Post a 250 work response to the following posts, discussing the information presented in terms of the social, economic, and/or political context of healthcare delivery.
Reminder: Be sure to cite your supporting documentation appropriately in correct APA format. Ensure that you include the reference for the article/news item you have selected and provide a link to it if possible.
I selected an article I found on the CNBC website entitled “Why American Doctors Keep Doing Expensive Procedures that Don’t Work.” (Pataschnik, 2017) I found this to be interesting as it relates to our recent assignments whereby we made comparisons of the U.S. health care system vs. other countries.
In this article, the author focuses on the use of unnecessary treatments, medications, and procedures that are needlessly increasing our Country’s health care spending. In fact, it is noted this wasteful spending added between $158 billion and $226 billion to U.S. health care spending in 2011. (Pataschnik, 2017).
Of course, many Americans do not have access to health care services; while others are receiving services that are not improving their conditions or providing a better quality of life. Evidence based medicine is one approach to improving prescribed protocols and ultimately improving patient outcomes. This care approach incorporates research into the care plan for the patient’s health condition. (Shi, Singh 2015). There is a coalition examining the evidence based medicine approach but it is too small. We need more medical professionals to participate in order to fully understand the pros and cons of this initiative. Doctors recommend the best treatments and they can also influence policy; however, patients need to be more of an advocate for their care plans. (Pataschnik, 2017)
Relative to all of this, is the impact this spending has on insurance reimbursements – as well as the huge impact on patient access and quality of care. A proposal from the Hamilton Project suggests the Centers for Medicare and Medicaid Services (CMS), have the flexibility to experiment with “reference pricing”. This approach would allow CMS to pay a single price for all treatments associated with a condition. If a patient desired a more costly procedure or medication, he/she would be responsible for paying the difference. (Bagley, Chandra, Frakt, Oct 2015).
There is much to be done to explore this and many other innovative approaches; however, as long as there is a political tug of war regarding health care services, it will hinder our ability to truly become the World’s leader in health care services.
The healthcare issue that is currently in the news that I chose to discuss this week is the Medicare cap that Congress recessed without addressing. Due to Congress recessing without approving removing the Medicare cap before December 31, 2017, the new Medicare cap will be $2010, and it will be a hard cap. What that means is there will be no exception (KX Modifier) that can be applied if a Medicare recipient needs additional therapy past the $2010. This is a terrible disservice to our Medicare recipients.
“The “therapy cap” was first adopted in the Balanced Budget Act of 1997. Under this policy, Medicare beneficiaries cannot receive outpatient occupational therapy services, and, separately, physical therapy and speech language pathology services combined, if those services would exceed the “cap” amount, regardless of medical need. For 2018 the cap will be set at $2,010. Since its adoption in 1997, Congress has only allowed this hard cap on therapy services to take effect four times: in 1999, 2003, 2006, and 2010. At all other times, they either put in place moratoria on the policy or implemented an exceptions process that allowed access to needed services” (AOTA, 2017).
“In late October, Congress seemed poised to enact a permanent repeal of the hard cap and included that change in a package of Medicare “extenders.” Had those extenders been approved, it would have ended Congress’ continual tradition of late-year scrambling to come up with a short-term exceptions process. Instead, Congress recessed without approving the extenders or enacting a temporary exceptions process” (APTA, 2017).
The disservice is grave for our Medicare recipients. “Congress’ inaction creates the worst-case scenario for patients and providers,” said APTA President Sharon Dunn, PT, Ph.D. “Medicare patients will start the new year unsure if they will receive medically necessary care. This inaction by Congress means arbitrary barriers, stress for patients and their families, and disruptions for providers.”
Per the Center for Medicare and Medicaid Services (CMS) website “Change Request (CR) 10341 provides the amounts for outpatient therapy caps for Calendar Year (CY) 2018. For physical therapy (PT) and speech-language pathology (ST) combined, the CY 2018 cap is $2,010” (CMS, 2018). So if a patient needed both PT and ST, they are only allowed $1,005 per discipline which averages out to about 7.5 visits each which are seen twice a week is not even two months. That is terrible.
The Kaiser Family Foundation conducted a large-scale, nationally representative telephone survey of 2,040 adults, including 998 interviews with people with recent experience with serious illness in older age, either personally or with a family member” (Kaiser Family Foundation, 2017). In this study 44% family members reported needing more help, 27% reported having trouble getting more help, and 18% did not get help due to cost. This cap will only make these numbers worse because this study was done in November of 2017.
This issue is of interest to me because I am a Physical Therapist Assistant and my patients will be significantly affected by this decrease in therapy that my patients need. I work with a geriatric population that has pain and falls on a daily/weekly basis. They need continued therapy to keep them at their prior level of function (PLOF). I work hard to keep my patients functioning as pain-free and as mobile as possible and Congress not addressing this critical issue has just crippled my ability to help them due to finances.