After Scott Wilson's victory for the Mass. seat in U.S. Senate, healthcare reform is in flux. However, the demographic/economic tsunami of aging boomers means healthcare economics must change.
DATAPOINT: My home state of Georgia may be about to lead the nation in a major healtcare change. The Georgia Healthcare Leadership Council, an assocation of large corporate employers, will collect, aggregate, correlate and report back to their members on what services their member's employees are using and how much they are paying. WEINIGER'S OBSERVATION: Big employers are going to know how much other big employers are paying for services.
DATAPOINT: 2/24/09 President Obama- " Already, we have done more to advance the cause of health care reform in the last 30 days than we have in the last decade". (in reference to expanding the State Children's Health Insurance Program (SCHIP). WEINIGER'S OBSERVATION: More children are being covered--at state fixed Medicaid rates.
DATAPOINT: CMS (the people who run Medicare) is projecting a rate reduction of 21.5 percent for 2010. WEINIGER'S OBSERVATION: This will be averted by "heroic last minute efforts". But reimbursements will be reduced to some degree.
WEINIGER'S CONJECTURE: As pricing becomes transparent, one employer will not want to pay more than another. As I learned when negotiating provider contracts with insurance companies ( and when the standard was "Medicare rates + x %") over time there will be a continual push towards lower rates.
MY ADVICE FOR HEALTHCARE PROVIDERS: Balance and blend personal pay and insurance practices.
For musculo-skeletal practices including chiropractors, physical therapists, massage and other professionals, this means using third party pay to build relationships with patients who receive and perceive the value of your care enough so that they are willing to pay for services in the absence of insurance/third party reimbursement.
PROMOTING The Posture Practice Model: Helps restore mobility and relieve pain, and then teaches people to do daily StrongPosture exercise to keep them moving well and valuing what you do.
If you want to be active tomorrow, you want to move well today.
Posture Practice Tip: Ask patients/clients if they take medication to control their lipids. Statins have different names ( pravastatin, Levacor, Zocor, Pravachol, Lipitor, Crestor and more), and can cause sudden or progressively worsening muscle and joint pain. Suggest they check with the prescribing physician about a trial of red yeast rice instead of Lipitor.
The irony: Taking medication to reduce lipids for cardiac health, but causing musculo-skeletal pain which causes them to stop exercising, worsening cardiac and general health.
((Political comment- if Medicare/ObamaCare pays for Levacor and not a red yeast rice,-how many people then also get prescribed and pay for muscle and joint pain medications---regardless of which works better!))
From the study:
"Conclusion- red yeast rice was tolerated as well as pravastatin and achieved a comparable reduction of low-density lipoprotein cholesterol in a population previously intolerant to statins."
"The low-density lipoprotein cholesterol level decreased 30% in the red yeast rice group and 27% in the pravastatin group."
Remember New Math? We've been seeing the New Economics, and now with the Senate's proposed $849 billion dollar bill (which will kill Flex-plans & HSAs but doesn't touch tort reform), we're about to be introduced to the New HealthCare Economics. And Coming Soon: the new economics of Alternative Health.
The past has the seeds of the future, so looking at how government handled 2009's first nearly trillion dollar social engineering project is instructive. The Great Recession and our economic problems began as people financed and spent more than they had on homes and toys, and so home prices cratered with deleveraging of devalued risk free loans. The $787 billion The Economic Stimulus Act was supposed to put money out in buyers hands and create jobs. However, Wall Street Journal (11/19/2009) reports a staggering exaggeration of numbers of jobs created.
DATAPOINTS: An $890. shoe order for 9 pairs of boots from Moore's shoes was credited by White House's recovery.gov with creating nine new jobs. A $540,071 Alabama Housing Authority grant was credited with creating 7,280 new jobs, but Birmingham News reported only 14 were created. I see people focused on paying off debt, not buying new toys, let alone moving up in their home.
In my opinion, little of the stimulus will help the long-term economy ( which will eventually improve despite the politicians) but it will make radical changes in our society. The administration's target is national health insurance. Whether it's national Medi-Gov or a public option plan, higher premiums/taxes, coverage restrictions, limits and waits will result.Washington included more than $150 billion for health care in the stimulus package, including $21 billion will go to modernize and computerize the national health care technology, but this will merely be s a "down-payment" on putting $50 billion into health care tech. Sounds great...but ask ANYONE in tech...it always costs way more than you budgeted...and half of corporate new tech programs never get implemented because of the complexity and cost overruns. And according to the CBO, and savings will be "overshadowed” by added government costs.
DATAPOINT: This weeks rejection of long standing breast cancer screenings was not due to any clinical review---it was a cost benefit review. Less young women have the problem, so don't bother screening. And women over 75 will likely pass on from something else sooner rather than later, so again, it's not worth it to screen them. A Breast Cancer Preview, Wall Street Journal (11/19/2009)
People are being trained to expect government insurance to pay for care, but their experience will increasingly be that many things OF VALUE have to be paid for out of pocket. President Obama told us we will have to take greater fiscal responsibility, but the opportunity is as people realize they are being forced to take greater personal responsibilty for their physical health as well.
Dr Weiniger's Suggestions for Thriving in the New HealthCare My prediction- Insurance will cover crisis, and people will get used to paying for more care out of pocket. As boomers age they will do what they can to age well. Position your practice towards best serving people who can and want to invest in wellness. Communicate in concepts with potential "virality"---that people can understand and have others agree with without your charisma. What's the best way to reposition a chiropractic or other bio-mechanical practice from pain towards what is coming?
Observations from the COCSA conference... Day 1 November 12, 2009
AWARENESS OF AMERICAN POLITICS: The HealthCare bill passed the House, and includes the public option while (hopefully) protecting state insurance equality laws. Next, the two Senate bills must be reconciled into one (which will happen) and then passed (a big question hinging on the votes of perhaps a dozen Senators, and what changes will happen to get those votes). Visit the ACA website and view John Fallardeau's HEALTH CARE REFORM WEEKLY BRIEFING videos for ongoing current status.
COOPERATION IN CHIROPRACTIC POLITICS: Our state associations work hard to support our profession. Along with inspiration from General Becky Halstead, a great spokesperson for F4CP who inspired us to contribute so the USA today, Wall Street Journal and other ads can continue, I was priviliged to hear hard-working delegates from the state associations discuss these DC roundtable topics:
CA Certification, PT infringment, Legislative initiatives, IPAs, Batttling the Blues, Ablility to do sports physicals, Medicare audits, Post payment audits, Electronic claims submission, Strengthening DC physican status, Medicaid, and ( in a challenge I heard of for the first time) Denial of ablility to bill patients for non covered service which would have been covered had the patient seen a different provider. Hard questions, but the attitude was of sharing insight and experience to find solutions.
Am inspired to be at COCSA, and looking forward to speaking on Saturday about how positioning DCs as "The Posture Expert" is the path to thriving in a time of healthcare change by integrating third party and personal pay practice
