as well as from the many discussions I have had with non-professional healthcare workers.  Certainly as a chiropractor many of the experiences related in this blog may be peculiar to chiropractic care.  However, many may also apply to a broad spectrum of other healthcare providers. 

Nonetheless, the opinions expressed in this blog are just that, my opinion.  Should you have a conflicting opinion you are certainly welcome to offer your comments.  Similarly, should you agree or have additional experiences you wish to relate, you are more than welcome to express those. 

This blog is simply a forum, both for you and me, to vent our frustrations relative to daily practice and what action steps have been implemented to better deal with a particular situation.  We will also have the opportunity to relate how those experiences have affected our practices and our life, as well as offering solutions designed to maintain our income in the current economy.

That said . . . here is my first blog post.  I hope you enjoy it and most of all I hope you benefit in one way, shape or form.  And, please come back again, I plan on updating this blog regularly.

In the Beginning

In the beginning health insurance was a contract between the subscriber and the carrier.  Doctors charged their fee, the insurance carrier paid their 80% and the patient paid their 20%; these were typically known as indemnity plans.  Then beginning in the 80’s health insurance started to become not only an agreement between the carrier and subscriber, but also between the carrier and the doctor.  This was the time when doctors began losing their autonomy; this was the time when the carriers started being in control; this was the beginning of the end!  From this time healthcare decisions were made by administrators and not necessarily doctors; and certainly not by the provider of the care. 

Even today, health decisions and doctor’s profiles are more about outcome studies, which are often derived from facts and figures compiled from doctors who are already on the provider panels and who know they are being “watched”.  Decisions for patient care is no longer based upon a private one-on-one doctor-patient relationship, and it certainly is NOT based upon the “gut feelings” of the doctor, nor the needs of the patient.

Why did you get into health care?  Did you want to help people or did you want to help people based on the kind of insurance they have?  With co-pays continuing to be on the rise it just makes more and more sense to convert to a cash practice.  By saving on the administrative end, including the cost of forms and postage, and not to mention the extra payroll necessary to submit and then to “chase” your payment, it would seem to me that a very reasonable fee can be established.  A fee that could be at, if not very close, to the patient’s co-pay.

That’s it for now . . . I’ll see you next time at FrustratedWithHealthcare.com