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<p>Understatement of the day! Medicare has a lot of rules that are simply “rules to have rules” so they don’t have to pay!</p>
<p>Could you name them, please?</p>
<p>(I’m always hearing this about business regulation. Our state governor as the Association of Washington Business to come up with a list of unnecessary and burdensome state regulations so that she could consider repealing them. In 18 months, they didn’t come up with a single one.)</p>
<p>I have a list of such rules gleaned during my stepfather’s final illness last year - but in each case, they worked in favor of the doc or institution receiving payment (including one for transporting and subsequently treating an already-dead person), but not one that went the other way.</p>
<p>^^^For example: A physical therapist is required to hold a state license. Then they have a National Provider ID (NPI). Then they ALSO require a separate Medicare license in order to treat a Medicare patient…</p>
<p>Another: They require a therapist to be One-on-One with a patient for 95% of all treatments. That’s really dificult to do especially when Medicare chooses to only pay something like 75% of the bill… They expect that therapist to stand over the patient while a patient does an exercise that they can easily do without direct supervision.</p>
<p>That’s an interesting observation^^^^. I’ve been at physical therapy and I’ve had to help elderly patients left alone by the physical therapist in unsafe conditions. Apparently Medicare has a reason for their rules. Since the physical therapy places use unskilled and unlicensed people to run huge mills, they more than make up for the Medicare shortfall. </p>
<p>Everyone also knows how hard it is to find a decent physical therapist. Please, tell us more.</p>
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<p>Then report them because it’s ILLEGAL. </p>
<p>And if they were adequately paid maybe they would “run huge mills” like you claim. Have you considered that? A PT spends significantly more time with a patient than most physicians do. Maybe Medicare should cut there?</p>
<p>Insurance is such a fiasco; I’m really glad I don’t have to deal with it on a daily basis like my co-workers do. </p>
<p>Here’s another: Medicare will not reimburse if an athletic trainer (a licensed healthcare provider!) works with a patient. Also, a PTA cannot treat a Medicare patient without a Medicare-licensed PT is onsite.</p>
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<p>You mean YOU could easily do it without direct supervision. Have you ever been 85 years old, with virtually no leg muscle, with poor balance and dementia? That’s my dad. And yes, if he’s left unsupervised at physical therapy, he gets into all kinds of trouble.</p>
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<p>Way to go to the extreme there! Have you ever heard of professional discretion? If a patient presents like that, you obviously would treat them differently than if a patient is healthy with the exception of a single body part!</p>
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<p>And I look forward to hearing some of your list too…</p>
<p>They aren’t illegal - there are multiple licensed PTs on site. </p>
<p>I think more than Medicare won’t reimburse athletic trainers. I’ve only seen them working with well athletes, and if there is an injury, a more highly trained provider is required.</p>
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<p>So which is it?</p>
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<p>If you’re a private insurance, why would you reimburse something if Medicare doesn’t? Most insurances follow similar guidelines as what the government chooses to do. As for the second comment, feel free to continue to be clueless… Athletic Trainers have extensive background in injuries and rehabilitation…</p>
<p>“Professional discretion” usually means that care will be wildly uneven from facility to facility. Some scrupulous facilities will adhere to professional standards. Many will not; they will find that cutting corners is more profitable. Our country does not have a stellar history of businesses voluntarily doing the right thing when there’s money to be made from not doing the right thing.</p>
<p>This is also, BTW, why there needs to be a Medicare-licensed PT on site.</p>
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<p>Then why have a state license? Because according to you, state licensed individuals aren’t good enough, huh?</p>
<p>So then hops, if you oppose the idea of single-payer, I can only assume that you have a better idea. I’ll ask you the same question I ask of all opponents of insurance reform (and few seem willing to answer):</p>
<p>–> How would you deal with the problem of 50-80 million uninsured Americans?</p>
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<p>It’s definitely a tough question and I wish I had the answer. But unfortunately I have seen too many cases of poor management by the state and federal government with their small groups of “insured” individuals to believe that a single payor system set up by the government could possibly be the answer.</p>
<p>Healthcare needs to be priority in an individual’s life. There are plenty of people who are uninsured simply because they will not pay for it. Young adults who claim they are invinceble, families who would rather have cell phones and go on vacations, etc. That shouldn’t be something the government forces onto them. That is a major concern of mine with the so-called “Obama-Care.” They want to force it on individuals. Another concern of mine is the fact that it was written but “we won’t know what’s in it until it’s passed” that Pelosi was saying. Red flag anyone? </p>
<p>Currently healthcare is too focused on reactive medicine and not preventative medicine. There are plenty of people to blame for that and I think we can all name groups at fault. The government, private insurance, doctors and other healthcare providers, and the individuals themselves. It was stated earlier that is so expensive because those sorts of treatments are much more expensive than handling something earlier on.</p>
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<p>Precisely. Doesn’t it make more sense for everyone to have basic insurance so that those things can be addressed early, when they’re much cheaper to treat? If the main concern is reducing cost, then our insurance system is completely insane.</p>
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<p>But wait: Didn’t I read earlier that insurance was supposed to be for “big things” and not all the little minor things?</p>
<p>hops, As to people choosing cell phones over health insurance, I only WISH the two were comparable in cost. I could give up my cell phone, my cable, my gas and electric, my car, my pets and my haircuts – and it STILL wouldn’t come anywhere close to paying for my insurance. </p>
<p>I have enough income that I don’t have to make those choices, but not everyone is so fortunate. (I’m lucky in this regard too: If a court hadn’t intervened against Anthem Blue Cross a couple of years ago, my insurance premiums would now be almost as much as my mortgage payment.)</p>
<p>So here’s another question: What would you do about the millions of Americans who simply cannot afford insurance without sacrificing basic needs like food and housing?</p>
<p>Well… as I said, opponents of reform seem strangely unwilling to offer an alternative.</p>
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<p>Because your solution is the answer… let the government pay for it! Umm… isn’t your state broke!!! I think it’s the only state worse than mine!</p>
<p>You’ve made it clear you don’t think single-payer is the answer. What do you think we should do instead?</p>
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<p>Reading would be a good start. I don’t have the answer. But I can see that putting the government in charge of it won’t work. They can’t handle the small population they have now; how do you expect them to take on 300+million?</p>
<p>Oh that’s right, you want to starve the providers because they don’t need money!!!</p>