- Posted March 9, 2013 by
Cortlandt Manor, New York
This iReport is part of an assignment:
Impact Your World
The Inside Tragedy of Healthcare
I am ABC (American Board for Certification) Certified in the field of Prosthetics and Orthotics (Artificial Limbs and Braces) with 32 years of experience, and a specialization in Pediatrics. I deal with children who suffer from Cerebral Palsy, Spina Bifida, and other neurological, congenital, or traumatic disorders and injuries. It needs to be made clear that our problem in healthcare today is the attempt and failure of the feds to micromanage a field such as Prosthetics and Orthotics (P&O), in addition, the new found ability of insurance companies to dictate patient care which compounds this problem.
The following is NOT an exaggeration, but rather a fact: In the days of my beginning, through the 80's & early 90's, I would be able to see my patient with the rehab team made up of the Doctor (in this case a Physiatrist), the Physical Therapist and myself. Together we would evaluate the patient's needs, generate the necessary prescription, and proceed with care. Once the item was delivered to the patient, I would bill the insurance company and payment would follow weeks later. There were no questions asked regarding the type of care or the justification for care. There were no arguments as to "medical necessity" and the Physician was the leader of the pack, as should be the case.
Today, the whole system is backwards, resulting in rationed care, and patients who sadly do not know the difference as to the care they receive vs. the care that would be in their best interest. Doctors are frustrated, Physical Therapists are climbing an uphill battle, and Prosthetists and Orthotists are forced to deliver end products to the patients which are often inadequate, inappropriate, dangerous to the patient's well being, and useless to their activities of daily living, not to mention detrimental to their long term rehabilitative care.
How is it that this poor state of service exists? Here is an example of the realistic progression of care:
Rather than the evaluation process described above, today a patient would be presented to the clinical team, which may or may not include the proper Physician with the proper credentials, may or may not include a qualified Physical Therapist, but usually would include the end provider; myself. Somehow a decision would be made as to the patient's needs. A prescription would "appear",and I would then have to contact the insurance company prior to beginning the fabrication of whatever appliance the patient needed. The process of insurance approval would begin in which case the insurance company would decide if the appliance was medically justified. Then the insurance company, having never seen the patient and with no clear qualifications to do so, would determine if they would pay for the prescribed service and if not, would then dictate what type of other service for which they would pay. In this case I would have to go back to the physician, all the while the patient is "on hold", and I would have to inform the Physician as to the limitations the insurance company has just placed on the product prescription. Hopefully, together we would back down, or redesign what we would have known to be previously appropriate for the patient, fabrication would then begin, and possibly the patient would be able to "make do" with the end product. The fact of the matter is that today Insurance companies, not qualified Physicians and a clinical team, is the prescriber of care for many patients. Why should a 35 year old male, a previous athlete, and an active productive member of society who suffered a traumatic amputation, be provided with a technologically advanced prosthesis which would allow him to return to his previous form of lifestyle, when a cheaper and more economical prosthesis would allow him to simply walk and "get by"? Why should a child, who suffers from Cerebral Palsy and has a very boney foot structure, be given Orthoses with adequate padding and componentry to allow him to be functional to the best of his abilities? Why not just provide him with something cheaper, with which maybe he can "get by" for a few hours a day, not necessarily attend school with his peers, and hopefully not suffer from sores and blisters as a result of an inadequate orthotic fit?
In my field we wake up every morning to announcements as to how much further below Medicare (the standard) prices an insurance company has decided to cut their reimbursement. We have suffered the inability to provide our patients with the best possible product to improve their lives. Together with Physicians and therapists we are bogged down with redundant paperwork due to new HIPAA regulations and the fear of litigation. Time is no longer considered valuable and Physicians, Therapists and myself are forced to shorten our attention to the patient in order to keep the bottom line affordable to sustain business. Hospitals are short staffed, qualified Physicians are being booted out of institutional practices in lieu of the Physical Therapists taking over the prescription process only to generate a "real" prescription by some back-door Doctor who never saw the patient at all.
Ultimately, this is what will destroy the fabric of our Country. Frankly I don't care about the recent drop in jobless claims, the uptick in housing, and the stock market boom. None of this will help our country to flourish without a proper and adequate healthcare system in place. I would rather not see billions of dollars in aid going overseas to other countries when we cannot provide adequate healthcare to our own US citizens. We need to go after FRUAD ! We need to be more specific as to where the entitlement programs concentrate their efforts. There is nothing wrong with a compassionate country, but when a patient rolls up to an office in their new Cadillac Escalade and then comes in only to present their Medicaid card for free services, something is wrong. The answer is not broad governmental cuts, but specific analysis.
I sincerely hope that this "iReport" finds it's way into the hands of a competent individual, who will consider an appropriate and effective response, for there is much more to be said, much more to be exposed, and much more to be corrected in this broken system.