Evidence Based Rehab

The Insurance Journal released an article discussing how a "surprising" share of work comp case costs come from unanticipated costs or, as they term it, "Adverse Surprise Costs." The study reported on was said to find:

Adverse surprise cases were disproportionately chronic conditions with multiple surgeries. They were also disproportionately back pain cases.

That's no surprise to me, however, and should really not be a surprise to anyone dealing with chronic pain and low back injuries. While back pain is not the only musculoskeletal condition being over-treated with narcotics, expensive imaging, and surgery, it certainly is the most costly of all. In fact, most of my recent posts have centered around this subject (you can find them here, here, and here).

What is surprising is that, despite all this research showing all this imaging, surgery, and narcotic prescription make things worse often, we are still using that recipe to treat most folks with LBP. In fact, those doing it are being the ones rewarded with reimbursement for doing so.

Jason L. Harris

Labels: evidence based medicine, insurance, LBP, Low back pain, over-use

Rising healthcare costs and the health insurance industries continuous push to maintain high profits have lead to higher and higher copays. Especially in PT where insurance companies aren't really sure what they are paying for. It's not uncommon for me to have patients come in with insurance benefits that require a $25-$35 copay per visit. Plus, there is usually some arbitrary visit limit to boot! Many patients balk at this, and our first reaction is to sympathize with them and help make excuses why they don't have to come in, or don't have to come in often. Is this the right approach, though?

A colleague and I just had a conversation today regarding this, and Larry Benz, coincidentally, posted his opinions related to copays over at Evidence in Motion. I won't cut and paste what he states, but I will express my take on the issue.

Do not make excuses for a patient's insurance copay. If you think it's too expensive, then did they really need to be in to see you in the first place? If they need your services, then don't be afraid to let them know and provide them with that service.

Another issue in the area I work in is the difference in copay for a PT owned outpatient clinic vs. a hospital run outpatient clinic. Basically, the PT owned copay is high and the hospital has none. What does one do in this situation? Refer to the hospital to "save" the patient money? If so, then what does that say about your business and your beliefs about your clinical skills when you confirm to this patient that the clinic choice doesn't matter, only the cost (so choose the cheapest?).

In the end, if you are providing quality, outcome oriented, evidence-based treatment, then you should let that prospective patient know that and then give them their moneys worth for treatment without letting that high copay rule over you.

Labels: Copays, Direct access, Healthcare, insurance, physical therapy

Lost a patient today to the local hospital PT. Was it because the local hospital had more convenient hours? Better PT's? Closer to home? None of the above. UHC limits her visits to 20 a year with a $30 to come to our PT owned clinic; but the pt had no copay or limits going to the hospital PT.

Where is the equity in that? ACN is horrible enough, now preference is again being given to physicians. Show me the evidence that the hospitals are providing better care at comparable costs and I'll understand. My guess is UHC will be charged more over greater number of visits than coming to a PT owned clinic that emphasizes quality care and outcomes over the bottom line of the hospital.

Labels: Direct access, Healthcare, insurance, over-use

I am set to begin somewhat of a "series" on the APTA's vision statement on what our profession should be in the future. It is title "Vision 2020". Here is the meat and potatoes of it:

Labels: APTA, Direct access, EBM, insurance

News that Massachusetts (to be referred to as Mass as I'm lucky to spell it correctly more than once) will now require it's citizens to have health insurance. I think this is significant as most people focus on health care improvement by formulating ways the government can provide more social insurance focused on health care. Now we have a state trying to solve uninsured by treating it like car insurance...it's simply something you must pay for.

This will be an interesting experiment. Success would likely lead to a flood of similar legislation through out the country.

I feel this is an excellent possible solution to the growing number of uninsured. I've always felt our health is our responsibility and we shouldn't blindly depend on the government to provide solutions for us.

Labels: Healthcare, insurance, legislation, reform

A nice story from MSNBC that points out what many of us in the health professions have believed for years. We pay more for less that other countries. While the article subtly attempts to link it to lack of universal health care, I feel it's more related to consumer (that's right consumer not patient) attitudes, laws that limit efficient choice of health care providers, and our for-profit insurance structure.

As we feel we are no longer patients but consumers of health care, we demand the best, demand it now, and demand to pay very little for it (for those with insurance). Unfortunately, these three are mutually exclusive. We have to give on one to receive the other two. We tried for many years to ignore that and operate like we could get away with it. Now, we are seeing the consequences. Insurance rates rising, health costs rising, and benefits being cut back. Universal health care won't fix this problem.

Personally, another bottleneck and source of increased health care costs is our inability to access rehab services with out a physicians ok. Often times this results in at least to unnecessary office visits to a practitioner with less musculoskeletal knowledge then the PT, and delayed care.

Finally, insurance providers are out to make money. Plain and simple. And with out proper regulation, they will continue to work together (when we can't do the same to oppose them) to drive down their costs. This includes increasing premiums, deductibles and co-pays while simultaneously decreasing what they pay to practitioners and what they will actually cover.

What is the answer? We as consumers need to take responsibility for what services we demand (not, well insurance will pay for it so just do it), and also require that our insurance companies incorporate our needs into figuring their bottom line.

Labels: insurance, over-use, physical therapy