Currently viewing the tag: "medicare"

Don’t say I didn’t tell you, cos I remember talking about this ad infinitum over the last two years. But the medical care you knew and loved is going away. And many reading this are perfectly happy about this, but not baby-boomers retiring to rural areas. Yes, seems that primary care physicians are hard to find in many small towns, and it looks like it may worsen.

Baby-boomers, the 78 million Americans born between 1946 and 1964, could have difficulty finding doctors over the next twenty years. With Medicare cuts proposed targeted under the federal health care overhaul, the shortage is likely to get even worse, said Mark Pauly, professor of health care management at the University of Pennsylvania. Primary care physicians out in rural areas make less per procedure in the Medicare schedule than their city counterparts, and with a cut in the already small reimbursement inherent in the system, doctors are running to the city in droves. Well, no duuuuuuhhhh…….

A 2009 survey of doctors in the Oregon Medical Association showed 19.1 percent of Oregon doctors had closed their practices to Medicare, and 28.1 percent had restricted the numbers of Medicare patients.

The good news is that we knew it was coming, right? Well, there’s at least one solution–Nurse Practitioners (NP). NPs can do medical exams, prescribe some drugs, give shots, take vitals, and so forth…sort of a doctor/nurse hybrid. It’s smart, and I like it. I have worked with a few NPs, and what they  can do—their scope—along with their competency, is top-notch. It’s like an all-in-one healthcare practitioner. I have lots of respect for NPs.

Now for you boomers who have decided to retire to rural communities, you may find that you’ll need to pay some things out of pocket. Just come to terms with that: health care is changing, and there’s no need to protest by neglecting your body. I know we all want to get what has been promised to us, and you know what…we just may, in fact, get that…but if for any reason it doesn’t go back to the way it once was, you still need your health. So take care of it, both by participating in health-enhancing behaviors (like seeing a chiropractor–also a primary care doctor, but sans prescription rights), but also by seeing your NP…hey many of them make house calls.

Listen, our old institutions are changing–in some ways for the better (like you taking a proactive approach to your health), and in others for the worse (quality will ultimately suffer, in my opinion). We’ve got to have creative solutions to these new problems–the easiest is to continue taking care of your body. But creating a self-funded medical account will probably be a wise move too.

Well no doubt that all this talk about health care reform has brought some long overdue can-o-worm opening. Take, for instance, unnecessary surgeries: a medical nuisance of the worst magnitude, and common practice for decades. A recent report discloses that riskier surgeries for low back pain have risen in number and in cost, yet many are unwarranted. Well n-o-o-o chit! You know what they say, “When all you have is a hammer, everything looks like a nail.”

Data on more than 32,000 Medicare patients with low back pain stemming from spinal stenosis (a narrowing of the spinal canal causing a squeezing low back pressure) showed that costlier, more complex spinal fusion surgeries were recommended and performed over a six year period. Less expensive decompression surgeries, costing roughly $20K, were often bypassed for $60-90K spinal fusions, despite the more expensive surgeries having greater complications and even leading to death.

Worse yet, many a spinal fusion was lacking in evidence for appropriateness of care. You don’t say? Our doctors doing the unnecessary? Nah, not McReamy. You bet your assets they are. And I love it, because we chiropractors have known about it for years, and we haven’t been quiet about it, either. We have tried to sway the public toward more natural and highly effective treatment options, but noooo, stay away from them chiropractors, they can hurt you.

Yeah? Listen to these number:

  • Risk of stroke in a $20Kspinal decompression (part of vertebrae hacked out to take pressure off nerve): 1 in 50
  • Risk of stroke in a $80K complex spinal fusion (vertebrae connected and joint removed): 1 in 20
  • Risk of stroke in a $3K round of chiropractic care: 1 in 5.85 million

Frickin’ duh!

According to the study, more than half the patients who had complex fusions had a simple stenosis, which usually calls for decompression alone. Rates of complex fusions in Medicare patients rose 15-fold from 2002-2007, while decompressions declined, and hospital charges grew 40 percent. There have been allegations of kickbacks to spine surgeons for using products of a particular hardware manufacturer. Hey Izzy, them screws you got in ya back sent me and the missus to Reno

Listen, I don’t really think there’s some big conspiracy here: It ain’t rocket science. The medicos are admittedly deficient in their training in treating musculoskeletal issues. Surgery is also notoriously ineffective at relieving low back pain for any significant stretch of time. So why are drugs (equally ineffective) and surgery still the treatments of choice by the cultural health authority? Simple. When all you have is a hammer…

OK people–say goodbye to doctors, and hello to nurses, physician’s assistants and disease educators, because that’s what you’ll be getting under the new health care system. That’s right, primary care physicians are on their way out—in droves. But you’re not surprised, right? I told you just that in this here blog, remember? And for my fellow chiropractors, I made that very clear in my Dynamic Chiropractic article, Chiropractic Suited for Primary Care?, last year.

Awright, good, you knew…just wanted to give a heads up, because new estimates have 40,000 primary care physicians leaving practice within the next decade. That’s how money is saved in a nationalized health system. Reminds me of the time my wife’s esthetician told me that she was a doctor in Russia. “Awesome!” I said. “Not really,” she replied. “Being a doctor there is not like over here, it doesn’t pay much and the hours are long; very few people want to do it.” And now she’s giving facials in Beverly Hills. Nice.

Only 30% of all doctors practice in primary care. If you don’t know, these are the docs that see you first. Don’t know why you’re gassy all day? Primary care physician. Don’t know why your baby toe tingles? Primary care physician. Pissing fire? You get it.

Interestingly, 65 million people currently live in areas designated as having a shortage of primary care physicians, according to the government. But never fear, the new health plan will offer to pay doctors 10% more to serve in those areas. Wow! So if I were to serve in those areas, they’d pay me an additional $3.10 (Medicare pays $31.00 for chiropractic; trust me, it’s my humanitarian gift to society to treat the elderly). Love the government–they sure know how to value a service.

Not only are primary care physicians leaving practice, but when the new health care system takes off in 2014, both the newly insured and existing patients will make a mad rush to doctors’ offices, putting a strain on an already buckling specialty.

No worries, less educated physicians assistants will pick up the slack. They’ll have their government manuals telling them how to handle each condition. Who needs doctors? Differential diagnosis is soooo overated.

I just hope I never see my PCP, Dr. Weiner giving haircuts at the local Fantastic Sams—that’d be awfully embarrassing.

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