People talk about change these days, expressing their desire and even frustrations with the sense that something must change, without even really knowing what or how nowhere is this displayed with more of a sense of urgency than in health care. Even in the ranks of health care providers those who actually profit and sustain a comfortable living at the involvement in a system that has marched into the arena we now find ourselves in, feel an urgent sense that something must change, that the system itself is drastically flawed, and that continuation under the present program or course is doomed to fail, as I myself do.
The American Public who have always been on the forefront of the pulse of not only liberty but hold in their collective heart a deep sense of what is wrong and right, and ultimately when given the choice will side, at least with the majority, into a direction that at least hopes to venture towards what is right. And while many may argue whether or not the election of President Trump represents right or wrong, there is no doubt that it represents a desire and even drastic “Hail Mary” shot for the hope of change.
There seems to be a steady and unrelenting current of discussion in the area of Health Care reform, particularly the need to facilitate change into a program that has seem to have rolled downstream in such a destructive and imminent way, that the majority of people not only recognize the seriousness of the dilemma we all find ourselves in, but are coming to the bleak conclusion that the healthcare environment as a whole is so far gone, that it seems to the typical bystander, as an image of someone who wishes; “now to live in the scraps of a house that has long washed down stream after the great and horrendous flood.” Low and behold if you as a person, you somehow find yourself floating rapidly downstream in this flood because in a flood you know at any moment you can become overcome or sucked under by the hidden dangers that rest just below the surface.
Health Care now, that is a difficult arena, and I myself as a practitioner as well as someone who has profited from the dispersant of medical recommendations and procedures to the people who suffer from ailments needing these bits of advice, feel at times like a hypocrite as I speak of the need of change within the very program I have participated with for over thirty years. But as I venture down this road myself and witness the care and options being delivered to my brothers and sisters, my children, I am left with a strong sense of sadness at the insufficiencies of the whole thing, and thus the urgent need for change.
As with any flood prevention, if real change is to occur an upstream application solution must be implemented to have even the slightest hope of effect on the overall status of the environment. I have seen as a Healthcare provider a steady decline in the decision making process surrounding the actions taken by people as it pertains to the care for sicknesses or injuries. One way this change may occur Insurance companies need to be taken out of the decision-making process of healthcare!
Years ago Stark Laws forbid Doctors to own or to partner in practices that they by way of referrals would possibly profit from, denying them the ability to send their patients to any augmenting service that they may partner with or profit from. This was implemented as a general practice to ensure no coercion was established in which Doctors might be swayed from making recommendations, or profiting from the recommendations of their patients care. This limitation was unfortunately not passed on to insurance companies themselves.
Insurance companies have been allowed by means of legislature, the ability to not only own any and all venues of healthcare from hospitals, specialty services, to private Doctors’ offices, but through the guise of contracting and authorizations, not only restrict and mandate the place where care is provided, thus who profits from this care, but also the actual decision making process as to whether or not the care will be provided. Basically, the entire decision-making pinnacle of all the health care no longer rests in the individual hands of the Physicians or more importantly the actual patients themselves, but sits in the hands of those who profit the most from limiting or denying the care altogether. The actual decision finds itself on the computer screen of clerks, or “Adjusters” that often have no medical training whatsoever, and merely give authorization or denials based purely upon the guidelines or recommendations of the programs set forth by the individual insurance companies themselves.
If I am not mistaken, when the insurance companies first set out to sell the American public the “Assurance” of medical insurance they often stated that; “If we pay them a monthly stipend, then, if and when an actual event would occur, they (The Insurance Companies) would then pay for the care necessary to overcome this tragedy. So, as a result, the general public that has given their money to the insurance companies for no other reason than to “Insure” when they will need care themselves the money will actually be there.
Being a Health Care Professional and a Private Practice owner for well over thirty years, gives one a bit of a perspective as to the process and the development of the medical environment, especially regarding the abilities of patient to receive the health care they were promised, as pertains to insurance, plus the need for any and all health care to basically go through the insurance company in and around the approval and payment. I have witnessed throughout the last thirty years a steady decline to the ability of an individual person to actually decide for themselves not only the form of health care they receive but even the decision as to whether or not they receive it at all.
There has been a steady decline in individualization of care as pertaining to patients and a gradual increase in standardization and protocols regarding treatment options. This all sounds great on the surface when it comes to cost containment and reduction of abuse of the funds, but the overall cost is that people are all placed in categories, and then it is so easy just to constantly wind down the benefit’s for each category or dictate exactly what care an individual will receive or not, based purely on the desire of the individual insurance company adjuster.
I have in thirty plus years seen every sort of atrocity that can be perpetrated against patients who have prescribed care for authenticated needs, most of the time by these adjusters who have admitted to either being prompted financially to reduce costs or deny care, or worse yet by clearing houses or better known as claims management companies who do nothing else but extremely limit care, dishing it out after long and tedious authorization procedures for like rations, then to cut cost significantly and then take their percentages profit payments based on these savings. The sad thing is the insurance company cannot even be sued for denying services because they are not the one doing it, and the clearinghouse has no contract with the insured so they are also beyond retribution, a loophole in the law continually abused by the insurance companies to cut costa t the expense of the patient.
Nowhere is this seen more then in the auxiliary care outpatient therapies or home health, where under the excuse of cost containment people are forced to wait up to weeks for authorization, limited to only a fraction of their need, or worse yet denied the care they already had ordered by a physician, even when it is often verified by a licensed therapeutic professional and more importantly been promised contractually by the insurance agency who by the way had no problem taking the patients monthly payment for years prior.
This behavior causes a reduction of the effectiveness of the treatment when it finally is delivered and can cause what was an acute occurrence to translate into a more chronic and longterm condition. It has been witnessed and proven that the effectiveness of therapeutic procedures is greatest when implemented immediately, as shortly after the event of injury or surgical procedure as possible. Waiting weeks or even months greatly increases the chance for normalization of symptoms, increased pharmacy dependency and basic placing people into a longterm patient mentality instead on the road to rapid recovery.
We must have a return to basics when it comes to healthcare!
A couple hundred years ago when this beautiful country was being penned and the foundations of liberty, with its pursuits of happiness, were being expressed, health care was nothing more than another part of the expectations of those who seek life and liberty. “Life”; what good parent wouldn’t want the best possible life for each of their children, and when an affliction found itself upon one of these children, a good parent would seek all the available knowledge out their to alleviate suffering from.
Did the wise grandmothers who had the knowledge issue it out for a price? Did they hold it or even deny it from a child in need, if said child failed to visit them or cut their grass, or give them money? I think not! But yet today knowledge and procedures for care, ideas that are not of their own, but learned by others, gifts of knowledge long ago bestowed upon brothers and sisters, fathers and mothers themselves, are now being issued out like rations for the many prisoners that find themselves in the wrong place, in the wrong prison, the sick and afflicted.
Worse yet these rations are regulated by those who profit the most by denying or control them. Information is being held, the best products with the purest of ingredients are tainted or manipulated for profit, courses of action are withheld, for the choice towards more profitable and chronically addicting possibilities, that have no intention of desire to cure anything, but merely alleviate symptoms and ensure that the pills will need to continue to be purchased.
I can remember with more pleasurable days a time when care was delivered without first the lengthy administrative paperwork ensuring the promise of payment. People would come to the medical provider with hope and trust, and the care would be given either in the form of advice or direct medical intervention. People understood the value of the care received and if they could not pay would extend something else of value from themselves to the healthcare provider.
In the early days of my physical therapy carrier, I remember a man who came in with an injury to his shoulder, and after a few direct applications of specific care he regained his motion, and while he didn’t have money to pay for what he received, he was a good friend of the owner of the facility and was sent away being told no cost would be assessed. Moments later he brought back a large piece of cured bacon, the man was a pig farmer, and this was how he paid for his care.
Somewhere along the line, we have been duped into believing that staying in a hospital room with those special little containers of sample toothpaste and little hotel soaps needs to cost thousands of dollars a day. It just seems funny to mess my contracted care with an insurance company for a single procedure in my practice hardly went up 5% over the course of twenty years, yet they had no problem paying thousands a day for that little room and those ridiculous items.
Fair market value for time spent, fair price for the items being used, I don’t think anyone would disagree with this kind of system. How sweet would it be to return to a system such as this?
Peter Colla Physical Therapist
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