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View from the far side of the recliner
What good is having a blog if you can’t rant? Well this is my blog and here is my rant.
I just spent a couple of hours today trying to finish a report for a Medicare Physical Therapy patient and I’m still not done. This patient has a long list of relatively common medical issues but also on that list is a rare neurological condition which had been misdiagnosed as another more common neurological disease. I was seeing this patient for a simple activity related neck and shoulder pain complaint with an onset about four months ago. In a rational system the initial evaluation and medical history should have been a thirty minute write up, a page and a half at the most. My patient didn’t understand that further Physical Therapy would have to be approved and that she isn’t allowed to pay us until we have billed her Medicare plan and secondary. It is not clear if this patient wants to continue or will go somewhere else. She is somewhat confused so I am somewhat confused.
Welcome to crazy town. All medical records now have to be electronic. This means that if there are nude pictures in your medical records they will likely be leaked any day now. Hope you look good in that blue gown with the open back! If hackers can get into secure sites of defense companies, banks and government agencies what chance is there that the people that brought you HealthCare.gov will do a better job. Even if a site isn’t hacked, theoretically anyone in a medical office or insurance company that has access to your records can help themselves to that information. Theft of information in the electronic age can happen so much faster and in incredible amounts compared to the old days of paper medical billing and tabbed patient files.
Medicare requires an incredible amount of irrelevant information. Levels of disability or function need to be chosen somewhat arbitrarily from lists. The function limits are from redundant, overlapping lists. The time spent doing all of this, is time not spent treating patients and is not reimbursed. The costs of the various programs and the monthly fees to use the documentation to be in compliance are an added burden. The effect of all this on medical providers has not been pretty. I know a number of family or general practice physicians who have closed their practices and either retired, become hospitalists or gone to work for large hospital based clinics. It is very difficult to find a physician that will take a new Medicare patient. It is harder and harder to make it as a small practice. I think something is being lost in the process and it’s not just old magazines in the waiting room.
A friend of mine who is a Physical Therapist and Certified Hand Therapist, recently became a Licensed Massage Therapist, teaches a bit at a massage school and runs a bed and breakfast. This very experienced, skilled specialist is only occasionally seeing hand patients and won’t bill insurance companies. The non-treatment parts of healthcare are taking the pleasure out of serving people. The reason people go into healthcare (hopefully) is to work with patients and not be mind-melded with an uncaring electronic bureaucracy.
One of the beauties of Hypnotherapy that I really appreciate, is the ability to really help people achieve their goals without dealing with insurance, paperwork, billing or bureaucracy. It is so simple, the client wants to make a change, comes up with a goal, determines who or what can help him/her achieve that goal, makes an appointment, receives the service and pays for the service. Just a person wanting to get somewhere, hiring another person to help them get there. Strange no one thought of that way of doing healthcare before.
I love that about Hypnotherapy and would like to see it happen with Physical Therapy.
Next week I’ll write about something. I got off track this week due to my paperwork issues. I’ve actually had a couple of hypnotherapy sessions on this curse of mine. Guess I need some more work on that, maybe a lot more work.
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