How Do We Combat the ever Rising Health Costs In the U.S.?

There is a great debate as to what we should do next and where we should go. Maybe not as a general consumer, but the practitioners are certainly having the debate. More and more private practices are being bought up by hospital groups or larger practices and Franchising so as to decrease overhead of Billing, Admin, Front desk and Medical Assistants. Even more that that, the rise of use of Nurse Practitioners and Physician Assistants. There are several practices in the Denver Metro area that have 1 Physician and 4-5 PA-C’s and NP’s instead of the Physician care our Parents were used to. Is the outcome of that good or bad? The answer is yet to be determined….

What else is happening to make people concerned about the insurance they pay for, the amount that comes out of their pocket and where that money goes? Simple answer: The money you pay out of pocket to your provider covers the day to day bills of overhead and providing your care. The Money you spend on premiums-Who Knows. Some say it goes to lining million dollar packages to CEO’s, CFO’s and upper level management at insurance companies. It does not really provide for your practitioners or your care. The interesting thing about the American Healthcare Reform Act was that it was supposed to create more competition and lower costs to consumers while providing more care to all. What it actually did was raise the cost of premiums by 42% over a three year period, develop websites or exchanges that don’t actually help persons enrolling in those plans(1); and disenfranchise providers further.

In April I sat at a table with other PT’s and had a great discussion about The Health of Physical Therapy Private Practice in this country. The outcome of that discussion was disheartening. The average PT goes through 7.5 years of education. They spend approximately $290,ooo on that education. Granted, some of it is Grants and Scholarships, PTs are smart, well educated individuals who have high GPAs entering both undergraduate and Graduate schools. In some states those well educated persons come out of school making $90k/year, but in states like Colorado they come out making closer to $60k/year and the student loan repayments are minimum of $500/month. If you make what a PT makes with a Doctorate degree and 33% is taken in Taxes, your putting away 6% for retirement then your bring home pay is closer to $3150/month. Now that may sound like a decent amount, but lets look at a budget:

Income: $3149

Student Loan:   ($500)

Rent:    (1200)

Utilities:  (200)

Health and Car Insurance: (360)

Groceries: (600)

Cell Phone: (110)

Cable/Internet: (100)

Gas For Car: (200)

Balance: ($121)

How Can we expect our well educated professionals to live on a deficit of $121/month? Keep in mind that this budget does not account for the fact they might need to use said Insurance and have a deductible to pay of $2000, nor does it allow for them to buy clothing. It also does not allow them to have a social life according to the standards of Colorado (Hello ski season?). I guess you could not save for retirement, Not eat decent food and live on mac-n-cheese or Ramen noodles, but then the health care expenses would likely go up. They could do without cable, but internet would still cost around $60/month. And what do we do about it? What is Driving it? The answer is insurance re-imbursement or lack there of.

This morning I was processing payments and posting to client accounts. There is an insurance company who thinks that my 30 minutes of dedicated time to their client is only worth $30. They pay the Physician $64 for 5 minutes, even if they are seen by the Assistant Physician or Nurse Practitioner. Where is the dis-connect? Should DPTs who spend time getting to know the client not get paid more for services. A lot of people say we are ancillary services; however, the APTA standard of education and testing says that we are Primary Care for Musculoskeletal Dysfunction. So If I am a PCP for an ankle sprain, why I am reimbursed at 3.9% the rate that the Physician is for the same injury?

One of my clients is a Pharmacist and he recommended that I become out of network with his insurance because the care provided is worth more that what insurance is paying us. He said that he has fought this battle as a pharmacist and thinks it is absurd.  He then went on to tell me that there was a time when every practitioner of medicine that was in private practice billed a cash rate and the Patient was then responsible to bill the insurance company and get the reimbursement on their own. He said he believes it is what kept costs so low for so long, but then in the 1980’s that all changed. I can’t help but think that maybe private practice should go back to cash rates and pushing the client to bill their own insurance company and see what they can do to get the prices for insurance, deductibles, co-pay/co-insurance reduced and then the payment to the providers up.

Here is a link to web page that talks about billing your own insurance company:

Thanks for your time,

Dr. Marci

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