Guest guest Posted December 23, 2009 Report Share Posted December 23, 2009 I am so out of it, I still don't know what are the Dems trying to pass so fast. Alan, what convinces you that it's for sure?! Hiten Dave' PT Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2009 Report Share Posted December 23, 2009 I am so out of it, I still don't know what are the Dems trying to pass so fast. Alan, what convinces you that it's for sure?! Hiten Dave' PT Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2009 Report Share Posted December 23, 2009 Alan To quote the old Saturday Night Live character Roseann Roseannadana, " Mr. Petrazzi, you sure ask a lot of questions. " They are important issues however. First point, what is being proposed is not Universal Healthcare. It brings us closer providing coverage for most people but does not cover everyone. There is a lot of biased interpretation being offered that makes understanding difficult. An excellent non-partisan resource is the Kaiser Family Foundation. Go to their website at www.kff.org. They summarize each of the proposed plans as well as line them up side by side and item by item to compare each. Remember there are two versions of bills. One from Congress and one from the Senate that have differences that need to be reconciled before they can become law. To answer your questions: There is nothing in it that addresses automony of therapists (what I assume you are asking?) Waiting times should not be a concern since it only addresses payment of services not practice The funds will go to pay for private insurance so Plans of care, frequency and duration will be defined by the private insurance companies. Reimbursement from Medicare is likely to be impacted. One of the provisions proposed is to take from Medicare to fund coverage to the currrently uninsured. The likely result is drop in either rates or coverage of procedures. Reimbursement from non-governmental insurance will largely be decided by these companies. They will not be able to deny services for pre-existing conditions or other underwriting practices of the past. This may effect their profitability, so it is unknown how they will react. The fear is that insurance premiums will go up for others to cover the formerly uninsurable. Salaries is an unknown. There may be a greater need for therapist in an already tight market, since more people will have insurance coverage and thus access to healthcare. The current shortage of therapists may create an employee advantage that makes therapist a valuable position that increases salaries. Or if insurance companies reduce amount of services they will authorize we could see the opposite. Small practices will face the same challenges they do today. If insurance companies partner with larger practices it could hurt the small ones. Insurance companies and physician groups could pit practices against each other to undercut prices. A small practice with low overhead could win. Or prices could be so low as to make the cost of delivering services more that the reimbursement. The % of Self-pay patients could drop as more people are covered by health insurance. If insurance companies cut back services, people who want additional services may have to pay out of pocket. Pursuit of patients seeking PT to delay surgery is unknown. That will likely depend on the insurance company, physician (group) and patient. Pursuit of patients seeking alternative health providers. It is important to note that the two bills being proposed are requiring those who can afford to buy health insurance to buy it and those who cannot buy it will get government assistance. This insurance will be from the same companies that now give us coverage. We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. Your question about the APTA is something you will have to answer for yourself. I think in the big picture of all that has been proposed as possible changes leading to healthcare reform, they have protected and advocated our interests well. I hope this clarifies some of your concerns. Truth is that until a final bill is signed and enacted we will not know all of the answers or ramifications. One last comment. Most of the provisions of both bills will not go into effect until 2013. There will be a long lead time to figure out our best strategy. There is likely to be a reaction by the healthcare industry prior to then that we will have to deal with sooner. Ron Wall Axiom Healthcare Group Ontario, CA To: PTManager From: alanpetrazzi@... Date: Wed, 23 Dec 2009 13:17:29 -0800 Subject: Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2009 Report Share Posted December 23, 2009 Alan To quote the old Saturday Night Live character Roseann Roseannadana, " Mr. Petrazzi, you sure ask a lot of questions. " They are important issues however. First point, what is being proposed is not Universal Healthcare. It brings us closer providing coverage for most people but does not cover everyone. There is a lot of biased interpretation being offered that makes understanding difficult. An excellent non-partisan resource is the Kaiser Family Foundation. Go to their website at www.kff.org. They summarize each of the proposed plans as well as line them up side by side and item by item to compare each. Remember there are two versions of bills. One from Congress and one from the Senate that have differences that need to be reconciled before they can become law. To answer your questions: There is nothing in it that addresses automony of therapists (what I assume you are asking?) Waiting times should not be a concern since it only addresses payment of services not practice The funds will go to pay for private insurance so Plans of care, frequency and duration will be defined by the private insurance companies. Reimbursement from Medicare is likely to be impacted. One of the provisions proposed is to take from Medicare to fund coverage to the currrently uninsured. The likely result is drop in either rates or coverage of procedures. Reimbursement from non-governmental insurance will largely be decided by these companies. They will not be able to deny services for pre-existing conditions or other underwriting practices of the past. This may effect their profitability, so it is unknown how they will react. The fear is that insurance premiums will go up for others to cover the formerly uninsurable. Salaries is an unknown. There may be a greater need for therapist in an already tight market, since more people will have insurance coverage and thus access to healthcare. The current shortage of therapists may create an employee advantage that makes therapist a valuable position that increases salaries. Or if insurance companies reduce amount of services they will authorize we could see the opposite. Small practices will face the same challenges they do today. If insurance companies partner with larger practices it could hurt the small ones. Insurance companies and physician groups could pit practices against each other to undercut prices. A small practice with low overhead could win. Or prices could be so low as to make the cost of delivering services more that the reimbursement. The % of Self-pay patients could drop as more people are covered by health insurance. If insurance companies cut back services, people who want additional services may have to pay out of pocket. Pursuit of patients seeking PT to delay surgery is unknown. That will likely depend on the insurance company, physician (group) and patient. Pursuit of patients seeking alternative health providers. It is important to note that the two bills being proposed are requiring those who can afford to buy health insurance to buy it and those who cannot buy it will get government assistance. This insurance will be from the same companies that now give us coverage. We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. Your question about the APTA is something you will have to answer for yourself. I think in the big picture of all that has been proposed as possible changes leading to healthcare reform, they have protected and advocated our interests well. I hope this clarifies some of your concerns. Truth is that until a final bill is signed and enacted we will not know all of the answers or ramifications. One last comment. Most of the provisions of both bills will not go into effect until 2013. There will be a long lead time to figure out our best strategy. There is likely to be a reaction by the healthcare industry prior to then that we will have to deal with sooner. Ron Wall Axiom Healthcare Group Ontario, CA To: PTManager From: alanpetrazzi@... Date: Wed, 23 Dec 2009 13:17:29 -0800 Subject: Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 24, 2009 Report Share Posted December 24, 2009 Mr. Wall, Thank you for your thorough response to Mr. Petrazzi's inquiry. While I agreed with most of what you said, I wanted to focus on something that you mentioned, " We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. " I believe this point needs to be reconsidered. I would argue that a government dictate of what insurance providers can and cannot do will directly impact our delivery of services. While a predicted 95% of Americans will have insurance once this legislation is enacted, what those services include will be different. Without setting off a firestorm of political debate here, I would argue that our therapy professions would be much better served if this legislation does not pass and here's why. The private sector and free market can make healthcare accessible to all Americans. EMTALA is legislation that requires that all persons who present to the ER receive treatment, regardless of ability to pay, and will be legally liable if care is withheld. Furthermore, hospitals such as mine already see 7% no-pay patients annually and I believe that's a fairly representative amount compared to other hospitals. Now let's talk medications...everyone who needs medications can receive them right now, if they can prove that they do not have the means to pay for them. You can go to www.needsmeds.com <http://www.needsmeds.com/> and get a list of pharmacies nation-wide that service a huge list of medications for those who need them. Is it the government that funds such a program? No, it's the private sector through private contributions. It's funny that such programs are not advertised by those lobbying for the current legislation and I'd be surprised if many of you knew about this website. Many would argue that a patient would not receive the same quality of healthcare in our current system without having insurance. That may be a legitimate point. However, please consider the quality of healthcare that we will all be subject to, once private insurance companies are required to cover the uninsured and pre-existing conditions. Most will have insurance, but the quality of the insurance will not be the same. Some would argue that the " free market " hasn't worked up to now, so why should we expect things to change? The fact is, there hasn't been a free market up to now. There are only 5 main insurers in this country and their practice of judging what is " reasonable and necessary " has been anything but transparent. Please write your legislators, urging them to allow the free market to do what it does best, drive down prices. Thank you for the consideration of my comments and Merry Christmas to all. Curtis Marti Therapy Manager Hillcrest Medical Center Tulsa, OK ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Ron Wall Sent: Wednesday, December 23, 2009 9:47 PM To: PTManager Group Subject: RE: Universal Healthcare Alan To quote the old Saturday Night Live character Roseann Roseannadana, " Mr. Petrazzi, you sure ask a lot of questions. " They are important issues however. First point, what is being proposed is not Universal Healthcare. It brings us closer providing coverage for most people but does not cover everyone. There is a lot of biased interpretation being offered that makes understanding difficult. An excellent non-partisan resource is the Kaiser Family Foundation. Go to their website at www.kff.org. They summarize each of the proposed plans as well as line them up side by side and item by item to compare each. Remember there are two versions of bills. One from Congress and one from the Senate that have differences that need to be reconciled before they can become law. To answer your questions: There is nothing in it that addresses automony of therapists (what I assume you are asking?) Waiting times should not be a concern since it only addresses payment of services not practice The funds will go to pay for private insurance so Plans of care, frequency and duration will be defined by the private insurance companies. Reimbursement from Medicare is likely to be impacted. One of the provisions proposed is to take from Medicare to fund coverage to the currrently uninsured. The likely result is drop in either rates or coverage of procedures. Reimbursement from non-governmental insurance will largely be decided by these companies. They will not be able to deny services for pre-existing conditions or other underwriting practices of the past. This may effect their profitability, so it is unknown how they will react. The fear is that insurance premiums will go up for others to cover the formerly uninsurable. Salaries is an unknown. There may be a greater need for therapist in an already tight market, since more people will have insurance coverage and thus access to healthcare. The current shortage of therapists may create an employee advantage that makes therapist a valuable position that increases salaries. Or if insurance companies reduce amount of services they will authorize we could see the opposite. Small practices will face the same challenges they do today. If insurance companies partner with larger practices it could hurt the small ones. Insurance companies and physician groups could pit practices against each other to undercut prices. A small practice with low overhead could win. Or prices could be so low as to make the cost of delivering services more that the reimbursement. The % of Self-pay patients could drop as more people are covered by health insurance. If insurance companies cut back services, people who want additional services may have to pay out of pocket. Pursuit of patients seeking PT to delay surgery is unknown. That will likely depend on the insurance company, physician (group) and patient. Pursuit of patients seeking alternative health providers. It is important to note that the two bills being proposed are requiring those who can afford to buy health insurance to buy it and those who cannot buy it will get government assistance. This insurance will be from the same companies that now give us coverage. We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. Your question about the APTA is something you will have to answer for yourself. I think in the big picture of all that has been proposed as possible changes leading to healthcare reform, they have protected and advocated our interests well. I hope this clarifies some of your concerns. Truth is that until a final bill is signed and enacted we will not know all of the answers or ramifications. One last comment. Most of the provisions of both bills will not go into effect until 2013. There will be a long lead time to figure out our best strategy. There is likely to be a reaction by the healthcare industry prior to then that we will have to deal with sooner. Ron Wall Axiom Healthcare Group Ontario, CA To: PTManager <mailto:PTManager%40yahoogroups.com> From: alanpetrazzi@... <mailto:alanpetrazzi%40yahoo.com> Date: Wed, 23 Dec 2009 13:17:29 -0800 Subject: Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 24, 2009 Report Share Posted December 24, 2009 Mr. Wall, Thank you for your thorough response to Mr. Petrazzi's inquiry. While I agreed with most of what you said, I wanted to focus on something that you mentioned, " We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. " I believe this point needs to be reconsidered. I would argue that a government dictate of what insurance providers can and cannot do will directly impact our delivery of services. While a predicted 95% of Americans will have insurance once this legislation is enacted, what those services include will be different. Without setting off a firestorm of political debate here, I would argue that our therapy professions would be much better served if this legislation does not pass and here's why. The private sector and free market can make healthcare accessible to all Americans. EMTALA is legislation that requires that all persons who present to the ER receive treatment, regardless of ability to pay, and will be legally liable if care is withheld. Furthermore, hospitals such as mine already see 7% no-pay patients annually and I believe that's a fairly representative amount compared to other hospitals. Now let's talk medications...everyone who needs medications can receive them right now, if they can prove that they do not have the means to pay for them. You can go to www.needsmeds.com <http://www.needsmeds.com/> and get a list of pharmacies nation-wide that service a huge list of medications for those who need them. Is it the government that funds such a program? No, it's the private sector through private contributions. It's funny that such programs are not advertised by those lobbying for the current legislation and I'd be surprised if many of you knew about this website. Many would argue that a patient would not receive the same quality of healthcare in our current system without having insurance. That may be a legitimate point. However, please consider the quality of healthcare that we will all be subject to, once private insurance companies are required to cover the uninsured and pre-existing conditions. Most will have insurance, but the quality of the insurance will not be the same. Some would argue that the " free market " hasn't worked up to now, so why should we expect things to change? The fact is, there hasn't been a free market up to now. There are only 5 main insurers in this country and their practice of judging what is " reasonable and necessary " has been anything but transparent. Please write your legislators, urging them to allow the free market to do what it does best, drive down prices. Thank you for the consideration of my comments and Merry Christmas to all. Curtis Marti Therapy Manager Hillcrest Medical Center Tulsa, OK ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Ron Wall Sent: Wednesday, December 23, 2009 9:47 PM To: PTManager Group Subject: RE: Universal Healthcare Alan To quote the old Saturday Night Live character Roseann Roseannadana, " Mr. Petrazzi, you sure ask a lot of questions. " They are important issues however. First point, what is being proposed is not Universal Healthcare. It brings us closer providing coverage for most people but does not cover everyone. There is a lot of biased interpretation being offered that makes understanding difficult. An excellent non-partisan resource is the Kaiser Family Foundation. Go to their website at www.kff.org. They summarize each of the proposed plans as well as line them up side by side and item by item to compare each. Remember there are two versions of bills. One from Congress and one from the Senate that have differences that need to be reconciled before they can become law. To answer your questions: There is nothing in it that addresses automony of therapists (what I assume you are asking?) Waiting times should not be a concern since it only addresses payment of services not practice The funds will go to pay for private insurance so Plans of care, frequency and duration will be defined by the private insurance companies. Reimbursement from Medicare is likely to be impacted. One of the provisions proposed is to take from Medicare to fund coverage to the currrently uninsured. The likely result is drop in either rates or coverage of procedures. Reimbursement from non-governmental insurance will largely be decided by these companies. They will not be able to deny services for pre-existing conditions or other underwriting practices of the past. This may effect their profitability, so it is unknown how they will react. The fear is that insurance premiums will go up for others to cover the formerly uninsurable. Salaries is an unknown. There may be a greater need for therapist in an already tight market, since more people will have insurance coverage and thus access to healthcare. The current shortage of therapists may create an employee advantage that makes therapist a valuable position that increases salaries. Or if insurance companies reduce amount of services they will authorize we could see the opposite. Small practices will face the same challenges they do today. If insurance companies partner with larger practices it could hurt the small ones. Insurance companies and physician groups could pit practices against each other to undercut prices. A small practice with low overhead could win. Or prices could be so low as to make the cost of delivering services more that the reimbursement. The % of Self-pay patients could drop as more people are covered by health insurance. If insurance companies cut back services, people who want additional services may have to pay out of pocket. Pursuit of patients seeking PT to delay surgery is unknown. That will likely depend on the insurance company, physician (group) and patient. Pursuit of patients seeking alternative health providers. It is important to note that the two bills being proposed are requiring those who can afford to buy health insurance to buy it and those who cannot buy it will get government assistance. This insurance will be from the same companies that now give us coverage. We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. Your question about the APTA is something you will have to answer for yourself. I think in the big picture of all that has been proposed as possible changes leading to healthcare reform, they have protected and advocated our interests well. I hope this clarifies some of your concerns. Truth is that until a final bill is signed and enacted we will not know all of the answers or ramifications. One last comment. Most of the provisions of both bills will not go into effect until 2013. There will be a long lead time to figure out our best strategy. There is likely to be a reaction by the healthcare industry prior to then that we will have to deal with sooner. Ron Wall Axiom Healthcare Group Ontario, CA To: PTManager <mailto:PTManager%40yahoogroups.com> From: alanpetrazzi@... <mailto:alanpetrazzi%40yahoo.com> Date: Wed, 23 Dec 2009 13:17:29 -0800 Subject: Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 24, 2009 Report Share Posted December 24, 2009 I bet the new healthcare bill will not change things too much in the PT world. When universal coverage hit here in Massachusetts, many people complained that the working uninsured had to pay through the nose for a plan. Some pretty affordable plans came out and most people are pretty happy about it. Our Free Care patients in out-patient PT have dropped to zero this year, and my hospital¡¯s Free Care has dropped to ¨÷ (we¡¯re on the New Hampshire border). We had to learn the new regulations and figure out the new hoops to jump through, but it was no different from BCBS adding another plan. Overall, everyone except the angry AM radio shout programs guys are happy with the MA program. I am rooting for the Houses a self funded public option since it may be more attractive than what the insurance companies currently provide. The insurances have been consistently difficult to work with; maybe a government program would provide a better option. The Right says that they want greater competition. That would really make insurance companies change to compete with a public option. Even better, I loved the national health care when I worked in Ireland. 1 secretary, for 12 therapists in my clinic. No billing department, no authorization manager, no denied treatments; it was nice. ProCon.org is another good website with both sides. Read it and call you senator, especially if you live in Maine, Connecticut or Nebraska where your senators have been on the fence. -Professional autonomy - No change -Waiting Times - No change -Plans of care, including frequency and duration - They have been decreasing and I expect that to continue regardless of congress. -Reimbursement from Medicare I hate to guess -Reimbursement from non-governmental insurance companies Dropping because they can. I don¡¯t see insurance premiums going up since there will be more people buying insurance. They may rise since costs rise. -Salaries - I hate to guess -% of Self-pay patients - Increase. As more plans have been added in MA, there are some ¡°Chevette plans¡± that only cover catastrophic indemnity, or have huge deductibles. It has increased the private pay population for us. Mostly small business owners and independent contractors have been in this population. -Pursuit of patients seeking PT to delay surgery - That is up to our efforts and getting the word out -Pursuit of patients seeking alternative health providers - That is up to our efforts and getting the word out von Lossnitzer, PT Manager of Sports Medicine and Rehabilitation Jaques Hospital Newburyport, Massachusetts > > I am so out of it, I still don't know what are the Dems trying to pass so fast. Alan, what convinces you that it's for sure?! > Hiten Dave' PT > Universal Healthcare > > > > > > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 24, 2009 Report Share Posted December 24, 2009 I bet the new healthcare bill will not change things too much in the PT world. When universal coverage hit here in Massachusetts, many people complained that the working uninsured had to pay through the nose for a plan. Some pretty affordable plans came out and most people are pretty happy about it. Our Free Care patients in out-patient PT have dropped to zero this year, and my hospital¡¯s Free Care has dropped to ¨÷ (we¡¯re on the New Hampshire border). We had to learn the new regulations and figure out the new hoops to jump through, but it was no different from BCBS adding another plan. Overall, everyone except the angry AM radio shout programs guys are happy with the MA program. I am rooting for the Houses a self funded public option since it may be more attractive than what the insurance companies currently provide. The insurances have been consistently difficult to work with; maybe a government program would provide a better option. The Right says that they want greater competition. That would really make insurance companies change to compete with a public option. Even better, I loved the national health care when I worked in Ireland. 1 secretary, for 12 therapists in my clinic. No billing department, no authorization manager, no denied treatments; it was nice. ProCon.org is another good website with both sides. Read it and call you senator, especially if you live in Maine, Connecticut or Nebraska where your senators have been on the fence. -Professional autonomy - No change -Waiting Times - No change -Plans of care, including frequency and duration - They have been decreasing and I expect that to continue regardless of congress. -Reimbursement from Medicare I hate to guess -Reimbursement from non-governmental insurance companies Dropping because they can. I don¡¯t see insurance premiums going up since there will be more people buying insurance. They may rise since costs rise. -Salaries - I hate to guess -% of Self-pay patients - Increase. As more plans have been added in MA, there are some ¡°Chevette plans¡± that only cover catastrophic indemnity, or have huge deductibles. It has increased the private pay population for us. Mostly small business owners and independent contractors have been in this population. -Pursuit of patients seeking PT to delay surgery - That is up to our efforts and getting the word out -Pursuit of patients seeking alternative health providers - That is up to our efforts and getting the word out von Lossnitzer, PT Manager of Sports Medicine and Rehabilitation Jaques Hospital Newburyport, Massachusetts > > I am so out of it, I still don't know what are the Dems trying to pass so fast. Alan, what convinces you that it's for sure?! > Hiten Dave' PT > Universal Healthcare > > > > > > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 24, 2009 Report Share Posted December 24, 2009 As the saying goes: " Government run healthcare: all the efficiency of the United States Postal Service coupled with all the compassion of the IRS. " The entities that will benefit the most from this program, in its present incarnation, are the two entities that have the most powerful lobbying influence in Washington: (1) the pharmaceutical companies and (2) the insurance companies. Patients will get some benefit. Providers ... well, better have flexible hamstrings.;-) Read Schiff's Economic Commentary for Dec. 23, " Dropping The Bomb on Healthcare " , to learn just one of the essential flaws of this program: http://www.europac.net/ Just remember, the last major legislation that was supposedly done for your benefit that was slipped in Christmas Eve was the Federal Reserve Act of 1913. That legislation was the ultimate source of the financial crisis that we are experiencing today. You think it's over? You think your 401K is coming back? Look again at its value in real dollar terms rather than nominal terms. It's actually losing money when you look at inflation adjusted Dow/gold ratios (and that's with a DJIA that's heavily manipulated). The middle class in America is being decimated by actions such as this and there's barely an outrage from the sheeple. Merry Christmas. , PT, OCS Marquette, MI Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 24, 2009 Report Share Posted December 24, 2009 As the saying goes: " Government run healthcare: all the efficiency of the United States Postal Service coupled with all the compassion of the IRS. " The entities that will benefit the most from this program, in its present incarnation, are the two entities that have the most powerful lobbying influence in Washington: (1) the pharmaceutical companies and (2) the insurance companies. Patients will get some benefit. Providers ... well, better have flexible hamstrings.;-) Read Schiff's Economic Commentary for Dec. 23, " Dropping The Bomb on Healthcare " , to learn just one of the essential flaws of this program: http://www.europac.net/ Just remember, the last major legislation that was supposedly done for your benefit that was slipped in Christmas Eve was the Federal Reserve Act of 1913. That legislation was the ultimate source of the financial crisis that we are experiencing today. You think it's over? You think your 401K is coming back? Look again at its value in real dollar terms rather than nominal terms. It's actually losing money when you look at inflation adjusted Dow/gold ratios (and that's with a DJIA that's heavily manipulated). The middle class in America is being decimated by actions such as this and there's barely an outrage from the sheeple. Merry Christmas. , PT, OCS Marquette, MI Universal Healthcare It looks like this universal healthcare is going to happen. Regardless of your political or philosophic views, I have two questions: Q1: What impact do you foresee (degrees of increase, decrease, no change) universal healthcare having on: -Professional autonomy -Waiting Times -Plans of care, including frequency and duration -Reimbursement from Medicare -Reimbursement from non-governmental insurance companies -Salaries -Small PT practices -% of Self-pay patients -Pursuit of patients seeking PT to delay surgery -Pursuit of patients seeking alternative health providers Q 2: Has the APTA served our interests well during this legislative process? Very respectfully intended, Alan Alan Petrazzi MPT, MPM Rehab Manager Pittsburgh, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 : you raise some interesting points. I read the article that you referenced with interest. I think is missing a major point. While under a clause of not denying for pre-existing conditions does allow one to obtain insurance " after the fact " , the cost of that illness or condition before obtaining the insurance is significant-taking many individuals and their families to bankruptcy. This fact completely eliminates that author's game of not buying insurance until he needs it. Additionally, if insurance companies were going to go bankrupt under this new model, why are they at 52 week highs in the market and reaching profitability levels unmatched? Insurance companies figured out a few years back rather than deny coverage, they should cover most things and just increase cost to employees and continue to make their money off of the arbitrage. There are many things I don't like about this so called healthcare reform but the provision of forcing insurance companies to not deny for pre-existing conditions is not one of them. Larry Benz PT, DPT CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak that none of us reads or understands is often contained here. > > > As the saying goes: " Government run healthcare: all the efficiency of the > United States Postal Service coupled with all the compassion of the IRS. " > > The entities that will benefit the most from this program, in its present > incarnation, are the two entities that have the most powerful lobbying > influence in Washington: (1) the pharmaceutical companies and (2) the > insurance companies. Patients will get some benefit. Providers ... well, > better have flexible hamstrings.;-) > > Read Schiff's Economic Commentary for Dec. 23, " Dropping The Bomb on > Healthcare " , to learn just one of the essential flaws of this program: > http://www.europac.net/ > > Just remember, the last major legislation that was supposedly done for your > benefit that was slipped in Christmas Eve was the Federal Reserve Act of > 1913. That legislation was the ultimate source of the financial crisis that > we are experiencing today. You think it's over? You think your 401K is > coming back? Look again at its value in real dollar terms rather than > nominal terms. It's actually losing money when you look at inflation > adjusted Dow/gold ratios (and that's with a DJIA that's heavily > manipulated). The middle class in America is being decimated by actions such > as this and there's barely an outrage from the sheeple. > > Merry Christmas. > > , PT, OCS > Marquette, MI > > Universal Healthcare > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) > universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 : you raise some interesting points. I read the article that you referenced with interest. I think is missing a major point. While under a clause of not denying for pre-existing conditions does allow one to obtain insurance " after the fact " , the cost of that illness or condition before obtaining the insurance is significant-taking many individuals and their families to bankruptcy. This fact completely eliminates that author's game of not buying insurance until he needs it. Additionally, if insurance companies were going to go bankrupt under this new model, why are they at 52 week highs in the market and reaching profitability levels unmatched? Insurance companies figured out a few years back rather than deny coverage, they should cover most things and just increase cost to employees and continue to make their money off of the arbitrage. There are many things I don't like about this so called healthcare reform but the provision of forcing insurance companies to not deny for pre-existing conditions is not one of them. Larry Benz PT, DPT CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak that none of us reads or understands is often contained here. > > > As the saying goes: " Government run healthcare: all the efficiency of the > United States Postal Service coupled with all the compassion of the IRS. " > > The entities that will benefit the most from this program, in its present > incarnation, are the two entities that have the most powerful lobbying > influence in Washington: (1) the pharmaceutical companies and (2) the > insurance companies. Patients will get some benefit. Providers ... well, > better have flexible hamstrings.;-) > > Read Schiff's Economic Commentary for Dec. 23, " Dropping The Bomb on > Healthcare " , to learn just one of the essential flaws of this program: > http://www.europac.net/ > > Just remember, the last major legislation that was supposedly done for your > benefit that was slipped in Christmas Eve was the Federal Reserve Act of > 1913. That legislation was the ultimate source of the financial crisis that > we are experiencing today. You think it's over? You think your 401K is > coming back? Look again at its value in real dollar terms rather than > nominal terms. It's actually losing money when you look at inflation > adjusted Dow/gold ratios (and that's with a DJIA that's heavily > manipulated). The middle class in America is being decimated by actions such > as this and there's barely an outrage from the sheeple. > > Merry Christmas. > > , PT, OCS > Marquette, MI > > Universal Healthcare > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) > universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 : you raise some interesting points. I read the article that you referenced with interest. I think is missing a major point. While under a clause of not denying for pre-existing conditions does allow one to obtain insurance " after the fact " , the cost of that illness or condition before obtaining the insurance is significant-taking many individuals and their families to bankruptcy. This fact completely eliminates that author's game of not buying insurance until he needs it. Additionally, if insurance companies were going to go bankrupt under this new model, why are they at 52 week highs in the market and reaching profitability levels unmatched? Insurance companies figured out a few years back rather than deny coverage, they should cover most things and just increase cost to employees and continue to make their money off of the arbitrage. There are many things I don't like about this so called healthcare reform but the provision of forcing insurance companies to not deny for pre-existing conditions is not one of them. Larry Benz PT, DPT CONFIDENTIALITY: This message is " Off The Record " . A lot of fancy legal speak that none of us reads or understands is often contained here. > > > As the saying goes: " Government run healthcare: all the efficiency of the > United States Postal Service coupled with all the compassion of the IRS. " > > The entities that will benefit the most from this program, in its present > incarnation, are the two entities that have the most powerful lobbying > influence in Washington: (1) the pharmaceutical companies and (2) the > insurance companies. Patients will get some benefit. Providers ... well, > better have flexible hamstrings.;-) > > Read Schiff's Economic Commentary for Dec. 23, " Dropping The Bomb on > Healthcare " , to learn just one of the essential flaws of this program: > http://www.europac.net/ > > Just remember, the last major legislation that was supposedly done for your > benefit that was slipped in Christmas Eve was the Federal Reserve Act of > 1913. That legislation was the ultimate source of the financial crisis that > we are experiencing today. You think it's over? You think your 401K is > coming back? Look again at its value in real dollar terms rather than > nominal terms. It's actually losing money when you look at inflation > adjusted Dow/gold ratios (and that's with a DJIA that's heavily > manipulated). The middle class in America is being decimated by actions such > as this and there's barely an outrage from the sheeple. > > Merry Christmas. > > , PT, OCS > Marquette, MI > > Universal Healthcare > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) > universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 Hi Larry, Schiff's comments were just one of the MANY problems with the proposed system. I agree with you that I would like coverage for pre-existing conditions. The terms of that arrangement have to be carefully established, however, to ensure that the situation he describes does not occur because of the market distortions it would impose upon the system. Unlike , I am not worried about insurance companies going bankrupt and I don't think he is either. I think he was just pointing out one of the potential fallacies of the proposed sytem. As far as 52 week highs for insurance companies (or many other equity sectors for that matter), it's mostly smoke and mirrors. The ratio of insider selling to buying is just one clue. Here's one illustration of how it works. http://www.rollingstone.com/politics/story/28816321/inside_the_great_american_bu\ bble_machine The strategy is, manipulate the market and play it long on the way up, be the first to exit and in doing so drive it down, and then play it short on the way down. It's a tried and true methodology that's been used over and over again. With Washington's present MOPE policy (Management of Perspective Economics), also known as " Pretend and Extend " , the stage is being set for further and greater economic disaster down the road. It's one of the reasons I recommend completely eschewing the domestic equities markets in the present economic cycle (unless you're very adept at market neutral trading). This chart of 2000-2009 gold prices is illustrative.. http://www.kitco.com/scripts/hist_charts/yearly_graphs.plx Compare it to the DJIA and the USD index in that same time frame. http://stockcharts.com/charts/historical/djia1900.html http://futures.tradingcharts.com/chart/US/M Basically, the dollar has been driven down to drive the equities markets up. In fact, the S & P 500 and USDI are almost perfectly reciprocal. As I said, the gains are mostly illusion. It's one of the reasons I loaded up big time on gold and silver in 2001 and encouraged everyone I knew to do the same. Sadly, the only one who listened was my mother and even she took a lot of convincing. Everyone else I know took a pounding in the recent crash. It shocks me how blind the American public seems to be to what is going on. If we have a currency crisis or collapse, only 1-2% of the populace that I'm aware of are prepared to weather the storm. The recession is NOT over! , PT, OCS Universal Healthcare > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) > universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 Hi Larry, Schiff's comments were just one of the MANY problems with the proposed system. I agree with you that I would like coverage for pre-existing conditions. The terms of that arrangement have to be carefully established, however, to ensure that the situation he describes does not occur because of the market distortions it would impose upon the system. Unlike , I am not worried about insurance companies going bankrupt and I don't think he is either. I think he was just pointing out one of the potential fallacies of the proposed sytem. As far as 52 week highs for insurance companies (or many other equity sectors for that matter), it's mostly smoke and mirrors. The ratio of insider selling to buying is just one clue. Here's one illustration of how it works. http://www.rollingstone.com/politics/story/28816321/inside_the_great_american_bu\ bble_machine The strategy is, manipulate the market and play it long on the way up, be the first to exit and in doing so drive it down, and then play it short on the way down. It's a tried and true methodology that's been used over and over again. With Washington's present MOPE policy (Management of Perspective Economics), also known as " Pretend and Extend " , the stage is being set for further and greater economic disaster down the road. It's one of the reasons I recommend completely eschewing the domestic equities markets in the present economic cycle (unless you're very adept at market neutral trading). This chart of 2000-2009 gold prices is illustrative.. http://www.kitco.com/scripts/hist_charts/yearly_graphs.plx Compare it to the DJIA and the USD index in that same time frame. http://stockcharts.com/charts/historical/djia1900.html http://futures.tradingcharts.com/chart/US/M Basically, the dollar has been driven down to drive the equities markets up. In fact, the S & P 500 and USDI are almost perfectly reciprocal. As I said, the gains are mostly illusion. It's one of the reasons I loaded up big time on gold and silver in 2001 and encouraged everyone I knew to do the same. Sadly, the only one who listened was my mother and even she took a lot of convincing. Everyone else I know took a pounding in the recent crash. It shocks me how blind the American public seems to be to what is going on. If we have a currency crisis or collapse, only 1-2% of the populace that I'm aware of are prepared to weather the storm. The recession is NOT over! , PT, OCS Universal Healthcare > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) > universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 Hi Larry, Schiff's comments were just one of the MANY problems with the proposed system. I agree with you that I would like coverage for pre-existing conditions. The terms of that arrangement have to be carefully established, however, to ensure that the situation he describes does not occur because of the market distortions it would impose upon the system. Unlike , I am not worried about insurance companies going bankrupt and I don't think he is either. I think he was just pointing out one of the potential fallacies of the proposed sytem. As far as 52 week highs for insurance companies (or many other equity sectors for that matter), it's mostly smoke and mirrors. The ratio of insider selling to buying is just one clue. Here's one illustration of how it works. http://www.rollingstone.com/politics/story/28816321/inside_the_great_american_bu\ bble_machine The strategy is, manipulate the market and play it long on the way up, be the first to exit and in doing so drive it down, and then play it short on the way down. It's a tried and true methodology that's been used over and over again. With Washington's present MOPE policy (Management of Perspective Economics), also known as " Pretend and Extend " , the stage is being set for further and greater economic disaster down the road. It's one of the reasons I recommend completely eschewing the domestic equities markets in the present economic cycle (unless you're very adept at market neutral trading). This chart of 2000-2009 gold prices is illustrative.. http://www.kitco.com/scripts/hist_charts/yearly_graphs.plx Compare it to the DJIA and the USD index in that same time frame. http://stockcharts.com/charts/historical/djia1900.html http://futures.tradingcharts.com/chart/US/M Basically, the dollar has been driven down to drive the equities markets up. In fact, the S & P 500 and USDI are almost perfectly reciprocal. As I said, the gains are mostly illusion. It's one of the reasons I loaded up big time on gold and silver in 2001 and encouraged everyone I knew to do the same. Sadly, the only one who listened was my mother and even she took a lot of convincing. Everyone else I know took a pounding in the recent crash. It shocks me how blind the American public seems to be to what is going on. If we have a currency crisis or collapse, only 1-2% of the populace that I'm aware of are prepared to weather the storm. The recession is NOT over! , PT, OCS Universal Healthcare > > It looks like this universal healthcare is going to happen. > > Regardless of your political or philosophic views, I have two questions: > > Q1: What impact do you foresee (degrees of increase, decrease, no change) > universal healthcare having on: > > -Professional autonomy > -Waiting Times > -Plans of care, including frequency and duration > -Reimbursement from Medicare > -Reimbursement from non-governmental insurance companies > -Salaries > -Small PT practices > -% of Self-pay patients > -Pursuit of patients seeking PT to delay surgery > -Pursuit of patients seeking alternative health providers > > Q 2: > Has the APTA served our interests well during this legislative process? > > Very respectfully intended, > > Alan > > Alan Petrazzi MPT, MPM > Rehab Manager > Pittsburgh, PA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 Curtis, The reason we have five major health insurance providers as you state below is because of the market. Consolidation of the insurance providers was a market driven activity, so what do you want people to tell their Congressmen about that letting the market do its thing since the market is what drove their consolidation in the first place? I believe the real issue isn't whether we should have a private or publicly financed system. Rather, it is the high cost nature of what I call our Nordstrom's health care system. Yes, it is very high quality, as are the Nordstrom's department stores, but only for those who can afford it. When most people had insurance or had decent insurance that covered most everything, no one cared that we had a high cost Nordstrom's delivery system. However, now that more people are having to pay for more of their care they are realizing that a Nordstrom's system has it's benefits in relation to quality but it's downsides in relation to cost. With every hospital having MRI units, 64 slice CT scanners, doing complex cardiac surgeries, etc., we are going to have a high cost system, especially as physicians and other providers open those same services in new facilities down the street from the hospitals. Costs have to be high to support the level of utilization that is necessary to pay for all of that, especially when there are more and more people who aren't paying for those services (so those who can pay have to pay more to cover for those who can't pay). Don't get me wrong, I'm not saying that providing MRI's, 64 bit CT, surgery services, etc.. is bad, but when everyone is offering the very best of everything and are charging what it takes to provide that high quality level of care, where does that leave people who cannot afford it? Think about it. If every store was a Nordstrom's, how many people would be able to afford clothing? Granted, what they could purchase from Nordstrom's would be of the highest quality, but would they be able to purchase enough to cover their needs? In the marketplace Nordstrom's has competitors that offer different price points, such as J.C. Penney, Target, and, of course, WalMart. Where are the WalMart's of healthcare? Who is doing WalMart cholecystectomies? Is a WalMart cholecystectomy any worse than a Nordstrom's cholecystectomy? Right now pretty much everyone is pricing everything at very high price points that require insurance in order to pay for them. When more people don't have insurance or are underinsured such that their insurance only pays for catastrophic care, yet there are no moderate or low cost alternatives available to those people, where does that leave us? I know there are free clinics and the like that people can use, but is that really our answer? It's a heck of a lot easier to offer a food kitchen and serve meals at a shelter (since it is low cost and requires no special training), or to provide a free primary care clinic, but how does one do that for a cholecystecomy? For a CABG? For a total hip? Even for free primary care clinics, how viable is that in rural areas where those physicians and providers may be barely scraping by now (in other words, how much more charity care can they take on)? Given the nature of physical therapy and that we generally see people for a series of visits (and not just one visit like what you may get at a free primary care clinic), how viable is it for PT's to do a lot of free clinic type of care? Markets work great when both price and innovation are points of competition (just look at computers, cameras, and cell phones). Healthcare in America has seen a tremendous amount of innovation, which we have all benefitted from, but we have not had price competition since before World War 2 when employer sponsored health insurance took off. Without price competition to rein in runaway price inflation, one could argue whether we really do have a true healthcare market. Mark Dwyer, PT, MHA markdwyer87@... Olathe, KS Re: Universal Healthcare Posted by: " Curtis Marti " cmarti@... csmarti Thu Dec 24, 2009 11:46 am (PST) Mr. Wall, Thank you for your thorough response to Mr. Petrazzi's inquiry. While I agreed with most of what you said, I wanted to focus on something that you mentioned, " We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. " I believe this point needs to be reconsidered. I would argue that a government dictate of what insurance providers can and cannot do will directly impact our delivery of services. While a predicted 95% of Americans will have insurance once this legislation is enacted, what those services include will be different. Without setting off a firestorm of political debate here, I would argue that our therapy professions would be much better served if this legislation does not pass and here's why. The private sector and free market can make healthcare accessible to all Americans. EMTALA is legislation that requires that all persons who present to the ER receive treatment, regardless of ability to pay, and will be legally liable if care is withheld. Furthermore, hospitals such as mine already see 7% no-pay patients annually and I believe that's a fairly representative amount compared to other hospitals. Now let's talk medications...everyone who needs medications can receive them right now, if they can prove that they do not have the means to pay for them. You can go to www.needsmeds.com <http://www.needsmeds.com/> and get a list of pharmacies nation-wide that service a huge list of medications for those who need them. Is it the government that funds such a program? No, it's the private sector through private contributions. It's funny that such programs are not advertised by those lobbying for the current legislation and I'd be surprised if many of you knew about this website. Many would argue that a patient would not receive the same quality of healthcare in our current system without having insurance. That may be a legitimate point. However, please consider the quality of healthcare that we will all be subject to, once private insurance companies are required to cover the uninsured and pre-existing conditions. Most will have insurance, but the quality of the insurance will not be the same. Some would argue that the " free market " hasn't worked up to now, so why should we expect things to change? The fact is, there hasn't been a free market up to now. There are only 5 main insurers in this country and their practice of judging what is " reasonable and necessary " has been anything but transparent. Please write your legislators, urging them to allow the free market to do what it does best, drive down prices. Thank you for the consideration of my comments and Merry Christmas to all. Curtis Marti Therapy Manager Hillcrest Medical Center Tulsa, OK ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Ron Wall Sent: Wednesday, December 23, 2009 9:47 PM To: PTManager Group Subject: RE: Universal Healthcare Alan To quote the old Saturday Night Live character Roseann Roseannadana, " Mr. Petrazzi, you sure ask a lot of questions. " They are important issues however. First point, what is being proposed is not Universal Healthcare. It brings us closer providing coverage for most people but does not cover everyone. There is a lot of biased interpretation being offered that makes understanding difficult. An excellent non-partisan resource is the Kaiser Family Foundation. Go to their website at www.kff.org. They summarize each of the proposed plans as well as line them up side by side and item by item to compare each. Remember there are two versions of bills. One from Congress and one from the Senate that have differences that need to be reconciled before they can become law. To answer your questions: There is nothing in it that addresses automony of therapists (what I assume you are asking?) Waiting times should not be a concern since it only addresses payment of services not practice The funds will go to pay for private insurance so Plans of care, frequency and duration will be defined by the private insurance companies. Reimbursement from Medicare is likely to be impacted. One of the provisions proposed is to take from Medicare to fund coverage to the currrently uninsured. The likely result is drop in either rates or coverage of procedures. Reimbursement from non-governmental insurance will largely be decided by these companies. They will not be able to deny services for pre-existing conditions or other underwriting practices of the past. This may effect their profitability, so it is unknown how they will react. The fear is that insurance premiums will go up for others to cover the formerly uninsurable. Salaries is an unknown. There may be a greater need for therapist in an already tight market, since more people will have insurance coverage and thus access to healthcare. The current shortage of therapists may create an employee advantage that makes therapist a valuable position that increases salaries. Or if insurance companies reduce amount of services they will authorize we could see the opposite. Small practices will face the same challenges they do today. If insurance companies partner with larger practices it could hurt the small ones. Insurance companies and physician groups could pit practices against each other to undercut prices. A small practice with low overhead could win. Or prices could be so low as to make the cost of delivering services more that the reimbursement. The % of Self-pay patients could drop as more people are covered by health insurance. If insurance companies cut back services, people who want additional services may have to pay out of pocket. Pursuit of patients seeking PT to delay surgery is unknown. That will likely depend on the insurance company, physician (group) and patient. Pursuit of patients seeking alternative health providers. It is important to note that the two bills being proposed are requiring those who can afford to buy health insurance to buy it and those who cannot buy it will get government assistance. This insurance will be from the same companies that now give us coverage. We are not facing any change in the delivery of services but a change in who has funding coverage and what the insurance providers can and cannot do. Your question about the APTA is something you will have to answer for yourself. I think in the big picture of all that has been proposed as possible changes leading to healthcare reform, they have protected and advocated our interests well. I hope this clarifies some of your concerns. Truth is that until a final bill is signed and enacted we will not know all of the answers or ramifications. One last comment. Most of the provisions of both bills will not go into effect until 2013. There will be a long lead time to figure out our best strategy. There is likely to be a reaction by the healthcare industry prior to then that we will have to deal with sooner. Ron Wall Axiom Healthcare Group Ontario, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 All, Curtis makes some compelling points. If you look at mandatory care e.g. ER mandates - this is what drives up cost. Regarding medicine - pharmaceutical companies offer rebates on all kinds of medicine however are not allowed to give coupons or rebates for anyone with government insurance (Medicaid or Medicare). Lastly, many hospitals have opened walk in clinics that evaluate and treat the underserved. The clinics are run by residents and cut hospital costs by keeping low level cases out of the ER. The free market healthcare system can work if the fed can realize there are lots of bright and able people who can care for folks and businesses which will do it while keeping costs low. Finally, if you want to stagnate a system and drive up labor hours, just add more regulation (more government involvement). Just look at the OASIS forms for home health services. Tom Plamondon PA-C, PT Northview Health Solutions LLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2009 Report Share Posted December 26, 2009 All, Curtis makes some compelling points. If you look at mandatory care e.g. ER mandates - this is what drives up cost. Regarding medicine - pharmaceutical companies offer rebates on all kinds of medicine however are not allowed to give coupons or rebates for anyone with government insurance (Medicaid or Medicare). Lastly, many hospitals have opened walk in clinics that evaluate and treat the underserved. The clinics are run by residents and cut hospital costs by keeping low level cases out of the ER. The free market healthcare system can work if the fed can realize there are lots of bright and able people who can care for folks and businesses which will do it while keeping costs low. Finally, if you want to stagnate a system and drive up labor hours, just add more regulation (more government involvement). Just look at the OASIS forms for home health services. Tom Plamondon PA-C, PT Northview Health Solutions LLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2009 Report Share Posted December 31, 2009 By the way, , the most successful people in stocks do regularly function off inside information. However, the most successful investors in the country are not U.S. Senators. Congress members are required top set up blind trust http://www.opensecrets.org/capital_eye/inside.php?ID=251 so that they are unaware of what assets they own. A trust, where a third party directs the congresspersons assets and the beneficiaries have no knowledge of the holdings of the trust. This avoids a conflict of interest between the beneficiary and votes cast. It is not a perfect system as Sen. Bill Frist got in trouble a couple of years ago for selling stock in a family business as it was tanking. It is not it is not a way to directly put money in senator's pockets. Unless you are looking for a short term gain, I would invest in your favorite company stocks now, they can only go up. von Lossnitzer, PT > > Hi Tim, > I'll let you address the " health of PT " issues as I think you've studied and developed this area much more than I have. My ideas in this area would be highly atypical and proprietary and not applicable to the general PT population. Let's just say I'm not betting the ranch on the next 20 years in PT being like the previous 20 years and leave it at that.;-) > > With regards to stocks and gold, you want to be careful not to fall for the Wall Street propapanda. It's commonly stated that the long term return on equities averages 12%. That figure is patently false but it's been endlessly promulgated from the level of your local financial advisor up to the moguls on Wall Street (the former of whom often don't know better, the latter of whom do) because of the obvious financial incentives. The average inflated adjusted return is actually less than 3%. In addition, the DJIA is the most commonly cited index for those 12% returns but, unfortunately, the DJIA is not all it appears to be at first glance. Underperforming stocks are regularly rotated out and better performing stocks are rotated in to replace them. If you look at ALL the stocks that were ever in the Dow, their average return is essentially flat, zippo, zero ... that's right, essentially no gains over decades. > > I'm not saying you can't make money off of stocks ... you obviously can. But the most successful people in stocks regularly function off inside information. The most successful investors in the country, for example, are not hedge fund managers but rather U.S. Senators. Interesting how they have the time to study investing while they're busy running the country <sarcasm> ... into the ground. FWIW though, most of the money on Wall Street is made by fees, commissions, bid/ask spreads, etc., especially when selling to " dumb money " (i.e. the average retail investor). It's not from outsider knowledge based investing in stocks (except when considering the naked short selling, front running, high frequency trading, etc. being practiced by firms such as Goldman Sachs <more sarcasm>). > > Thanks for the gold advice Tim. I'm well aware of its pros and cons. To allay your fears, I'm a cyclical investor, not a gold bug. Just like son who made his billions in credit default swaps and is now 46% invested in gold or gold related instruments, I know there's a time to get in (when gold drops below production cost) and a time to get out (which is known to most savvy gold investors), just like with any other asset class. If the time comes to buy Iowa farmland, I'll buy that. If you study cycles, you'll see that there's an approximately 17-18 year reciprocal cycle between stocks and commodities ... during one cycle, one predominate, during the next cycle the other predominates. For example, from 2001 to the present has been a commodity dominant cycle. That's one reason why gold has gone up from $258/oz. to $1225 oz. while the Dow has stayed essentially the same. Don't forget though that gold is not just a commodity, it's also a currency. Also, don't forget silver which has often outperformed gold and returned well over 3000% in one ten year period. How often do stocks match that? > > When you talk about gold only going up during " a period of global unrest and economic turmoil " , what do you think we're going through now?!? > > , PT, OCS > > P.S. LOL, Mom would still invite me to Christmas dinner even in the unlikely event that I blew the entire nest egg (which won't happen because she's smart enough to know never to put all your eggs in one basket).:-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2009 Report Share Posted December 31, 2009 By the way, , the most successful people in stocks do regularly function off inside information. However, the most successful investors in the country are not U.S. Senators. Congress members are required top set up blind trust http://www.opensecrets.org/capital_eye/inside.php?ID=251 so that they are unaware of what assets they own. A trust, where a third party directs the congresspersons assets and the beneficiaries have no knowledge of the holdings of the trust. This avoids a conflict of interest between the beneficiary and votes cast. It is not a perfect system as Sen. Bill Frist got in trouble a couple of years ago for selling stock in a family business as it was tanking. It is not it is not a way to directly put money in senator's pockets. Unless you are looking for a short term gain, I would invest in your favorite company stocks now, they can only go up. von Lossnitzer, PT > > Hi Tim, > I'll let you address the " health of PT " issues as I think you've studied and developed this area much more than I have. My ideas in this area would be highly atypical and proprietary and not applicable to the general PT population. Let's just say I'm not betting the ranch on the next 20 years in PT being like the previous 20 years and leave it at that.;-) > > With regards to stocks and gold, you want to be careful not to fall for the Wall Street propapanda. It's commonly stated that the long term return on equities averages 12%. That figure is patently false but it's been endlessly promulgated from the level of your local financial advisor up to the moguls on Wall Street (the former of whom often don't know better, the latter of whom do) because of the obvious financial incentives. The average inflated adjusted return is actually less than 3%. In addition, the DJIA is the most commonly cited index for those 12% returns but, unfortunately, the DJIA is not all it appears to be at first glance. Underperforming stocks are regularly rotated out and better performing stocks are rotated in to replace them. If you look at ALL the stocks that were ever in the Dow, their average return is essentially flat, zippo, zero ... that's right, essentially no gains over decades. > > I'm not saying you can't make money off of stocks ... you obviously can. But the most successful people in stocks regularly function off inside information. The most successful investors in the country, for example, are not hedge fund managers but rather U.S. Senators. Interesting how they have the time to study investing while they're busy running the country <sarcasm> ... into the ground. FWIW though, most of the money on Wall Street is made by fees, commissions, bid/ask spreads, etc., especially when selling to " dumb money " (i.e. the average retail investor). It's not from outsider knowledge based investing in stocks (except when considering the naked short selling, front running, high frequency trading, etc. being practiced by firms such as Goldman Sachs <more sarcasm>). > > Thanks for the gold advice Tim. I'm well aware of its pros and cons. To allay your fears, I'm a cyclical investor, not a gold bug. Just like son who made his billions in credit default swaps and is now 46% invested in gold or gold related instruments, I know there's a time to get in (when gold drops below production cost) and a time to get out (which is known to most savvy gold investors), just like with any other asset class. If the time comes to buy Iowa farmland, I'll buy that. If you study cycles, you'll see that there's an approximately 17-18 year reciprocal cycle between stocks and commodities ... during one cycle, one predominate, during the next cycle the other predominates. For example, from 2001 to the present has been a commodity dominant cycle. That's one reason why gold has gone up from $258/oz. to $1225 oz. while the Dow has stayed essentially the same. Don't forget though that gold is not just a commodity, it's also a currency. Also, don't forget silver which has often outperformed gold and returned well over 3000% in one ten year period. How often do stocks match that? > > When you talk about gold only going up during " a period of global unrest and economic turmoil " , what do you think we're going through now?!? > > , PT, OCS > > P.S. LOL, Mom would still invite me to Christmas dinner even in the unlikely event that I blew the entire nest egg (which won't happen because she's smart enough to know never to put all your eggs in one basket).:-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2009 Report Share Posted December 31, 2009 By the way, , the most successful people in stocks do regularly function off inside information. However, the most successful investors in the country are not U.S. Senators. Congress members are required top set up blind trust http://www.opensecrets.org/capital_eye/inside.php?ID=251 so that they are unaware of what assets they own. A trust, where a third party directs the congresspersons assets and the beneficiaries have no knowledge of the holdings of the trust. This avoids a conflict of interest between the beneficiary and votes cast. It is not a perfect system as Sen. Bill Frist got in trouble a couple of years ago for selling stock in a family business as it was tanking. It is not it is not a way to directly put money in senator's pockets. Unless you are looking for a short term gain, I would invest in your favorite company stocks now, they can only go up. von Lossnitzer, PT > > Hi Tim, > I'll let you address the " health of PT " issues as I think you've studied and developed this area much more than I have. My ideas in this area would be highly atypical and proprietary and not applicable to the general PT population. Let's just say I'm not betting the ranch on the next 20 years in PT being like the previous 20 years and leave it at that.;-) > > With regards to stocks and gold, you want to be careful not to fall for the Wall Street propapanda. It's commonly stated that the long term return on equities averages 12%. That figure is patently false but it's been endlessly promulgated from the level of your local financial advisor up to the moguls on Wall Street (the former of whom often don't know better, the latter of whom do) because of the obvious financial incentives. The average inflated adjusted return is actually less than 3%. In addition, the DJIA is the most commonly cited index for those 12% returns but, unfortunately, the DJIA is not all it appears to be at first glance. Underperforming stocks are regularly rotated out and better performing stocks are rotated in to replace them. If you look at ALL the stocks that were ever in the Dow, their average return is essentially flat, zippo, zero ... that's right, essentially no gains over decades. > > I'm not saying you can't make money off of stocks ... you obviously can. But the most successful people in stocks regularly function off inside information. The most successful investors in the country, for example, are not hedge fund managers but rather U.S. Senators. Interesting how they have the time to study investing while they're busy running the country <sarcasm> ... into the ground. FWIW though, most of the money on Wall Street is made by fees, commissions, bid/ask spreads, etc., especially when selling to " dumb money " (i.e. the average retail investor). It's not from outsider knowledge based investing in stocks (except when considering the naked short selling, front running, high frequency trading, etc. being practiced by firms such as Goldman Sachs <more sarcasm>). > > Thanks for the gold advice Tim. I'm well aware of its pros and cons. To allay your fears, I'm a cyclical investor, not a gold bug. Just like son who made his billions in credit default swaps and is now 46% invested in gold or gold related instruments, I know there's a time to get in (when gold drops below production cost) and a time to get out (which is known to most savvy gold investors), just like with any other asset class. If the time comes to buy Iowa farmland, I'll buy that. If you study cycles, you'll see that there's an approximately 17-18 year reciprocal cycle between stocks and commodities ... during one cycle, one predominate, during the next cycle the other predominates. For example, from 2001 to the present has been a commodity dominant cycle. That's one reason why gold has gone up from $258/oz. to $1225 oz. while the Dow has stayed essentially the same. Don't forget though that gold is not just a commodity, it's also a currency. Also, don't forget silver which has often outperformed gold and returned well over 3000% in one ten year period. How often do stocks match that? > > When you talk about gold only going up during " a period of global unrest and economic turmoil " , what do you think we're going through now?!? > > , PT, OCS > > P.S. LOL, Mom would still invite me to Christmas dinner even in the unlikely event that I blew the entire nest egg (which won't happen because she's smart enough to know never to put all your eggs in one basket).:-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2009 Report Share Posted December 31, 2009 , Thank you for your thoughtful reply - I won't make any more comments about your financial knowledge or positions since you've obviously put in a good deal of time and effort in study and your results seem to speak for themselves. Well done. I will, however, qualify your observation that the next ten years in the physical therapy industry won't be like the last ten years. Let's hope not. Speaking strictly from a returns standpoint (wages being the return on labor) the last few years have been acceptable to be a PT employee. In 1999 the annual mean PT wage was $58,350 while in 2009 the mean wage was $74,410. Before inflation that is an increase of 2.75% per year - not great, but not a kick in the teeth either. In an era of declining reimbursements most PT employees ought to be thrilled. PT owners, however, are struggling between high labor costs and the aforementioned reimbursements. From an outcomes standpoint physical therapy still has a long way to go. Many therapists still treat at the impairment level, over-utilize modalities and ignore predictive psychosocial factors. Only 48% of PTs even use outcome measures. Blame fee-for-service which rewards volume over results. Disability in America is rising <http://www.oandpbiznews.com/200503a/trends.asp> - at the same time that our ability to pay for ill-considered care is declining. So, if health care reform brings a game-changing paradigm and a transition to outcomes-based reimbursement then who wins? The patient. Who loses? By and large, the current holders of capital who are expecting a certain positive return on some fixed, illiquid assets. BTW, your (and my) PT education could be considered a fixed, illiquid asset. What to do? I'm still long on PT. Under an outcomes scenario that rewards us for keeping our patients healthy we can out-compete expensive, pathology-oriented orthopedic and neurosurgeons. If we can get rid of silly 'process measures' that mandate how we perform physical therapy (do you care which hand the farmer uses to milk his cows?) then we can lower our costs and pass the savings on to the patient. Or to profit. Societies are cyclic, but individuals aren't. What matters most at the individual level is innovation and effort. I'm betting that physical therapist innovation and effort can make the next ten years the best ever. Have a Happy New Year Tim , PTTimRichPT@... > > > > > > > > > > > As the saying goes: " Government run healthcare: all the efficiency of the > > > United States Postal Service coupled with all the compassion of the IRS. " > > > > > > The entities that will benefit the most from this program, in its present > > > incarnation, are the two entities that have the most powerful lobbying > > > influence in Washington: (1) the pharmaceutical companies and (2) the > > > insurance companies. Patients will get some benefit. Providers .... well, > > > better have flexible hamstrings.;-) > > > > > > Read Schiff's Economic Commentary for Dec. 23, " Dropping The Bomb on > > > Healthcare " , to learn just one of the essential flaws of this program: > > > http://www.europac.net/ > > > > > > Just remember, the last major legislation that was supposedly done for your > > > benefit that was slipped in Christmas Eve was the Federal Reserve Act of > > > 1913. That legislation was the ultimate source of the financial crisis that > > > we are experiencing today. You think it's over? You think your 401K is > > > coming back? Look again at its value in real dollar terms rather than > > > nominal terms. It's actually losing money when you look at inflation > > > adjusted Dow/gold ratios (and that's with a DJIA that's heavily > > > manipulated). The middle class in America is being decimated by actions such > > > as this and there's barely an outrage from the sheeple. > > > > > > Merry Christmas. > > > > > > , PT, OCS > > > Marquette, MI > > > > > > Universal Healthcare > > > > > > It looks like this universal healthcare is going to happen. > > > > > > Regardless of your political or philosophic views, I have two questions: > > > > > > Q1: What impact do you foresee (degrees of increase, decrease, no change) > > > universal healthcare having on: > > > > > > -Professional autonomy > > > -Waiting Times > > > -Plans of care, including frequency and duration > > > -Reimbursement from Medicare > > > -Reimbursement from non-governmental insurance companies > > > -Salaries > > > -Small PT practices > > > -% of Self-pay patients > > > -Pursuit of patients seeking PT to delay surgery > > > -Pursuit of patients seeking alternative health providers > > > > > > Q 2: > > > Has the APTA served our interests well during this legislative process? > > > > > > Very respectfully intended, > > > > > > Alan > > > > > > Alan Petrazzi MPT, MPM > > > Rehab Manager > > > Pittsburgh, PA > > > > > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.