Rambling on the state of healthcare

Bill Curtis reminded me recently of advice he told me when I was a student and then worked for him.

“What you do the first two to three years in practice will shape the clinician you become for the rest of your career”

This is a quote that I still use when mentoring students and new grads.

Taking this quote a step further, this is also sad for our profession.

Not many students are able to get the job that fosters clinical growth and patient-centered care over profitability, productivity and bonus-centered care.

When looking at the quote through this lens, many Physical Therapists (PTs) then become engrained in this as the norm for our profession.

This is what I believe is a threat to not only our profession, but healthcare in general.

We are seeing independent private practices (both in PT and medicine) selling to the larger corporate or hospital practices. This changes the culture of the clinic from one of owner beliefs to one of corporate beliefs.

When we see Medicare giving PT an 8% cut in reimbursement, leading to an average cost of session at about $94, there is less money to go around for salaries, rent, insurance, EMR, benefits, and profit.

From the corporate position, the profit can not be the variable to take a loss. The structural costs (rent/utilities) stay relatively stable, but also goes up with time.

This means that benefits and salaries are what takes a hit. We’ve seen company matches for retirement go down over the years. We’ve seen salaries stagnate and in some areas reduce with time.

This forces corporations to demand higher productivity (I call it widget making). The problem with increasing the number of widgets we produce is…WE WORK WITH PEOPLE AND PEOPLE AREN’T WIDGETS!

I’m not sure if the solution is universal healthcare, getting rid of EMRs, going back to the old cash/bartering days, eliminating Insurance companies trickery on charges, etc, but something will need to change.

Patients have trouble…hell healthcare professionals have trouble…understanding what is actually being charged to patients.

Some hospital systems are charging over $1,000 per visit of physical therapy (PT), only to show an adjustment (a discount that was agreed upon with the insurance company) in order to show the patient how much money they saved by using their insurance.

The funny thing is this…if we actually charged what we wanted to get paid and not what we want to bill the insurance company in order to get a discount, the public may be paying less for healthcare in total (monthly premiums, deductibles, copays, etc).

Just rambling, but if you made it this far…thanks for reading and I hope it inspires thought.

What are your thoughts on the direction healthcare is going?

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1 thought on “Rambling on the state of healthcare

  1. I made it far enough : )

    I agree, I would love to see a hospital out there re-base their pricing to something we might see in a normal market. Work with the insurance companies to get there. I also agree that as hospital systems absorb more and more private practices, we are certainly moving from a “business owner” culture to a corporate culture. As you said, people aren’t widgets.

    On the bright side, at least Medicare finally did away with functional G code reporting : )



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