Heads up: Medicare cuts coming

On Nov. 1, the federal government issued a final ruling that's going to result in Medicare cuts of 4.5%. In an already dysfunctional and overcrowded health care system - this is going to be a problem for you (the consumer) - and here's why.

Health care is ultimately a business. And its goal is to make a profit. Revenue and profit come from things like procedures, tests, images and surgery - not from disease prevention and keeping people healthy.

What does that mean for you?

It means health care specialities such as orthopedic surgery, neurology, and gastroenterology, for example - those that are procedurally-driven - generate higher revenues and get paid more for their services. On the flip side - disciplines like primary care physicians, rehab therapies (like physical therapy), and endocrinologists (those that manage chronic conditions like diabetes and osteoporosis) - get paid less. The consequence is that the disciplines who actually need more time with you - so they can get to know you and your lifestyle - because that's what is required to give you a good strategy for disease and injury prevention - are forced to do more work for less.

Eventually, something has to give.

Family medicine doctors have to see patients every 10 minutes and that's if you can even get in to see them in a timely fashion. Physical therapists have to see multiple patients per hour, resulting in 12 to 16 patients per day. These caseloads and demands are not supportive of a health care practitioner truly getting to know you as a person, what your concerns are, or what your particular lifestyle and burdens are. (A recent commentary by Shirlene Obuobi, MD in the Washington Post illustrates this dilemma quite well.) These are all critically important factors if you want to get effective treatment and advice that's going to match your needs and deliver the outcome you want. The consequence is sub-par preventative care. And you risk unnecessarily getting shuffled off to the "specialist" who uses fancy tests and procedures (instead of getting to know you and asking questions) to make (often costly) decisions about your health.

Now, my intention here is not to paint specialists who use procedures and tests as their norm of examination as the "bad guys." The problem is you, the patient, is getting pawned off on them too soon because the people who are meant to protect you and help you defend against disease and injury are getting crushed (and not valued) by the health insurance companies. Medicare tends to be the leader and everyone else follows suit. If these 2023 cuts go through, commercial insurers will be next.

So what can you do?

First, you must do everything in your power to become educated about health and wellness so you can prevent disease and injuries on your own. This may require hiring certain, key, preventative health care professionals to guide you - such as getting your own dietician, your own physical therapist, and your own mental health professional. Ironically, we already do this without even thinking about it when it comes to our dental care. Why wouldn't we want to do this with other aspects - like digestive, mental and musculoskeletal health? Health insurance companies add red-tape when it comes to accessing these services - such as requiring a referral - which our already overburdened primary care physicians don't have time to give.

This leads me to my second recommendation ... start thinking outside the box and be willing and able to invest in the health care you both desire and need. Believe it or not, going outside of your health insurance and paying out of pocket for preventative health care services is not as expensive as you may think and your options open up exponentially. Especially if you budget and plan for it. At some point, it's not going to be in your favor to rely on your health insurance to fund all your health care needs anymore - because it's clear they're not interested. Instead, look at your finances and start budgeting. One of the best ways to do this is to open up a health savings account. If your health plan doesn't allow for that, then open up a separate savings account to save on your own. More and more practitioners are ditching insurance - if not leaving their respective professions altogether. If you want to stay out of the hospital or big corporate health care systems and see someone private who has the time to care about you, you'll need to be prepared to pay. Personally, I believe this is the way to go but I understand it's not for everyone. However, with some planning and foresight, it could be. While I hope things do eventually change for the long-term - I believe that staying educated, taking some control over the administration and funding of your health care in the short term, is a far better alternative than heading to Washington and fighting Congress on your own.

Dr. Carrie Jose, physical therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or get one of her free guides for preventing back pain, knee pain, or vertigo - visit www.cjphysicaltherapy.com or call 603-605-0402.

Health and Wellness

Dr. Carrie Jose

Guest coumnist