RE: Effect of National Health Care on Private Practice Physical Therapy Clinics

[Guest guest]

What are you all in this field for? To make money or to do rehab? It's great

when you can do both but very often, in this country, the two don't go together.

The problem is getting care is not based on need, it's based on ability to pay.

After 17 years I've seen enough to write a book on the people that have received

poor care or no care. Consistently, these are people who don't have the

finanicial resources. I see people for free on a regular basis. Think about

the cycle our system creates....someone gets hurt and can't work. Insurance or

not, they can't afford the copay of PT 2-3x/wk. So they don't come for

treatment or the Dr. simply doesn't send them and does the " pill treatment " to

save them the financial burden. The problem progresses, secondary conditions

develop, and before you know it they can't return to work, ever. I've seen many

cases where this could have been prevented. I ask my class this question the

first day... " If this career only paid $20,000

per year, would you still want to do it? " Do we need national health care?

Absolutely. Will it come with problems? Absolutely. No system is perfect.

But I would rather take less money and know that everyone CAN get care when they

need it and that no one will have to lose their home or file bankruptcy because

of their healthcare needs. I was recently offered a postion as a staff

therapist with a salary range of $90,000-$120,000/yr, much more than I currently

make. I turned it down. It sounds wonderful but it's insane. What is going to

happen to our field in the next 5-10 years with salarys like that, but insurance

reimbusement continues to drop? Anyone remember what the field was like in the

late 1990's?

Amy Marshall, PT

BIAPT

biapt000@...

Kathleen e wrote:

We need national health care. Medicare and Medicaid are essentially

the

same system. Well-run private practices can be profitable under these

systems serving theMedicare population.

40% of the population in my county do not have heath insurance. It is

selfish and self-serving to think about a private practice " loosing out "

under an all payor system. People with serious health problems do not get

care here. I have treated 4 clients in the past year who were relatively

young, had HTN,and could not afford to pay for a doctor's vist.All of these

people had significant CVAs.

I have worked with therapists from Ireland and the UK that have incredible

respect and autonomy there under there national heath care system in their

country of origin. If you offer a level of expertise not found in the

national health plan, people will pay out of pocket,if you choose to do a

private practice. A win-win with the cash up front!

Kathleen e, PT

Modesto, CA

Effect of National Health Care on Private Practice

Physical Therapy Clinics

Dear Group,

This is more of an information gathering post than an information giving

post, so I'll get right to it. In my research over the last few years of

politics and political agendas, I have come to the conclusion that allowing

the government to enact any plan of Nationalized Healthcare - outside of

Medicare, Medicaid, and SCHIP as they are right now - would in effect put

all of our private practices out of business. I believe that the lack of

choices available to the general public, and the government being in control

of yet another failing system in this country would destroy competition in

our industry, and would be a great benefit to hospital based therapy

services, but would be terrible for private practice. I don't know what it

is like trying to get credentialed with HMO insurance companies outside of

Wisconsin, but in our practice, we have been told in no uncertain terms that

we will NEVER be allowed in any HMO network as long as there is a hospital

based clinic within 20 miles of us.

Consequently, there are at least 4 hospital based clinics within 20 miles of

our clinic, and all of our attempts to join HMO networks, so that we might

be able to cater to a larger range of patients, has ended in a denial from

the insurance company for the very reason listed above. With the government

possibly taking over Healthcare for everyone, it becomes easy to imagine

that they would want to sped as little money as possible in order to cover

as many people as possible, and HMO Health Insurance will become the norm in

our industry, making it nearly impossible to serve those patients unless

they are willing to pay out of pocket. This is severely unlikely, being

that they could just go to the hospital based clinic down the block and get

" free " Physical Therapy because it's covered under their taxpayer funded -

and capped like Medicare - Health plan.

Not only do we have to worry about the HMO issue, but we also have to worry

about the hospitals and their bureaucrats being able to charge less than

private practices to " the insurance company " than we can because they have

so much more revenue to go around to keep them in business, and keep us out

of competition just by undercutting our prices.

So, with that out of the way, I'd like to know how some of you are dealing

with the prospect of having Nationalized Health Care... By the way, if you

can give me good, viable, verifiable reasons why Nationalized Health Care

might actually benefit Private Practices, I might be swayed, but as yet, the

best argument anyone can come up with is that the cheapest insurance pool is

one where everyone is enrolled. I often hear the same poor arguments, and

then I look to countries that have had National Health Care programs for

years like Great Britain and Canada, who's patients are literally flying to

the United States in droves just to get their healthcare NOW instead of

having to wait up to 6 months for a CT scan when cancer is the likely

diagnosis. In most cases, if a patient has a possible brain cancer

diagnosis, 6 months could very well be too late. I don't want to have that

risk here in this country... it scares me.

Adam Jeschke

Optimal PT

Lake Mills, WI

[Guest guest]

Kathleen,

Here Here. I agree. I think it is really selfish that only a portion of

those that need physical therapy have access to it. We need direct access and

we need access to those services for everyone. This should be a right, not a

benefit. Can you imagine if everyone that needed physical therapy could have

it? Our waiting rooms would be packed everyday. Market based healthcare may

increase competition but at what cost? The insurance companies are a business

and they have a bottom line and that bottom line too often takes precedence over

a patent's health. By the way, how well paid are the CEO's and insurance

company shareholders? How nicely their marble halls shine, too bad that money

did not go to providing care to the patients who needed it. And to the physical

therapist who could have helped them. I don't know what the solution is. All I

know is whatever we have in place is not working.

Lori

Kathleen e wrote:

We need national health care. Medicare and Medicaid are essentially

the

same system. Well-run private practices can be profitable under these

systems serving theMedicare population.

40% of the population in my county do not have heath insurance. It is

selfish and self-serving to think about a private practice " loosing out "

under an all payor system. People with serious health problems do not get

care here. I have treated 4 clients in the past year who were relatively

young, had HTN,and could not afford to pay for a doctor's vist.All of these

people had significant CVAs.

I have worked with therapists from Ireland and the UK that have incredible

respect and autonomy there under there national heath care system in their

country of origin. If you offer a level of expertise not found in the

national health plan, people will pay out of pocket,if you choose to do a

private practice. A win-win with the cash up front!

Kathleen e, PT

Modesto, CA

Effect of National Health Care on Private Practice

Physical Therapy Clinics

Dear Group,

This is more of an information gathering post than an information giving

post, so I'll get right to it. In my research over the last few years of

politics and political agendas, I have come to the conclusion that allowing

the government to enact any plan of Nationalized Healthcare - outside of

Medicare, Medicaid, and SCHIP as they are right now - would in effect put

all of our private practices out of business. I believe that the lack of

choices available to the general public, and the government being in control

of yet another failing system in this country would destroy competition in

our industry, and would be a great benefit to hospital based therapy

services, but would be terrible for private practice. I don't know what it

is like trying to get credentialed with HMO insurance companies outside of

Wisconsin, but in our practice, we have been told in no uncertain terms that

we will NEVER be allowed in any HMO network as long as there is a hospital

based clinic within 20 miles of us.

Consequently, there are at least 4 hospital based clinics within 20 miles of

our clinic, and all of our attempts to join HMO networks, so that we might

be able to cater to a larger range of patients, has ended in a denial from

the insurance company for the very reason listed above. With the government

possibly taking over Healthcare for everyone, it becomes easy to imagine

that they would want to sped as little money as possible in order to cover

as many people as possible, and HMO Health Insurance will become the norm in

our industry, making it nearly impossible to serve those patients unless

they are willing to pay out of pocket. This is severely unlikely, being

that they could just go to the hospital based clinic down the block and get

" free " Physical Therapy because it's covered under their taxpayer funded -

and capped like Medicare - Health plan.

Not only do we have to worry about the HMO issue, but we also have to worry

about the hospitals and their bureaucrats being able to charge less than

private practices to " the insurance company " than we can because they have

so much more revenue to go around to keep them in business, and keep us out

of competition just by undercutting our prices.

So, with that out of the way, I'd like to know how some of you are dealing

with the prospect of having Nationalized Health Care... By the way, if you

can give me good, viable, verifiable reasons why Nationalized Health Care

might actually benefit Private Practices, I might be swayed, but as yet, the

best argument anyone can come up with is that the cheapest insurance pool is

one where everyone is enrolled. I often hear the same poor arguments, and

then I look to countries that have had National Health Care programs for

years like Great Britain and Canada, who's patients are literally flying to

the United States in droves just to get their healthcare NOW instead of

having to wait up to 6 months for a CT scan when cancer is the likely

diagnosis. In most cases, if a patient has a possible brain cancer

diagnosis, 6 months could very well be too late. I don't want to have that

risk here in this country... it scares me.

Adam Jeschke

Optimal PT

Lake Mills, WI

[Guest guest]

In reference to Mr. Jeschke's comments I actually believe there are advantages

and disadvantages in both a socialized healthcare environment and in a

capitalistic healthcare environment. The bottom line depends on whom it

benefits. It is in the best financial interest of the average consumer to be in

an environment where healthcare is delivered in a socialized manner as in most

industrialized nations, but it is in the best financial interest of myself and

other busienss owners/executives (e.g. private practice owners, corporate

executives (e.g. HealthSouth, Physiotherapy Assoc., etc.), hospital executives,

SNF owners and executives, Home Health Agency owners and executives, contracting

agency owners, and physicians who own PT practices and CORFs) to do business in

capitalistic environments where we can " capitalize " on opportunties created by

healthcare.

If we don't change our business philosophies and policies, then others will.

Although, many business owners are willing to offer employment opportunities to

physical therapists, assistants, athletic trainers, etc... to capitalize on the

opportunites described above, few are willing to share ownership. To prevent

non-physical therapists from OWNING physical therapists and physical therapy

assistants we MUST empower our colleagues with partnership/ownership

opportunites. When we understand and share the rewards and losses of owning a

physical therapy business, only then we will be able to truely understand the

implications associated with non-physical therapists having control of our

present and future (e.g. impact of hospital based clinics).

Dr. Sumesh , PT, DPT, OCS

P.S. Most of my patients wait longer than expected before being able to see

specialists or undergo imaging studies, and a few become non-compliant with

their prescribed medications due to cost and other insurance issues. In

addition, although I have family and friends in many counties with socialized

healthcare none of them have expressed a desire to come to the US for

healthcare.

Effect of National Health Care on Private Practice

Physical Therapy Clinics

Dear Group,

This is more of an information gathering post than an information giving

post, so I'll get right to it. In my research over the last few years of

politics and political agendas, I have come to the conclusion that allowing

the government to enact any plan of Nationalized Healthcare - outside of

Medicare, Medicaid, and SCHIP as they are right now - would in effect put

all of our private practices out of business. I believe that the lack of

choices available to the general public, and the government being in control

of yet another failing system in this country would destroy competition in

our industry, and would be a great benefit to hospital based therapy

services, but would be terrible for private practice. I don't know what it

is like trying to get credentialed with HMO insurance companies outside of

Wisconsin, but in our practice, we have been told in no uncertain terms that

we will NEVER be allowed in any HMO network as long as there is a hospital

based clinic within 20 miles of us.

Consequently, there are at least 4 hospital based clinics within 20 miles of

our clinic, and all of our attempts to join HMO networks, so that we might

be able to cater to a larger range of patients, has ended in a denial from

the insurance company for the very reason listed above. With the government

possibly taking over Healthcare for everyone, it becomes easy to imagine

that they would want to sped as little money as possible in order to cover

as many people as possible, and HMO Health Insurance will become the norm in

our industry, making it nearly impossible to serve those patients unless

they are willing to pay out of pocket. This is severely unlikely, being

that they could just go to the hospital based clinic down the block and get

" free " Physical Therapy because it's covered under their taxpayer funded -

and capped like Medicare - Health plan.

Not only do we have to worry about the HMO issue, but we also have to worry

about the hospitals and their bureaucrats being able to charge less than

private practices to " the insurance company " than we can because they have

so much more revenue to go around to keep them in business, and keep us out

of competition just by undercutting our prices.

So, with that out of the way, I'd like to know how some of you are dealing

with the prospect of having Nationalized Health Care... By the way, if you

can give me good, viable, verifiable reasons why Nationalized Health Care

might actually benefit Private Practices, I might be swayed, but as yet, the

best argument anyone can come up with is that the cheapest insurance pool is

one where everyone is enrolled. I often hear the same poor arguments, and

then I look to countries that have had National Health Care programs for

years like Great Britain and Canada, who's patients are literally flying to

the United States in droves just to get their healthcare NOW instead of

having to wait up to 6 months for a CT scan when cancer is the likely

diagnosis. In most cases, if a patient has a possible brain cancer

diagnosis, 6 months could very well be too late. I don't want to have that

risk here in this country... it scares me.

Adam Jeschke

Optimal PT

Lake Mills, WI

[Guest guest]

For those interested there was recently a very good NPR podcast on the

subject of Comprehensive Health Care. Here is the link:

http://www.npr.org/templates/story/story.php?storyId=17243160

Mark F. Schwall, PT

Future Physical Therapy, PC

1594 Route 9

Unit 2

Toms River, NJ 08755

Fax

President

New Jersey Society of Independent Physical Therapists

2123 Route 35

Sea Girt, NJ 08750

From: PTManager [mailto:PTManager ] On Behalf

Of Sumesh

Sent: Thursday, January 17, 2008 10:42 AM

To: PTManager

Subject: Re: Effect of National Health Care on Private Practice

Physical Therapy Clinics

In reference to Mr. Jeschke's comments I actually believe there are

advantages and disadvantages in both a socialized healthcare environment and

in a capitalistic healthcare environment. The bottom line depends on whom it

benefits. It is in the best financial interest of the average consumer to be

in an environment where healthcare is delivered in a socialized manner as in

most industrialized nations, but it is in the best financial interest of

myself and other busienss owners/executives (e.g. private practice owners,

corporate executives (e.g. HealthSouth, Physiotherapy Assoc., etc.),

hospital executives, SNF owners and executives, Home Health Agency owners

and executives, contracting agency owners, and physicians who own PT

practices and CORFs) to do business in capitalistic environments where we

can " capitalize " on opportunties created by healthcare.

If we don't change our business philosophies and policies, then others will.

Although, many business owners are willing to offer employment opportunities

to physical therapists, assistants, athletic trainers, etc... to capitalize

on the opportunites described above, few are willing to share ownership. To

prevent non-physical therapists from OWNING physical therapists and physical

therapy assistants we MUST empower our colleagues with partnership/ownership

opportunites. When we understand and share the rewards and losses of owning

a physical therapy business, only then we will be able to truely understand

the implications associated with non-physical therapists having control of

our present and future (e.g. impact of hospital based clinics).

Dr. Sumesh , PT, DPT, OCS

P.S. Most of my patients wait longer than expected before being able to see

specialists or undergo imaging studies, and a few become non-compliant with

their prescribed medications due to cost and other insurance issues. In

addition, although I have family and friends in many counties with

socialized healthcare none of them have expressed a desire to come to the US

for healthcare.

Effect of National Health Care on Private Practice

Physical Therapy Clinics

Dear Group,

This is more of an information gathering post than an information giving

post, so I'll get right to it. In my research over the last few years of

politics and political agendas, I have come to the conclusion that allowing

the government to enact any plan of Nationalized Healthcare - outside of

Medicare, Medicaid, and SCHIP as they are right now - would in effect put

all of our private practices out of business. I believe that the lack of

choices available to the general public, and the government being in control

of yet another failing system in this country would destroy competition in

our industry, and would be a great benefit to hospital based therapy

services, but would be terrible for private practice. I don't know what it

is like trying to get credentialed with HMO insurance companies outside of

Wisconsin, but in our practice, we have been told in no uncertain terms that

we will NEVER be allowed in any HMO network as long as there is a hospital

based clinic within 20 miles of us.

Consequently, there are at least 4 hospital based clinics within 20 miles of

our clinic, and all of our attempts to join HMO networks, so that we might

be able to cater to a larger range of patients, has ended in a denial from

the insurance company for the very reason listed above. With the government

possibly taking over Healthcare for everyone, it becomes easy to imagine

that they would want to sped as little money as possible in order to cover

as many people as possible, and HMO Health Insurance will become the norm in

our industry, making it nearly impossible to serve those patients unless

they are willing to pay out of pocket. This is severely unlikely, being

that they could just go to the hospital based clinic down the block and get

" free " Physical Therapy because it's covered under their taxpayer funded -

and capped like Medicare - Health plan.

Not only do we have to worry about the HMO issue, but we also have to worry

about the hospitals and their bureaucrats being able to charge less than

private practices to " the insurance company " than we can because they have

so much more revenue to go around to keep them in business, and keep us out

of competition just by undercutting our prices.

So, with that out of the way, I'd like to know how some of you are dealing

with the prospect of having Nationalized Health Care... By the way, if you

can give me good, viable, verifiable reasons why Nationalized Health Care

might actually benefit Private Practices, I might be swayed, but as yet, the

best argument anyone can come up with is that the cheapest insurance pool is

one where everyone is enrolled. I often hear the same poor arguments, and

then I look to countries that have had National Health Care programs for

years like Great Britain and Canada, who's patients are literally flying to

the United States in droves just to get their healthcare NOW instead of

having to wait up to 6 months for a CT scan when cancer is the likely

diagnosis. In most cases, if a patient has a possible brain cancer

diagnosis, 6 months could very well be too late. I don't want to have that

risk here in this country... it scares me.

Adam Jeschke

Optimal PT

Lake Mills, WI

[Guest guest]

There is a Constitutional Amendment that forbids us to refuse anyone " Health

Care " ... it is " Health Insurance " that people do not have, and that is not

guaranteed by the Constitution, nor is it within the Constitutionally

Granted Powers of Congress to impose such legislation on this country. You

should have taken the $90-120,000 a year job, because you'll be paying more

in taxes - already close to 50% of annual income for our practice - in order

to support the 45 million+ people we have to supply with " free " National

Health Insurance. Let me reiterate.... it is 100% illegal for you, me, or

anyone in the medical profession to turn someone away because they don't

have health insurance. You can inform them of your cash-pay policy, do

pro-bono work as you see fit, but you can't refuse their care outright.

That is guaranteed in the Constitution of the United States of America.

I suppose those of you who support the idea of a national healthcare system

- read:

socialized-single-payer-taxpayer-funded-government-regulated-health-insurance-th\

at-we-can't-afford-in-its-current-state-of-medicare-and-medicaid

- also support the idea of supplying that same health care to illegal

aliens, no matter where they might be from, North, South, East or West...

The current system in place is financially bankrupt right now, just as

Social Security is financially bankrupt, and both programs are taking this

country further into debt with the rest of the world, because we can't

possibly contribute more than is being taken out of the funds to pay for

services. On that note, I'd guess that you also support the idea of

allowing illegal aliens to vote in our elections.

Socialist programs are the fastest way to completely destroy the

infrastructure of a country. The UK is losing money every day because of

their healthcare system, Sweden has all but done away with their Welfare

System, as it nearly bankrupted the entire country. I would expect those of

us in private practice - small business owners especially - would want the

government to stay as far away from our industry as possible. The only good

thing the government can do to improve the economy, get more people to pay

for health insurance and/or healthcare, and bring more business into our

clinics - which should be read as more patients being helped rather than

more revenue, because I honestly don't care about money, but I don't want

the government to take any of it for the benefit of the masses - is to get

out of the way and let nature take its course.

The greatest economic boom in this country was in the early 1980s, when

Reagan was president... he didn't pass any new spending bills, he cut

taxes, he got the government out of the way, and the economy of this country

skyrocketed. It is sad that people have become so used to the government

interfering in everything we do that they've forgotten that the government

is supposed to serve the people, the people aren't supposed to serve the

government, but that's where we are going if things like Nationalized Health

Plans are implemented. We're already slaves to the Federal Reserve, Social

Security, Medicare, and Medicaid, and now you want to add on another 45+

million people because you think people should be guaranteed health

insurance.... Self-imposed slavery is an ugly beast, and we've done it to

ourselves by not putting a check on everything our government feels like

doing this week, and over the last 50-75 years.

Like I said in my first post, it's 100% impossible for our clinic to

participate in any HMO insurance plans in the area because they cater to

hospitals only. I was specifically told that there are no free-standing

physical therapy clinics in the network of one of our local plans, and that

I could apply but we would be denied access to the HMO network because there

is a hospital-owned clinic less than a block away from us. When the

government takes over, I hope you have planned to either see only " Cash "

patients, or have lined up a job at a local hospital-owned clinic, because

unless you are in an area where you have such a huge understaffing of PTs

that every free-standing clinic is already in network with all the local

HMOs, you won't be seeing many insurance patients outside of Medicare.

Heh... you think the therapy cap is bad now, wait until every person (man,

woman, and child) in the country is all in the same network, and the

government can't tax us enough to cover the costs.... that, or the

reimbursement rates will plummet, and we'll be driven out of business

because we just can't afford to pay the rent anymore.

I hope no one takes anything I've said as a personal insult, I just find

that many people who like the idea of Nationalized Health Care, don't

realize that Health Care - not Health Insurance - is already guaranteed in

the Constitution, and once they realize this they often change their tune.

Adam Jeschke

Optimal Physical Therapy, LLC

Lake Mills, WI

> In reference to Mr. Jeschke's comments I actually believe there are

> advantages and disadvantages in both a socialized healthcare environment and

> in a capitalistic healthcare environment. The bottom line depends on whom it

> benefits. It is in the best financial interest of the average consumer to be

> in an environment where healthcare is delivered in a socialized manner as in

> most industrialized nations, but it is in the best financial interest of

> myself and other busienss owners/executives (e.g. private practice owners,

> corporate executives (e.g. HealthSouth, Physiotherapy Assoc., etc.),

> hospital executives, SNF owners and executives, Home Health Agency owners

> and executives, contracting agency owners, and physicians who own PT

> practices and CORFs) to do business in capitalistic environments where we

> can " capitalize " on opportunties created by healthcare.

>

> If we don't change our business philosophies and policies, then others

> will. Although, many business owners are willing to offer employment

> opportunities to physical therapists, assistants, athletic trainers, etc...

> to capitalize on the opportunites described above, few are willing to share

> ownership. To prevent non-physical therapists from OWNING physical

> therapists and physical therapy assistants we MUST empower our colleagues

> with partnership/ownership opportunites. When we understand and share the

> rewards and losses of owning a physical therapy business, only then we will

> be able to truely understand the implications associated with non-physical

> therapists having control of our present and future (e.g. impact of

> hospital based clinics).

>

> Dr. Sumesh , PT, DPT, OCS

>

> P.S. Most of my patients wait longer than expected before being able to

> see specialists or undergo imaging studies, and a few become non-compliant

> with their prescribed medications due to cost and other insurance issues. In

> addition, although I have family and friends in many counties with

> socialized healthcare none of them have expressed a desire to come to the US

> for healthcare.

>

>

> Effect of National Health Care on Private Practice

> Physical Therapy Clinics

>

> Dear Group,

>

> This is more of an information gathering post than an information giving

> post, so I'll get right to it. In my research over the last few years of

> politics and political agendas, I have come to the conclusion that

> allowing

> the government to enact any plan of Nationalized Healthcare - outside of

> Medicare, Medicaid, and SCHIP as they are right now - would in effect put

> all of our private practices out of business. I believe that the lack of

> choices available to the general public, and the government being in

> control

> of yet another failing system in this country would destroy competition in

> our industry, and would be a great benefit to hospital based therapy

> services, but would be terrible for private practice. I don't know what it

> is like trying to get credentialed with HMO insurance companies outside of

> Wisconsin, but in our practice, we have been told in no uncertain terms

> that

> we will NEVER be allowed in any HMO network as long as there is a hospital

> based clinic within 20 miles of us.

>

> Consequently, there are at least 4 hospital based clinics within 20 miles

> of

> our clinic, and all of our attempts to join HMO networks, so that we might

> be able to cater to a larger range of patients, has ended in a denial from

> the insurance company for the very reason listed above. With the

> government

> possibly taking over Healthcare for everyone, it becomes easy to imagine

> that they would want to sped as little money as possible in order to cover

> as many people as possible, and HMO Health Insurance will become the norm

> in

> our industry, making it nearly impossible to serve those patients unless

> they are willing to pay out of pocket. This is severely unlikely, being

> that they could just go to the hospital based clinic down the block and

> get

> " free " Physical Therapy because it's covered under their taxpayer funded -

> and capped like Medicare - Health plan.

>

> Not only do we have to worry about the HMO issue, but we also have to

> worry

> about the hospitals and their bureaucrats being able to charge less than

> private practices to " the insurance company " than we can because they have

> so much more revenue to go around to keep them in business, and keep us

> out

> of competition just by undercutting our prices.

>

> So, with that out of the way, I'd like to know how some of you are dealing

> with the prospect of having Nationalized Health Care... By the way, if you

> can give me good, viable, verifiable reasons why Nationalized Health Care

> might actually benefit Private Practices, I might be swayed, but as yet,

> the

> best argument anyone can come up with is that the cheapest insurance pool

> is

> one where everyone is enrolled. I often hear the same poor arguments, and

> then I look to countries that have had National Health Care programs for

> years like Great Britain and Canada, who's patients are literally flying

> to

> the United States in droves just to get their healthcare NOW instead of

> having to wait up to 6 months for a CT scan when cancer is the likely

> diagnosis. In most cases, if a patient has a possible brain cancer

> diagnosis, 6 months could very well be too late. I don't want to have that

> risk here in this country... it scares me.

>

> Adam Jeschke

> Optimal PT

> Lake Mills, WI

>

>

>

[Guest guest]

You all have very valid points. I am sorry I do not also have

Shumesh's comments atthe bottom of this reply as well. Those points

are also quite true (especially those of his family/friends not

wanting to come to the US for treatment).

What I am not seeing here is the point that no matter which way we

go, will we be able to support a clinic financially. High salaries

would be out the window, likely. But will we be able to support the

supplies, linens, gels, QUALITY equipment (not fancy) in a socialized

arena?

Would the socialized system relax some of the rules and regulations

in order for clinics to treat an appropriate, sane number of

treatments and continue to stay open and incentivise their staff?

There are those of us who LOVE what we do. But we still must live

now and retire eventually. I for one don't need a lot now, but would

like to be reasonably comfortable and not do without my needs when I

retire.

Also, looking for niche markets, and pushing oneself harder as a

therapist in a for profit private practice setting to stand out to

the patients/physicians/payors would be harder to foster in the

national healthcare system.

Sorry this is a little stream of conscious, I am about to begin the

PM patient load and have been fielding phone calls.

Lane Blondheim, PT, MT

Active Health and Rehab

Montgomery, AL

> We need national health care. Medicare and Medicaid are

essentially the

> same system. Well-run private practices can be profitable under

these

> systems serving theMedicare population.

>

> 40% of the population in my county do not have heath insurance. It

is

> selfish and self-serving to think about a private practice " loosing

out "

> under an all payor system. People with serious health problems do

not get

> care here. I have treated 4 clients in the past year who were

relatively

> young, had HTN,and could not afford to pay for a doctor's vist.All

of these

> people had significant CVAs.

>

> I have worked with therapists from Ireland and the UK that have

incredible

> respect and autonomy there under there national heath care system

in their

> country of origin. If you offer a level of expertise not found in

the

> national health plan, people will pay out of pocket,if you choose

to do a

> private practice. A win-win with the cash up front!

>

> Kathleen e, PT

>

> Modesto, CA

>

> Effect of National Health Care on Private

Practice

> Physical Therapy Clinics

>

> Dear Group,

>

> This is more of an information gathering post than an information

giving

> post, so I'll get right to it. In my research over the last few

years of

> politics and political agendas, I have come to the conclusion that

allowing

> the government to enact any plan of Nationalized Healthcare -

outside of

> Medicare, Medicaid, and SCHIP as they are right now - would in

effect put

> all of our private practices out of business. I believe that the

lack of

> choices available to the general public, and the government being

in control

> of yet another failing system in this country would destroy

competition in

> our industry, and would be a great benefit to hospital based therapy

> services, but would be terrible for private practice. I don't know

what it

> is like trying to get credentialed with HMO insurance companies

outside of

> Wisconsin, but in our practice, we have been told in no uncertain

terms that

> we will NEVER be allowed in any HMO network as long as there is a

hospital

> based clinic within 20 miles of us.

>

> Consequently, there are at least 4 hospital based clinics within 20

miles of

> our clinic, and all of our attempts to join HMO networks, so that

we might

> be able to cater to a larger range of patients, has ended in a

denial from

> the insurance company for the very reason listed above. With the

government

> possibly taking over Healthcare for everyone, it becomes easy to

imagine

> that they would want to sped as little money as possible in order

to cover

> as many people as possible, and HMO Health Insurance will become

the norm in

> our industry, making it nearly impossible to serve those patients

unless

> they are willing to pay out of pocket. This is severely unlikely,

being

> that they could just go to the hospital based clinic down the block

and get

> " free " Physical Therapy because it's covered under their taxpayer

funded -

> and capped like Medicare - Health plan.

>

> Not only do we have to worry about the HMO issue, but we also have

to worry

> about the hospitals and their bureaucrats being able to charge less

than

> private practices to " the insurance company " than we can because

they have

> so much more revenue to go around to keep them in business, and

keep us out

> of competition just by undercutting our prices.

>

> So, with that out of the way, I'd like to know how some of you are

dealing

> with the prospect of having Nationalized Health Care... By the way,

if you

> can give me good, viable, verifiable reasons why Nationalized

Health Care

> might actually benefit Private Practices, I might be swayed, but as

yet, the

> best argument anyone can come up with is that the cheapest

insurance pool is

> one where everyone is enrolled. I often hear the same poor

arguments, and

> then I look to countries that have had National Health Care

programs for

> years like Great Britain and Canada, who's patients are literally

flying to

> the United States in droves just to get their healthcare NOW

instead of

> having to wait up to 6 months for a CT scan when cancer is the

likely

> diagnosis. In most cases, if a patient has a possible brain cancer

> diagnosis, 6 months could very well be too late. I don't want to

have that

> risk here in this country... it scares me.

>

> Adam Jeschke

> Optimal PT

> Lake Mills, WI

>

>

>

[Guest guest]

Adam -

Thanks for your insights, and raising this topic. I can feel your

anguish and unmet expectations.

You wrote: " There is a Constitutional Amendment that forbids us to

refuse anyone `Health Care'... " . While there may be that expectation by

many of the public, I'd be interested to see which Amendment, and what

language it contains.

Hospitals and physicians do have an expectation to provide lifesaving

care to whomever may present at their Emergency Departments. Beyond that, I

do not believe that services such as rehabilitation in the outpatient

environment are mandated, however.

Once, I heard a speaker assert that " If Health Care is a `right', then

it is the only right which, to be obtained, must be it be taken from another

person. " My understanding of European national health care (Germany,

Switzerland) is that it requires 50% taxation of the worker's pay to provide

it. I'm not sure that all American workers would be happy with that. A

couple of years ago in California, there was actually a strike of

supermarket workers when employers proposed that the individuals absorb

co-pays when accessing healthcare services through their employer-paid

insurance.

Employers themselves rebel at the prospect of 14% increases in their

employee healthcare insurance premiums. They can't remain competitive with

overseas companies with uncontrolled costs. The issue of " what to do " is

not something that we can thoroughly analyze in the internet environment,

but every one of us should understand that something must -- and will --

change. In fact, as we see in this discussion, it already is changing.

Best regards,

Dick Hillyer, PT,DPT, MBA,MSM

Dr. W. Hillyer

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Adam Jeschke

Sent: Thursday, January 17, 2008 12:58 PM

To: PTManager

Subject: Re: Effect of National Health Care on Private Practice

Physical Therapy Clinics

There is a Constitutional Amendment that forbids us to refuse anyone " Health

Care " ... it is " Health Insurance " that people do not have, and that is not

guaranteed by the Constitution, nor is it within the Constitutionally

Granted Powers of Congress to impose such legislation on this country. You

should have taken the $90-120,000 a year job, because you'll be paying more

in taxes - already close to 50% of annual income for our practice - in order

to support the 45 million+ people we have to supply with " free " National

Health Insurance. Let me reiterate.... it is 100% illegal for you, me, or

anyone in the medical profession to turn someone away because they don't

have health insurance. You can inform them of your cash-pay policy, do

pro-bono work as you see fit, but you can't refuse their care outright.

That is guaranteed in the Constitution of the United States of America.

I suppose those of you who support the idea of a national healthcare system

- read:

socialized-single-payer-taxpayer-funded-government-regulated-health-insuranc

e-that-we-can't-afford-in-its-current-state-of-medicare-and-medicaid

- also support the idea of supplying that same health care to illegal

aliens, no matter where they might be from, North, South, East or West...

The current system in place is financially bankrupt right now, just as

Social Security is financially bankrupt, and both programs are taking this

country further into debt with the rest of the world, because we can't

possibly contribute more than is being taken out of the funds to pay for

services. On that note, I'd guess that you also support the idea of

allowing illegal aliens to vote in our elections.

Socialist programs are the fastest way to completely destroy the

infrastructure of a country. The UK is losing money every day because of

their healthcare system, Sweden has all but done away with their Welfare

System, as it nearly bankrupted the entire country. I would expect those of

us in private practice - small business owners especially - would want the

government to stay as far away from our industry as possible. The only good

thing the government can do to improve the economy, get more people to pay

for health insurance and/or healthcare, and bring more business into our

clinics - which should be read as more patients being helped rather than

more revenue, because I honestly don't care about money, but I don't want

the government to take any of it for the benefit of the masses - is to get

out of the way and let nature take its course.

The greatest economic boom in this country was in the early 1980s, when

Reagan was president... he didn't pass any new spending bills, he cut

taxes, he got the government out of the way, and the economy of this country

skyrocketed. It is sad that people have become so used to the government

interfering in everything we do that they've forgotten that the government

is supposed to serve the people, the people aren't supposed to serve the

government, but that's where we are going if things like Nationalized Health

Plans are implemented. We're already slaves to the Federal Reserve, Social

Security, Medicare, and Medicaid, and now you want to add on another 45+

million people because you think people should be guaranteed health

insurance.... Self-imposed slavery is an ugly beast, and we've done it to

ourselves by not putting a check on everything our government feels like

doing this week, and over the last 50-75 years.

Like I said in my first post, it's 100% impossible for our clinic to

participate in any HMO insurance plans in the area because they cater to

hospitals only. I was specifically told that there are no free-standing

physical therapy clinics in the network of one of our local plans, and that

I could apply but we would be denied access to the HMO network because there

is a hospital-owned clinic less than a block away from us. When the

government takes over, I hope you have planned to either see only " Cash "

patients, or have lined up a job at a local hospital-owned clinic, because

unless you are in an area where you have such a huge understaffing of PTs

that every free-standing clinic is already in network with all the local

HMOs, you won't be seeing many insurance patients outside of Medicare.

Heh... you think the therapy cap is bad now, wait until every person (man,

woman, and child) in the country is all in the same network, and the

government can't tax us enough to cover the costs.... that, or the

reimbursement rates will plummet, and we'll be driven out of business

because we just can't afford to pay the rent anymore.

I hope no one takes anything I've said as a personal insult, I just find

that many people who like the idea of Nationalized Health Care, don't

realize that Health Care - not Health Insurance - is already guaranteed in

the Constitution, and once they realize this they often change their tune.

Adam Jeschke

Optimal Physical Therapy, LLC

Lake Mills, WI

On Jan 17, 2008 9:42 AM, Sumesh <brockbridgetherapy@

<mailto:brockbridgetherapy%40yahoo.com> yahoo.com> wrote:

> In reference to Mr. Jeschke's comments I actually believe there are

> advantages and disadvantages in both a socialized healthcare environment

and

> in a capitalistic healthcare environment. The bottom line depends on whom

it

> benefits. It is in the best financial interest of the average consumer to

be

> in an environment where healthcare is delivered in a socialized manner as

in

> most industrialized nations, but it is in the best financial interest of

> myself and other busienss owners/executives (e.g. private practice owners,

> corporate executives (e.g. HealthSouth, Physiotherapy Assoc., etc.),

> hospital executives, SNF owners and executives, Home Health Agency owners

> and executives, contracting agency owners, and physicians who own PT

> practices and CORFs) to do business in capitalistic environments where we

> can " capitalize " on opportunties created by healthcare.

>

> If we don't change our business philosophies and policies, then others

> will. Although, many business owners are willing to offer employment

> opportunities to physical therapists, assistants, athletic trainers,

etc...

> to capitalize on the opportunites described above, few are willing to

share

> ownership. To prevent non-physical therapists from OWNING physical

> therapists and physical therapy assistants we MUST empower our colleagues

> with partnership/ownership opportunites. When we understand and share the

> rewards and losses of owning a physical therapy business, only then we

will

> be able to truely understand the implications associated with non-physical

> therapists having control of our present and future (e.g. impact of

> hospital based clinics).

>

> Dr. Sumesh , PT, DPT, OCS

>

> P.S. Most of my patients wait longer than expected before being able to

> see specialists or undergo imaging studies, and a few become non-compliant

> with their prescribed medications due to cost and other insurance issues.

In

> addition, although I have family and friends in many counties with

> socialized healthcare none of them have expressed a desire to come to the

US

> for healthcare.

>

>

> Effect of National Health Care on Private Practice

> Physical Therapy Clinics

>

> Dear Group,

>

> This is more of an information gathering post than an information giving

> post, so I'll get right to it. In my research over the last few years of

> politics and political agendas, I have come to the conclusion that

> allowing

> the government to enact any plan of Nationalized Healthcare - outside of

> Medicare, Medicaid, and SCHIP as they are right now - would in effect put

> all of our private practices out of business. I believe that the lack of

> choices available to the general public, and the government being in

> control

> of yet another failing system in this country would destroy competition in

> our industry, and would be a great benefit to hospital based therapy

> services, but would be terrible for private practice. I don't know what it

> is like trying to get credentialed with HMO insurance companies outside of

> Wisconsin, but in our practice, we have been told in no uncertain terms

> that

> we will NEVER be allowed in any HMO network as long as there is a hospital

> based clinic within 20 miles of us.

>

> Consequently, there are at least 4 hospital based clinics within 20 miles

> of

> our clinic, and all of our attempts to join HMO networks, so that we might

> be able to cater to a larger range of patients, has ended in a denial from

> the insurance company for the very reason listed above. With the

> government

> possibly taking over Healthcare for everyone, it becomes easy to imagine

> that they would want to sped as little money as possible in order to cover

> as many people as possible, and HMO Health Insurance will become the norm

> in

> our industry, making it nearly impossible to serve those patients unless

> they are willing to pay out of pocket. This is severely unlikely, being

> that they could just go to the hospital based clinic down the block and

> get

> " free " Physical Therapy because it's covered under their taxpayer funded -

> and capped like Medicare - Health plan.

>

> Not only do we have to worry about the HMO issue, but we also have to

> worry

> about the hospitals and their bureaucrats being able to charge less than

> private practices to " the insurance company " than we can because they have

> so much more revenue to go around to keep them in business, and keep us

> out

> of competition just by undercutting our prices.

>

> So, with that out of the way, I'd like to know how some of you are dealing

> with the prospect of having Nationalized Health Care... By the way, if you

> can give me good, viable, verifiable reasons why Nationalized Health Care

> might actually benefit Private Practices, I might be swayed, but as yet,

> the

> best argument anyone can come up with is that the cheapest insurance pool

> is

> one where everyone is enrolled. I often hear the same poor arguments, and

> then I look to countries that have had National Health Care programs for

> years like Great Britain and Canada, who's patients are literally flying

> to

> the United States in droves just to get their healthcare NOW instead of

> having to wait up to 6 months for a CT scan when cancer is the likely

> diagnosis. In most cases, if a patient has a possible brain cancer

> diagnosis, 6 months could very well be too late. I don't want to have that

> risk here in this country... it scares me.

>

> Adam Jeschke

> Optimal PT

> Lake Mills, WI

>

>

>

[Guest guest]

Adam, could you show us that Constitutional Amendment to which you're

referring?

Could you be referring to EMTALA?

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

In other words, I'm pretty sure that EMTALA ensures that we provide

folks with screening/emergency treatment/stabilization without regard

to ability to pay... but I've never heard of the Amendment (or

anything else) mandating us to provide anything beyond Emergency care.

Just wondering, Thanks for the discussion-

Ty Keeter DPT, MHA

Boulder, Colorado

>

> > In reference to Mr. Jeschke's comments I actually believe there are

> > advantages and disadvantages in both a socialized healthcare

environment and

> > in a capitalistic healthcare environment. The bottom line depends

on whom it

> > benefits. It is in the best financial interest of the average

consumer to be

> > in an environment where healthcare is delivered in a socialized

manner as in

> > most industrialized nations, but it is in the best financial

interest of

> > myself and other busienss owners/executives (e.g. private practice

owners,

> > corporate executives (e.g. HealthSouth, Physiotherapy Assoc., etc.),

> > hospital executives, SNF owners and executives, Home Health Agency

owners

> > and executives, contracting agency owners, and physicians who own PT

> > practices and CORFs) to do business in capitalistic environments

where we

> > can " capitalize " on opportunties created by healthcare.

> >

> > If we don't change our business philosophies and policies, then others

> > will. Although, many business owners are willing to offer employment

> > opportunities to physical therapists, assistants, athletic

trainers, etc...

> > to capitalize on the opportunites described above, few are willing

to share

> > ownership. To prevent non-physical therapists from OWNING physical

> > therapists and physical therapy assistants we MUST empower our

colleagues

> > with partnership/ownership opportunites. When we understand and

share the

> > rewards and losses of owning a physical therapy business, only

then we will

> > be able to truely understand the implications associated with

non-physical

> > therapists having control of our present and future (e.g. impact of

> > hospital based clinics).

> >

> > Dr. Sumesh , PT, DPT, OCS

> >

> > P.S. Most of my patients wait longer than expected before being

able to

> > see specialists or undergo imaging studies, and a few become

non-compliant

> > with their prescribed medications due to cost and other insurance

issues. In

> > addition, although I have family and friends in many counties with

> > socialized healthcare none of them have expressed a desire to come

to the US

> > for healthcare.

> >

> >

> > Effect of National Health Care on Private

Practice

> > Physical Therapy Clinics

> >

> > Dear Group,

> >

> > This is more of an information gathering post than an information

giving

> > post, so I'll get right to it. In my research over the last few

years of

> > politics and political agendas, I have come to the conclusion that

> > allowing

> > the government to enact any plan of Nationalized Healthcare -

outside of

> > Medicare, Medicaid, and SCHIP as they are right now - would in

effect put

> > all of our private practices out of business. I believe that the

lack of

> > choices available to the general public, and the government being in

> > control

> > of yet another failing system in this country would destroy

competition in

> > our industry, and would be a great benefit to hospital based therapy

> > services, but would be terrible for private practice. I don't know

what it

> > is like trying to get credentialed with HMO insurance companies

outside of

> > Wisconsin, but in our practice, we have been told in no uncertain

terms

> > that

> > we will NEVER be allowed in any HMO network as long as there is a

hospital

> > based clinic within 20 miles of us.

> >

> > Consequently, there are at least 4 hospital based clinics within

20 miles

> > of

> > our clinic, and all of our attempts to join HMO networks, so that

we might

> > be able to cater to a larger range of patients, has ended in a

denial from

> > the insurance company for the very reason listed above. With the

> > government

> > possibly taking over Healthcare for everyone, it becomes easy to

imagine

> > that they would want to sped as little money as possible in order

to cover

> > as many people as possible, and HMO Health Insurance will become

the norm

> > in

> > our industry, making it nearly impossible to serve those patients

unless

> > they are willing to pay out of pocket. This is severely unlikely,

being

> > that they could just go to the hospital based clinic down the

block and

> > get

> > " free " Physical Therapy because it's covered under their taxpayer

funded -

> > and capped like Medicare - Health plan.

> >

> > Not only do we have to worry about the HMO issue, but we also have to

> > worry

> > about the hospitals and their bureaucrats being able to charge

less than

> > private practices to " the insurance company " than we can because

they have

> > so much more revenue to go around to keep them in business, and

keep us

> > out

> > of competition just by undercutting our prices.

> >

> > So, with that out of the way, I'd like to know how some of you are

dealing

> > with the prospect of having Nationalized Health Care... By the

way, if you

> > can give me good, viable, verifiable reasons why Nationalized

Health Care

> > might actually benefit Private Practices, I might be swayed, but

as yet,

> > the

> > best argument anyone can come up with is that the cheapest

insurance pool

> > is

> > one where everyone is enrolled. I often hear the same poor

arguments, and

> > then I look to countries that have had National Health Care

programs for

> > years like Great Britain and Canada, who's patients are literally

flying

> > to

> > the United States in droves just to get their healthcare NOW

instead of

> > having to wait up to 6 months for a CT scan when cancer is the likely

> > diagnosis. In most cases, if a patient has a possible brain cancer

> > diagnosis, 6 months could very well be too late. I don't want to

have that

> > risk here in this country... it scares me.

> >

> > Adam Jeschke

> > Optimal PT

> > Lake Mills, WI

> >

> >

> >

[Guest guest]

Dick,

I beg your pardon, and everyone else who has been reading this thread.

There is no actual Amendment to the Constitution that forbids us to refuse

anyone " Health Care " , however it is illegal in this country to refuse

" emergency medical attention due to lack of insurance " . So, no... it isn't

necessarily required of us to cater to every patient who walks into the

door, whether they carry insurance or not, but it does seem like our moral

responsibility that every patient be given a fair chance to choose for

themselves whether they go to another provider or pay cash out of pocket to

see you in particular.

Your comment about the speaker who said that " If Health Care is a 'right',

then it is the only right which, to be obtained, must be taken from another

person. " is the reason I can't and will never support a National Health Care

System as proposed by the Democrats in congress and the Democratic

presidential hopefuls. As I already alluded to in an earlier post, we're

already close to the 50% mark on taxes as it is, right now I believe my wife

and I paid about 38% of our adjusted income last year in taxes.

In Denmark, everyone makes the equivalent of $14,000 a year, no matter how

much work they do... Citizens who only make $7,000 a year are given another

$7,000 by the government, which was taken from those in the country who make

more than $21,000 a year. This eliminates competition, and without

competition, what motivation is there to do better than your former

competitor? If people in this country know that the ones who make the money

will be paying for their Health Insurance, what motivation will those people

have to go out and get a job so they can contribute to their own Health

Insurance fund. There is also no way to control spending in a Nationalized

Health Care plan, a wonderful example made by Wilkow, in a country

where everyone is in the same health insurance pool, how do you tell someone

to eat better so they will lose weight? Or tell someone they can't smoke

because it will cause lung cancer? You can't very well tell them you'll

suspend their insurance coverage, because everyone qualifies, no matter what

their health or financial status. Nationalized Health Care will destroy the

economic AND health benefit to a free market insurance system, because as it

stands right now, a high risk, obese cancer patient pays more for insurance

coverage than someone who never gets sick, never smoked, exercises daily,

and is physically fit. In a Nationalized plan, everyone will pay the same

amount, regardless of their financial or health status, and we'll have

millions of people abusing the " free " system just because its free.

We had an employee from Taiwan for a couple months, and she explained that

anytime someone catches a cold, sneezes, cries, or farts, they go directly

to the emergency room, which costs about $4.00 per visit. They get their

medicine, and go about their business. Can you imagine if we did that

here? Can you imagine if you only got paid $4.00 per patient visit, no

matter how long you were attending to that patient? We're in this business

because we like to help people... but you need to at least make enough to

live on... Private practice will go the way of the dinosaurs in short order

if any of these plans make it onto the books. The best thing the government

can do for the country is take a step back and watch the action... while

getting rid of as many taxes as possible. I don't know about you, but if

our sovereignty is at stake, I'll be contributing money to our military hand

over fist, without the government stepping in and telling me how much I have

to donate to save our great nation. Everyone here should go re-read the

Constitution - if you've read it before - and see where we've gone in this

country, with allowing the government to turn us into slaves for its debt.

Adam Jeschke

Optimal Physical Therapy, LLC

Lake Mills, WI

> Adam -

> Thanks for your insights, and raising this topic. I can feel your

> anguish and unmet expectations.

>

> You wrote: " There is a Constitutional Amendment that forbids us to

> refuse anyone `Health Care'... " . While there may be that expectation by

> many of the public, I'd be interested to see which Amendment, and what

> language it contains.

>

> Hospitals and physicians do have an expectation to provide lifesaving

> care to whomever may present at their Emergency Departments. Beyond that,

> I

> do not believe that services such as rehabilitation in the outpatient

> environment are mandated, however.

>

> Once, I heard a speaker assert that " If Health Care is a `right', then

> it is the only right which, to be obtained, must be it be taken from

> another

> person. " My understanding of European national health care (Germany,

> Switzerland) is that it requires 50% taxation of the worker's pay to

> provide

> it. I'm not sure that all American workers would be happy with that. A

> couple of years ago in California, there was actually a strike of

> supermarket workers when employers proposed that the individuals absorb

> co-pays when accessing healthcare services through their employer-paid

> insurance.

>

> Employers themselves rebel at the prospect of 14% increases in their

> employee healthcare insurance premiums. They can't remain competitive with

> overseas companies with uncontrolled costs. The issue of " what to do " is

> not something that we can thoroughly analyze in the internet environment,

> but every one of us should understand that something must -- and will --

> change. In fact, as we see in this discussion, it already is changing.

>

> Best regards,

> Dick Hillyer, PT,DPT, MBA,MSM

>

> Dr. W. Hillyer

> Hillyer Consulting

> Cape Coral, FL 33914

>

> _____

>

> From: PTManager <PTManager%40yahoogroups.com> [mailto:

> PTManager <PTManager%40yahoogroups.com>] On Behalf

> Of Adam Jeschke

> Sent: Thursday, January 17, 2008 12:58 PM

> To: PTManager <PTManager%40yahoogroups.com>

> Subject: Re: Effect of National Health Care on Private

> Practice

> Physical Therapy Clinics

>

> There is a Constitutional Amendment that forbids us to refuse anyone

> " Health

> Care " ... it is " Health Insurance " that people do not have, and that is not

> guaranteed by the Constitution, nor is it within the Constitutionally

> Granted Powers of Congress to impose such legislation on this country. You

> should have taken the $90-120,000 a year job, because you'll be paying

> more

> in taxes - already close to 50% of annual income for our practice - in

> order

> to support the 45 million+ people we have to supply with " free " National

> Health Insurance. Let me reiterate.... it is 100% illegal for you, me, or

> anyone in the medical profession to turn someone away because they don't

> have health insurance. You can inform them of your cash-pay policy, do

> pro-bono work as you see fit, but you can't refuse their care outright.

> That is guaranteed in the Constitution of the United States of America.

>

> I suppose those of you who support the idea of a national healthcare

> system

> - read:

>

> socialized-single-payer-taxpayer-funded-government-regulated-health-insuranc

> e-that-we-can't-afford-in-its-current-state-of-medicare-and-medicaid

> - also support the idea of supplying that same health care to illegal

> aliens, no matter where they might be from, North, South, East or West...

> The current system in place is financially bankrupt right now, just as

> Social Security is financially bankrupt, and both programs are taking this

> country further into debt with the rest of the world, because we can't

> possibly contribute more than is being taken out of the funds to pay for

> services. On that note, I'd guess that you also support the idea of

> allowing illegal aliens to vote in our elections.

>

> Socialist programs are the fastest way to completely destroy the

> infrastructure of a country. The UK is losing money every day because of

> their healthcare system, Sweden has all but done away with their Welfare

> System, as it nearly bankrupted the entire country. I would expect those

> of

> us in private practice - small business owners especially - would want the

> government to stay as far away from our industry as possible. The only

> good

> thing the government can do to improve the economy, get more people to pay

> for health insurance and/or healthcare, and bring more business into our

> clinics - which should be read as more patients being helped rather than

> more revenue, because I honestly don't care about money, but I don't want

> the government to take any of it for the benefit of the masses - is to get

> out of the way and let nature take its course.

>

> The greatest economic boom in this country was in the early 1980s, when

> Reagan was president... he didn't pass any new spending bills, he

> cut

> taxes, he got the government out of the way, and the economy of this

> country

> skyrocketed. It is sad that people have become so used to the government

> interfering in everything we do that they've forgotten that the government

> is supposed to serve the people, the people aren't supposed to serve the

> government, but that's where we are going if things like Nationalized

> Health

> Plans are implemented. We're already slaves to the Federal Reserve, Social

> Security, Medicare, and Medicaid, and now you want to add on another 45+

> million people because you think people should be guaranteed health

> insurance.... Self-imposed slavery is an ugly beast, and we've done it to

> ourselves by not putting a check on everything our government feels like

> doing this week, and over the last 50-75 years.

>

> Like I said in my first post, it's 100% impossible for our clinic to

> participate in any HMO insurance plans in the area because they cater to

> hospitals only. I was specifically told that there are no free-standing

> physical therapy clinics in the network of one of our local plans, and

> that

> I could apply but we would be denied access to the HMO network because

> there

> is a hospital-owned clinic less than a block away from us. When the

> government takes over, I hope you have planned to either see only " Cash "

> patients, or have lined up a job at a local hospital-owned clinic, because

> unless you are in an area where you have such a huge understaffing of PTs

> that every free-standing clinic is already in network with all the local

> HMOs, you won't be seeing many insurance patients outside of Medicare.

> Heh... you think the therapy cap is bad now, wait until every person (man,

> woman, and child) in the country is all in the same network, and the

> government can't tax us enough to cover the costs.... that, or the

> reimbursement rates will plummet, and we'll be driven out of business

> because we just can't afford to pay the rent anymore.

>

> I hope no one takes anything I've said as a personal insult, I just find

> that many people who like the idea of Nationalized Health Care, don't

> realize that Health Care - not Health Insurance - is already guaranteed in

> the Constitution, and once they realize this they often change their tune.

>

> Adam Jeschke

> Optimal Physical Therapy, LLC

> Lake Mills, WI

>

>

> On Jan 17, 2008 9:42 AM, Sumesh <brockbridgetherapy@

> <mailto:brockbridgetherapy%40yahoo.com> yahoo.com> wrote:

>

> > In reference to Mr. Jeschke's comments I actually believe there are

> > advantages and disadvantages in both a socialized healthcare environment

> and

> > in a capitalistic healthcare environment. The bottom line depends on

> whom

> it

> > benefits. It is in the best financial interest of the average consumer

> to

> be

> > in an environment where healthcare is delivered in a socialized manner

> as

> in

> > most industrialized nations, but it is in the best financial interest of

> > myself and other busienss owners/executives (e.g. private practice

> owners,

> > corporate executives (e.g. HealthSouth, Physiotherapy Assoc., etc.),

> > hospital executives, SNF owners and executives, Home Health Agency

> owners

> > and executives, contracting agency owners, and physicians who own PT

> > practices and CORFs) to do business in capitalistic environments where

> we

> > can " capitalize " on opportunties created by healthcare.

> >

> > If we don't change our business philosophies and policies, then others

> > will. Although, many business owners are willing to offer employment

> > opportunities to physical therapists, assistants, athletic trainers,

> etc...

> > to capitalize on the opportunites described above, few are willing to

> share

> > ownership. To prevent non-physical therapists from OWNING physical

> > therapists and physical therapy assistants we MUST empower our

> colleagues

> > with partnership/ownership opportunites. When we understand and share

> the

> > rewards and losses of owning a physical therapy business, only then we

> will

> > be able to truely understand the implications associated with

> non-physical

> > therapists having control of our present and future (e.g. impact of

> > hospital based clinics).

> >

> > Dr. Sumesh , PT, DPT, OCS

> >

> > P.S. Most of my patients wait longer than expected before being able to

> > see specialists or undergo imaging studies, and a few become

> non-compliant

> > with their prescribed medications due to cost and other insurance

> issues.

> In

> > addition, although I have family and friends in many counties with

> > socialized healthcare none of them have expressed a desire to come to

> the

> US

> > for healthcare.

> >

> >

> > Effect of National Health Care on Private Practice

> > Physical Therapy Clinics

> >

> > Dear Group,

> >

> > This is more of an information gathering post than an information giving

> > post, so I'll get right to it. In my research over the last few years of

> > politics and political agendas, I have come to the conclusion that

> > allowing

> > the government to enact any plan of Nationalized Healthcare - outside of

> > Medicare, Medicaid, and SCHIP as they are right now - would in effect

> put

> > all of our private practices out of business. I believe that the lack of

> > choices available to the general public, and the government being in

> > control

> > of yet another failing system in this country would destroy competition

> in

> > our industry, and would be a great benefit to hospital based therapy

> > services, but would be terrible for private practice. I don't know what

> it

> > is like trying to get credentialed with HMO insurance companies outside

> of

> > Wisconsin, but in our practice, we have been told in no uncertain terms

> > that

> > we will NEVER be allowed in any HMO network as long as there is a

> hospital

> > based clinic within 20 miles of us.

> >

> > Consequently, there are at least 4 hospital based clinics within 20

> miles

> > of

> > our clinic, and all of our attempts to join HMO networks, so that we

> might

> > be able to cater to a larger range of patients, has ended in a denial

> from

> > the insurance company for the very reason listed above. With the

> > government

> > possibly taking over Healthcare for everyone, it becomes easy to imagine

> > that they would want to sped as little money as possible in order to

> cover

> > as many people as possible, and HMO Health Insurance will become the

> norm

> > in

> > our industry, making it nearly impossible to serve those patients unless

> > they are willing to pay out of pocket. This is severely unlikely, being

> > that they could just go to the hospital based clinic down the block and

> > get

> > " free " Physical Therapy because it's covered under their taxpayer funded

> -

> > and capped like Medicare - Health plan.

> >

> > Not only do we have to worry about the HMO issue, but we also have to

> > worry

> > about the hospitals and their bureaucrats being able to charge less than

> > private practices to " the insurance company " than we can because they

> have

> > so much more revenue to go around to keep them in business, and keep us

> > out

> > of competition just by undercutting our prices.

> >

> > So, with that out of the way, I'd like to know how some of you are

> dealing

> > with the prospect of having Nationalized Health Care... By the way, if

> you

> > can give me good, viable, verifiable reasons why Nationalized Health

> Care

> > might actually benefit Private Practices, I might be swayed, but as yet,

> > the

> > best argument anyone can come up with is that the cheapest insurance

> pool

> > is

> > one where everyone is enrolled. I often hear the same poor arguments,

> and

> > then I look to countries that have had National Health Care programs for

> > years like Great Britain and Canada, who's patients are literally flying

> > to

> > the United States in droves just to get their healthcare NOW instead of

> > having to wait up to 6 months for a CT scan when cancer is the likely

> > diagnosis. In most cases, if a patient has a possible brain cancer

> > diagnosis, 6 months could very well be too late. I don't want to have

> that

> > risk here in this country... it scares me.

> >

> > Adam Jeschke

> > Optimal PT

> > Lake Mills, WI

> >

> >

> >

[Guest guest]

I agree wholeheartedly that it is selfish not to enable others to have access to

services. But, is it the government's place to provide for such services or

should that responsibility lie within the community. I believe the latter.

Before the days of health insurance everyone paid for their own healthcare and

those who couldn't afford it were served by the community. Pro bono or barter,

etc. The question is truly, is it the responsibility of the government? And is

it truly an inalienable right such as freedom of speach or should people strive

to actually pay their way and then grace and compassion within the community

fill the gap? What is the real and overarching purpose of government. I think

it would behoove us to look way back at the original writings of the founding

fathers to understand before we make a decision for Socialized medicine.

Carroll , PT

Chattanooga, TN

Effect of National Health Care on Private Practice

Physical Therapy Clinics

Dear Group,

This is more of an information gathering post than an information giving

post, so I'll get right to it. In my research over the last few years of

politics and political agendas, I have come to the conclusion that allowing

the government to enact any plan of Nationalized Healthcare - outside of

Medicare, Medicaid, and SCHIP as they are right now - would in effect put

all of our private practices out of business. I believe that the lack of

choices available to the general public, and the government being in control

of yet another failing system in this country would destroy competition in

our industry, and would be a great benefit to hospital based therapy

services, but would be terrible for private practice. I don't know what it

is like trying to get credentialed with HMO insurance companies outside of

Wisconsin, but in our practice, we have been told in no uncertain terms that

we will NEVER be allowed in any HMO network as long as there is a hospital

based clinic within 20 miles of us.

Consequently, there are at least 4 hospital based clinics within 20 miles of

our clinic, and all of our attempts to join HMO networks, so that we might

be able to cater to a larger range of patients, has ended in a denial from

the insurance company for the very reason listed above. With the government

possibly taking over Healthcare for everyone, it becomes easy to imagine

that they would want to sped as little money as possible in order to cover

as many people as possible, and HMO Health Insurance will become the norm in

our industry, making it nearly impossible to serve those patients unless

they are willing to pay out of pocket. This is severely unlikely, being

that they could just go to the hospital based clinic down the block and get

" free " Physical Therapy because it's covered under their taxpayer funded -

and capped like Medicare - Health plan.

Not only do we have to worry about the HMO issue, but we also have to worry

about the hospitals and their bureaucrats being able to charge less than

private practices to " the insurance company " than we can because they have

so much more revenue to go around to keep them in business, and keep us out

of competition just by undercutting our prices.

So, with that out of the way, I'd like to know how some of you are dealing

with the prospect of having Nationalized Health Care... By the way, if you

can give me good, viable, verifiable reasons why Nationalized Health Care

might actually benefit Private Practices, I might be swayed, but as yet, the

best argument anyone can come up with is that the cheapest insurance pool is

one where everyone is enrolled. I often hear the same poor arguments, and

then I look to countries that have had National Health Care programs for

years like Great Britain and Canada, who's patients are literally flying to

the United States in droves just to get their healthcare NOW instead of

having to wait up to 6 months for a CT scan when cancer is the likely

diagnosis. In most cases, if a patient has a possible brain cancer

diagnosis, 6 months could very well be too late. I don't want to have that

risk here in this country... it scares me.

Adam Jeschke

Optimal PT

Lake Mills, WI

[Guest guest]

I couldn't have said it better myself... Jefferson would turn in his

grave if we ever enacted Socialized Medicine, because it would be the

opposite of what the founding fathers vision was for this country. We

declared our independence from England because of a 4% tax on our

communities.... and now we're inviting a 50% tax on our income so we can

provide health insurance to everyone who is too lazy to get up and get a job

so they can pay for their own health care. I don't want to pay for your

health, mine is much more important... You want to trade my services for

yours, great, but don't expect any handouts... the problem is, everyone in

this country has become so used to the government getting their grubby

little hands into everyone else's cookie jars, that they don't see it as an

evil deed anymore.... rather, they see it as " the norm " , and what's a little

bit more of " the norm " going to do? If you give a man a fish, he'll eat for

a day... if you teach the man to fish, he'll eat for a lifetime... It's not

just a biblical quote, it holds true in every part of this country, from the

richest computer mogul, down to the poorest bum on the street. The sloth in

this country makes me sick... The apathy... ugh... it's disgusting... People

would rather be taken care of by their government than take care of

themselves. " We The People " of the Republic have become " We The Sheeple " of

the Democracy... it's truly frightening... And before anyone says anything

about my last comment, please make sure you know the difference between

Republic and Democracy.... the latter of which this country has never been,

and should never be allowed to become.

Adam Jeschke

Optimal Physical Therapy

Lake Mills, WI

On Jan 17, 2008 9:42 PM, Carroll L

wrote:

> I agree wholeheartedly that it is selfish not to enable others to have

> access to services. But, is it the government's place to provide for such

> services or should that responsibility lie within the community. I believe

> the latter. Before the days of health insurance everyone paid for their own

> healthcare and those who couldn't afford it were served by the community.

> Pro bono or barter, etc. The question is truly, is it the responsibility of

> the government? And is it truly an inalienable right such as freedom of

> speach or should people strive to actually pay their way and then grace and

> compassion within the community fill the gap? What is the real and

> overarching purpose of government. I think it would behoove us to look way

> back at the original writings of the founding fathers to understand before

> we make a decision for Socialized medicine.

>

> Carroll , PT

> Chattanooga, TN

>

>

> Effect of National Health Care on Private Practice

> Physical Therapy Clinics

>

> Dear Group,

>

> This is more of an information gathering post than an information giving

> post, so I'll get right to it. In my research over the last few years of

> politics and political agendas, I have come to the conclusion that

> allowing

> the government to enact any plan of Nationalized Healthcare - outside of

> Medicare, Medicaid, and SCHIP as they are right now - would in effect put

> all of our private practices out of business. I believe that the lack of

> choices available to the general public, and the government being in

> control

> of yet another failing system in this country would destroy competition in

> our industry, and would be a great benefit to hospital based therapy

> services, but would be terrible for private practice. I don't know what it

> is like trying to get credentialed with HMO insurance companies outside of

> Wisconsin, but in our practice, we have been told in no uncertain terms

> that

> we will NEVER be allowed in any HMO network as long as there is a hospital

> based clinic within 20 miles of us.

>

> Consequently, there are at least 4 hospital based clinics within 20 miles

> of

> our clinic, and all of our attempts to join HMO networks, so that we might

> be able to cater to a larger range of patients, has ended in a denial from

> the insurance company for the very reason listed above. With the

> government

> possibly taking over Healthcare for everyone, it becomes easy to imagine

> that they would want to sped as little money as possible in order to cover

> as many people as possible, and HMO Health Insurance will become the norm

> in

> our industry, making it nearly impossible to serve those patients unless

> they are willing to pay out of pocket. This is severely unlikely, being

> that they could just go to the hospital based clinic down the block and

> get

> " free " Physical Therapy because it's covered under their taxpayer funded -

> and capped like Medicare - Health plan.

>

> Not only do we have to worry about the HMO issue, but we also have to

> worry

> about the hospitals and their bureaucrats being able to charge less than

> private practices to " the insurance company " than we can because they have

> so much more revenue to go around to keep them in business, and keep us

> out

> of competition just by undercutting our prices.

>

> So, with that out of the way, I'd like to know how some of you are dealing

> with the prospect of having Nationalized Health Care... By the way, if you

> can give me good, viable, verifiable reasons why Nationalized Health Care

> might actually benefit Private Practices, I might be swayed, but as yet,

> the

> best argument anyone can come up with is that the cheapest insurance pool

> is

> one where everyone is enrolled. I often hear the same poor arguments, and

> then I look to countries that have had National Health Care programs for

> years like Great Britain and Canada, who's patients are literally flying

> to

> the United States in droves just to get their healthcare NOW instead of

> having to wait up to 6 months for a CT scan when cancer is the likely

> diagnosis. In most cases, if a patient has a possible brain cancer

> diagnosis, 6 months could very well be too late. I don't want to have that

> risk here in this country... it scares me.

>

> Adam Jeschke

> Optimal PT

> Lake Mills, WI

>

>

>

[Guest guest]

Now this is an interesting thread! In a class I teach each spring I

have two small groups of PT students debate National Health Insurance

(NHI), with one group being PRO and one being CON. It always gets

the entire class stirred up. It is interesting to see how classes of

20-30 students who are close friends can divide so quickly (even

those in the audience and not just the groups debating). Is it any

wonder why a country with 300 million people cannot come to a

conclusion on this question when 20-30 PT students who like each

other cannot either?

One point that I wanted to make about your original post, Adam, is

this. Your example about being locked out of the HMO contracts has

nothing to do with the government. That is our market system in

action. A private corporation (the insurer) has decided to only

allow certain providers in their network. As a private corporation,

that is their perogative. Just as it is your perogative as a

provider not to accept an insurer's contract, it is the insurer's

perogative not to offer you one. Maybe I am not interpreting your

intent correctly, but in your example our private market system is

the one locking you out, whereas Medicare allows every provider in.

As a result, I don't understand why you are advocating for a market

system versus government system since the market system is the one

mistreating you now per your example.

As the other posts have pointed out, there are legitimate concerns

about government sponsored health care (can anyone say " 10% Medicare

fee schedule reduction " and " Part B caps " ?), but you have to admit

that there are inequities in our market based system also. At least

Medicare covers everyone over 65, whereas insurers get to choose who

they sign contracts with.

Your other point about sick people paying the same premiums as well

people is interesting also. When risk is spread over large

populations that is called " community rating " so that the people who

don't use health services (or use them less) help pay for those who

do, then when you need health care, others help pay for yours. What

we have now is " experience rating " that blossomed in the heyday of

managed care. With this premiums charged to employers and their

employees are based upon the health history of their employees and

not on the entire community in which they exist. That means Business

A with generally healthy employees will pay less in premiums than

Business B with the same demographics but with a few employees with

cancer, AIDS, MS, or other high cost diseases (or who just use

regular health services more). Thay may seem fair to you, but what

if you are healthy and working for company B versus A? Your premiums

will be higher, meaning your community rating is now within your own

company rather than throughout society. That increases your risk of

higher premiums or loss of insurance based on the health of just your

coworkers rather than a larger insurance pool of the entire

community.

The option for those who do not want to share risk with others is to

forego insurance altogether, therby exposing themselves to their own

health risk, and with healthcare costs being so high, that is a

significant risk indeed. If you chose to take on that risk yourself

knowing full well the consequences of doing so, then a hospital or PT

clinic or any other such entity should not have to write it off, you

should pay what you owe. We see this in other sectors, don't we? If

I choose to forego homeowner's insurance and my roof is destroyed by

hail damage, how many roofing companies do you know of that will

write it off or give me a 50-75% discount right off the top just

because I don't have insurance?

Any wonder why those PT students struggle with the NHI debate?

Mark Dwyer, PT, MHA

Olathe, Kansas

markdwyer87@...

>

> > In reference to Mr. Jeschke's comments I actually believe there

are

> > advantages and disadvantages in both a socialized healthcare

environment and

> > in a capitalistic healthcare environment. The bottom line depends

on whom it

> > benefits. It is in the best financial interest of the average

consumer to be

> > in an environment where healthcare is delivered in a socialized

manner as in

> > most industrialized nations, but it is in the best financial

interest of

> > myself and other busienss owners/executives (e.g. private

practice owners,

> > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

etc.),

> > hospital executives, SNF owners and executives, Home Health

Agency owners

> > and executives, contracting agency owners, and physicians who own

PT

> > practices and CORFs) to do business in capitalistic environments

where we

> > can " capitalize " on opportunties created by healthcare.

> >

> > If we don't change our business philosophies and policies, then

others

> > will. Although, many business owners are willing to offer

employment

> > opportunities to physical therapists, assistants, athletic

trainers, etc...

> > to capitalize on the opportunites described above, few are

willing to share

> > ownership. To prevent non-physical therapists from OWNING physical

> > therapists and physical therapy assistants we MUST empower our

colleagues

> > with partnership/ownership opportunites. When we understand and

share the

> > rewards and losses of owning a physical therapy business, only

then we will

> > be able to truely understand the implications associated with non-

physical

> > therapists having control of our present and future (e.g. impact

of

> > hospital based clinics).

> >

> > Dr. Sumesh , PT, DPT, OCS

> >

> > P.S. Most of my patients wait longer than expected before being

able to

> > see specialists or undergo imaging studies, and a few become non-

compliant

> > with their prescribed medications due to cost and other insurance

issues. In

> > addition, although I have family and friends in many counties with

> > socialized healthcare none of them have expressed a desire to

come to the US

> > for healthcare.

> >

> >

> > Effect of National Health Care on Private

Practice

> > Physical Therapy Clinics

> >

> > Dear Group,

> >

> > This is more of an information gathering post than an information

giving

> > post, so I'll get right to it. In my research over the last few

years of

> > politics and political agendas, I have come to the conclusion that

> > allowing

> > the government to enact any plan of Nationalized Healthcare -

outside of

> > Medicare, Medicaid, and SCHIP as they are right now - would in

effect put

> > all of our private practices out of business. I believe that the

lack of

> > choices available to the general public, and the government being

in

> > control

> > of yet another failing system in this country would destroy

competition in

> > our industry, and would be a great benefit to hospital based

therapy

> > services, but would be terrible for private practice. I don't

know what it

> > is like trying to get credentialed with HMO insurance companies

outside of

> > Wisconsin, but in our practice, we have been told in no uncertain

terms

> > that

> > we will NEVER be allowed in any HMO network as long as there is a

hospital

> > based clinic within 20 miles of us.

> >

> > Consequently, there are at least 4 hospital based clinics within

20 miles

> > of

> > our clinic, and all of our attempts to join HMO networks, so that

we might

> > be able to cater to a larger range of patients, has ended in a

denial from

> > the insurance company for the very reason listed above. With the

> > government

> > possibly taking over Healthcare for everyone, it becomes easy to

imagine

> > that they would want to sped as little money as possible in order

to cover

> > as many people as possible, and HMO Health Insurance will become

the norm

> > in

> > our industry, making it nearly impossible to serve those patients

unless

> > they are willing to pay out of pocket. This is severely unlikely,

being

> > that they could just go to the hospital based clinic down the

block and

> > get

> > " free " Physical Therapy because it's covered under their taxpayer

funded -

> > and capped like Medicare - Health plan.

> >

> > Not only do we have to worry about the HMO issue, but we also

have to

> > worry

> > about the hospitals and their bureaucrats being able to charge

less than

> > private practices to " the insurance company " than we can because

they have

> > so much more revenue to go around to keep them in business, and

keep us

> > out

> > of competition just by undercutting our prices.

> >

> > So, with that out of the way, I'd like to know how some of you

are dealing

> > with the prospect of having Nationalized Health Care... By the

way, if you

> > can give me good, viable, verifiable reasons why Nationalized

Health Care

> > might actually benefit Private Practices, I might be swayed, but

as yet,

> > the

> > best argument anyone can come up with is that the cheapest

insurance pool

> > is

> > one where everyone is enrolled. I often hear the same poor

arguments, and

> > then I look to countries that have had National Health Care

programs for

> > years like Great Britain and Canada, who's patients are literally

flying

> > to

> > the United States in droves just to get their healthcare NOW

instead of

> > having to wait up to 6 months for a CT scan when cancer is the

likely

> > diagnosis. In most cases, if a patient has a possible brain cancer

> > diagnosis, 6 months could very well be too late. I don't want to

have that

> > risk here in this country... it scares me.

> >

> > Adam Jeschke

> > Optimal PT

> > Lake Mills, WI

> >

> >

> >

[Guest guest]

One of the more successful programs we have for good coverage is Medicare.

Our form of socialzed medicine.

Insurance for healthcare is dependent on employment in the US. Most working

class people do not get this benefit. We are already paying for their care

through Medcaid!

We have the worst statistics in the industrialized world for child

mortality, cardiovascular disease,etc Universal care would change this!

K Cllarke, PT

Modesto CA

Re: Effect of National Health Care on Private Practice

Physical Therapy Clinics

I agree wholeheartedly that it is selfish not to enable others to have

access to services. But, is it the government's place to provide for such

services or should that responsibility lie within the community. I believe

the latter. Before the days of health insurance everyone paid for their own

healthcare and those who couldn't afford it were served by the community.

Pro bono or barter, etc. The question is truly, is it the responsibility of

the government? And is it truly an inalienable right such as freedom of

speach or should people strive to actually pay their way and then grace and

compassion within the community fill the gap? What is the real and

overarching purpose of government. I think it would behoove us to look way

back at the original writings of the founding fathers to understand before

we make a decision for Socialized medicine.

Carroll , PT

Chattanooga, TN

Effect of National Health Care on Private Practice

Physical Therapy Clinics

Dear Group,

This is more of an information gathering post than an information giving

post, so I'll get right to it. In my research over the last few years of

politics and political agendas, I have come to the conclusion that allowing

the government to enact any plan of Nationalized Healthcare - outside of

Medicare, Medicaid, and SCHIP as they are right now - would in effect put

all of our private practices out of business. I believe that the lack of

choices available to the general public, and the government being in control

of yet another failing system in this country would destroy competition in

our industry, and would be a great benefit to hospital based therapy

services, but would be terrible for private practice. I don't know what it

is like trying to get credentialed with HMO insurance companies outside of

Wisconsin, but in our practice, we have been told in no uncertain terms that

we will NEVER be allowed in any HMO network as long as there is a hospital

based clinic within 20 miles of us.

Consequently, there are at least 4 hospital based clinics within 20 miles of

our clinic, and all of our attempts to join HMO networks, so that we might

be able to cater to a larger range of patients, has ended in a denial from

the insurance company for the very reason listed above. With the government

possibly taking over Healthcare for everyone, it becomes easy to imagine

that they would want to sped as little money as possible in order to cover

as many people as possible, and HMO Health Insurance will become the norm in

our industry, making it nearly impossible to serve those patients unless

they are willing to pay out of pocket. This is severely unlikely, being

that they could just go to the hospital based clinic down the block and get

" free " Physical Therapy because it's covered under their taxpayer funded -

and capped like Medicare - Health plan.

Not only do we have to worry about the HMO issue, but we also have to worry

about the hospitals and their bureaucrats being able to charge less than

private practices to " the insurance company " than we can because they have

so much more revenue to go around to keep them in business, and keep us out

of competition just by undercutting our prices.

So, with that out of the way, I'd like to know how some of you are dealing

with the prospect of having Nationalized Health Care... By the way, if you

can give me good, viable, verifiable reasons why Nationalized Health Care

might actually benefit Private Practices, I might be swayed, but as yet, the

best argument anyone can come up with is that the cheapest insurance pool is

one where everyone is enrolled. I often hear the same poor arguments, and

then I look to countries that have had National Health Care programs for

years like Great Britain and Canada, who's patients are literally flying to

the United States in droves just to get their healthcare NOW instead of

having to wait up to 6 months for a CT scan when cancer is the likely

diagnosis. In most cases, if a patient has a possible brain cancer

diagnosis, 6 months could very well be too late. I don't want to have that

risk here in this country... it scares me.

Adam Jeschke

Optimal PT

Lake Mills, WI

[Guest guest]

Kathleen,

Under the AMA's watch, a host of very serious chronic diseases, in the space of

a very short time, have become epidemic. Heart disease and cancer, rare at the

turn of the century, now strike huge numbers of Americans, in spite of billions

of dollars in research and tremendous advances in diagnostic and surgical

techniques to combat them. One person in three suffers from allergies, one in

ten will have ulcers. Arthritis, MS, digestive disorders, diabetes,

osteoporosis, dementia, epilepsy, and chronic fatigue, afflict a significant

majority of our citizens. All these diseases were extremely rare in our

not-too-distant past. How can this be in this age of modern medical care?

It is simply wrong that Europeans or anyone else for that matter are healthier

because they receive more medicines and surgeries. That factoid is promoted only

by a medical machine that defines wellness as proper management of disease. But

that is NOT wellness---it is the OPPOSITE.

Our medical systems' unrelenting focus on early detection and treatment has come

at a terrible price. We no longer even know what health is. I recently heard a

classic example on NPR: It was a sound-bite advertisement for Planned

Parenthood, proclaiming that PP is " all about prevention. " Their example? PP

promotes mammograms! Need we be reminded that mammograms are all about detecting

EXISTING disease? (And, perhaps not incidentally, opening the door to even more

diagnostics and treatments?)

I, for one, am not happy at all that that we must (must!) all pay handsomely for

that sort of " healthcare. "

Dave Milano, PT, Director of Rehab Services

Laurel Health System

32-36 Central Ave.

Wellsboro, PA 16901

dmilano@...

Re: Effect of National Health Care on Private Practice

Physical Therapy Clinics

There is a Constitutional Amendment that forbids us to refuse anyone " Health

Care " ... it is " Health Insurance " that people do not have, and that is not

guaranteed by the Constitution, nor is it within the Constitutionally

Granted Powers of Congress to impose such legislation on this country. You

should have taken the $90-120,000 a year job, because you'll be paying more

in taxes - already close to 50% of annual income for our practice - in order

to support the 45 million+ people we have to supply with " free " National

Health Insurance. Let me reiterate.... it is 100% illegal for you, me, or

anyone in the medical profession to turn someone away because they don't

have health insurance. You can inform them of your cash-pay policy, do

pro-bono work as you see fit, but you can't refuse their care outright.

That is guaranteed in the Constitution of the United States of America.

I suppose those of you who support the idea of a national healthcare system

- read:

socialized-single-payer-taxpayer-funded-government-regulated-health-insuranc

e-that-we-can't-afford-in-its-current-state-of-medicare-and-medicaid

- also support the idea of supplying that same health care to illegal

aliens, no matter where they might be from, North, South, East or West...

The current system in place is financially bankrupt right now, just as

Social Security is financially bankrupt, and both programs are taking this

country further into debt with the rest of the world, because we can't

possibly contribute more than is being taken out of the funds to pay for

services. On that note, I'd guess that you also support the idea of

allowing illegal aliens to vote in our elections.

Socialist programs are the fastest way to completely destroy the

infrastructure of a country. The UK is losing money every day because of

their healthcare system, Sweden has all but done away with their Welfare

System, as it nearly bankrupted the entire country. I would expect those of

us in private practice - small business owners especially - would want the

government to stay as far away from our industry as possible. The only good

thing the government can do to improve the economy, get more people to pay

for health insurance and/or healthcare, and bring more business into our

clinics - which should be read as more patients being helped rather than

more revenue, because I honestly don't care about money, but I don't want

the government to take any of it for the benefit of the masses - is to get

out of the way and let nature take its course.

The greatest economic boom in this country was in the early 1980s, when

Reagan was president... he didn't pass any new spending bills, he cut

taxes, he got the government out of the way, and the economy of this country

skyrocketed. It is sad that people have become so used to the government

interfering in everything we do that they've forgotten that the government

is supposed to serve the people, the people aren't supposed to serve the

government, but that's where we are going if things like Nationalized Health

Plans are implemented. We're already slaves to the Federal Reserve, Social

Security, Medicare, and Medicaid, and now you want to add on another 45+

million people because you think people should be guaranteed health

insurance.... Self-imposed slavery is an ugly beast, and we've done it to

ourselves by not putting a check on everything our government feels like

doing this week, and over the last 50-75 years.

Like I said in my first post, it's 100% impossible for our clinic to

participate in any HMO insurance plans in the area because they cater to

hospitals only. I was specifically told that there are no free-standing

physical therapy clinics in the network of one of our local plans, and that

I could apply but we would be denied access to the HMO network because there

is a hospital-owned clinic less than a block away from us. When the

government takes over, I hope you have planned to either see only " Cash "

patients, or have lined up a job at a local hospital-owned clinic, because

unless you are in an area where you have such a huge understaffing of PTs

that every free-standing clinic is already in network with all the local

HMOs, you won't be seeing many insurance patients outside of Medicare.

Heh... you think the therapy cap is bad now, wait until every person (man,

woman, and child) in the country is all in the same network, and the

government can't tax us enough to cover the costs.... that, or the

reimbursement rates will plummet, and we'll be driven out of business

because we just can't afford to pay the rent anymore.

I hope no one takes anything I've said as a personal insult, I just find

that many people who like the idea of Nationalized Health Care, don't

realize that Health Care - not Health Insurance - is already guaranteed in

the Constitution, and once they realize this they often change their tune.

Adam Jeschke

Optimal Physical Therapy, LLC

Lake Mills, WI

On Jan 17, 2008 9:42 AM, Sumesh <brockbridgetherapy@

<mailto:brockbridgetherapy%40yahoo.com> yahoo.com> wrote:

> In reference to Mr. Jeschke's comments I actually believe there are

> advantages and disadvantages in both a socialized healthcare environment

and

> in a capitalistic healthcare environment. The bottom line depends on whom

it

> benefits. It is in the best financial interest of the average consumer to

be

> in an environment where healthcare is delivered in a socialized manner as

in

> most industrialized nations, but it is in the best financial interest of

> myself and other busienss owners/executives (e.g. private practice owners,

> corporate executives (e.g. HealthSouth, Physiotherapy Assoc., etc.),

> hospital executives, SNF owners and executives, Home Health Agency owners

> and executives, contracting agency owners, and physicians who own PT

> practices and CORFs) to do business in capitalistic environments where we

> can " capitalize " on opportunties created by healthcare.

>

> If we don't change our business philosophies and policies, then others

> will. Although, many business owners are willing to offer employment

> opportunities to physical therapists, assistants, athletic trainers,

etc...

> to capitalize on the opportunites described above, few are willing to

share

> ownership. To prevent non-physical therapists from OWNING physical

> therapists and physical therapy assistants we MUST empower our colleagues

> with partnership/ownership opportunites. When we understand and share the

> rewards and losses of owning a physical therapy business, only then we

will

> be able to truely understand the implications associated with non-physical

> therapists having control of our present and future (e.g. impact of

> hospital based clinics).

>

> Dr. Sumesh , PT, DPT, OCS

>

> P.S. Most of my patients wait longer than expected before being able to

> see specialists or undergo imaging studies, and a few become non-compliant

> with their prescribed medications due to cost and other insurance issues.

In

> addition, although I have family and friends in many counties with

> socialized healthcare none of them have expressed a desire to come to the

US

> for healthcare.

>

>

> Effect of National Health Care on Private Practice

> Physical Therapy Clinics

>

> Dear Group,

>

> This is more of an information gathering post than an information giving

> post, so I'll get right to it. In my research over the last few years of

> politics and political agendas, I have come to the conclusion that

> allowing

> the government to enact any plan of Nationalized Healthcare - outside of

> Medicare, Medicaid, and SCHIP as they are right now - would in effect put

> all of our private practices out of business. I believe that the lack of

> choices available to the general public, and the government being in

> control

> of yet another failing system in this country would destroy competition in

> our industry, and would be a great benefit to hospital based therapy

> services, but would be terrible for private practice. I don't know what it

> is like trying to get credentialed with HMO insurance companies outside of

> Wisconsin, but in our practice, we have been told in no uncertain terms

> that

> we will NEVER be allowed in any HMO network as long as there is a hospital

> based clinic within 20 miles of us.

>

> Consequently, there are at least 4 hospital based clinics within 20 miles

> of

> our clinic, and all of our attempts to join HMO networks, so that we might

> be able to cater to a larger range of patients, has ended in a denial from

> the insurance company for the very reason listed above. With the

> government

> possibly taking over Healthcare for everyone, it becomes easy to imagine

> that they would want to sped as little money as possible in order to cover

> as many people as possible, and HMO Health Insurance will become the norm

> in

> our industry, making it nearly impossible to serve those patients unless

> they are willing to pay out of pocket. This is severely unlikely, being

> that they could just go to the hospital based clinic down the block and

> get

> " free " Physical Therapy because it's covered under their taxpayer funded -

> and capped like Medicare - Health plan.

>

> Not only do we have to worry about the HMO issue, but we also have to

> worry

> about the hospitals and their bureaucrats being able to charge less than

> private practices to " the insurance company " than we can because they have

> so much more revenue to go around to keep them in business, and keep us

> out

> of competition just by undercutting our prices.

>

> So, with that out of the way, I'd like to know how some of you are dealing

> with the prospect of having Nationalized Health Care... By the way, if you

> can give me good, viable, verifiable reasons why Nationalized Health Care

> might actually benefit Private Practices, I might be swayed, but as yet,

> the

> best argument anyone can come up with is that the cheapest insurance pool

> is

> one where everyone is enrolled. I often hear the same poor arguments, and

> then I look to countries that have had National Health Care programs for

> years like Great Britain and Canada, who's patients are literally flying

> to

> the United States in droves just to get their healthcare NOW instead of

> having to wait up to 6 months for a CT scan when cancer is the likely

> diagnosis. In most cases, if a patient has a possible brain cancer

> diagnosis, 6 months could very well be too late. I don't want to have that

> risk here in this country... it scares me.

>

> Adam Jeschke

> Optimal PT

> Lake Mills, WI

>

>

>

[Guest guest]

You're absolutely right... Universal Care would amplify an already bad

situation, because after a couple years of everyone being seen for every

cough, sniffle, sneeze, and fart, the system would run out of money, and

we'd start limiting and restricting health care like Sweden did, and like

the UK does, and like Canada does. I'm sorry, but show me how to avoid the

continually rising costs in a government funded (read: taxpayer funded)

health care system, and how to avoid the inevitable 11 month waiting period

to get things like an angiogram, and then another 6 months to wait for

bypass surgery as they had in Sweden, and now have in the UK and Canada.

You can literally get an MRI for your dog's hips on the same day in Canada,

but you have to wait 4-5 months for the MRI on YOUR hips...

Wait... the system is already out of money... the 9 trillion that we are in

debt is in large part BECAUSE of Medicare, Medicaid, and Social Security....

The Medicare Tax is 2.9% right now.... on $100,000 income, that's $2900 a

year that we pay in to a Government Funded Health Care System... If you

make $50,000 a year, that's $1450 a year... The proposed cost for the SCHIP

Expansion Bill to cover 45 million uninsured and underinsured kids last year

was $500 Billion a year to start, and would increase over time. To begin

with, that would be another $1500 added to your annual tax bill each year,

and the costs would continue to rise each year because it's a tax....

I pay less than $100 a month for my personal Health Insurance premium...

$240 a month for my whole family. Have a good insurance plan, and I don't

want the government FORCING me to have THEIR idea of a " good " insurance

plan.... I like that I can actually afford my insurance... I like that my

contributions to a Health Savings Account are tax free, and that I can roll

that money over year after year for times when I really need it. I like

that when I don't need it, I'm actually gaining value in my HSA through my

contributions, instead of my payments to an insurance company for a small

deductible high payout being tossed out with this month's garbage if I don't

get sick... Oh, and I especially like the fact that my bank can't

discontinue my coverage because it's MY MONEY, not COMMUNITY MONEY, and

there is no cap on my insurance plan after I meet my deductible and out of

pocket. I've yet to reach my deductible in any year since I've been

married. The answer is NOT to have the government run our Health Care

System, nor is it to remain in the same " Big Payer " system that we are in

now. The solution is to make people take responsibility for their own

health care. People in this country used to pride themselves on how much

money they saved that year... how much was in the bank for a rainy day...

Now people pride themselves on how much they spent that year... how many

toys they have in the house, for when its raining outside. It's sad

really.... Apathy is ugly.

The following is excerpted from a gentleman in Brookfield, WI, who says

exactly what I've been saying, except he says it in a not so nice way.

It's the cost of health care, stupid, not the cost of health insurance,

> that plagues us. Let's say it another way. The problem with the high cost of

> health care IS the high cost of health care.

>

> Do you get it now?

>

> What's the answer? We can demand that everyone in the health care

> industry take a big cut in pay. I'm sure they would all agree if everyone

> else agreed to the same pay reduction in their line of work. Say, for

> instance, that personal injury attorneys agreed to work for 10 percent,

> instead of 33 percent. Ministers should work for free, as they are doing

> God's work. How about athletes and movies stars? I am sure they would gladly

> give up half of their income so we could have cheaper health care.

>

> Do you get it now?

>

> Another way would be to discontinue expensive medical research and the use

> of miracle drugs and go back to the proven methods like aspirin and

> grandma's home remedies.

>

> Do you get it now?

>

> Let's take another approach. How can we decrease the cost of

> gasoline? Well, first of all, we must decrease the cost of oil as the cost

> of gasoline is directly related to the cost of oil.

>

> Do you get it now?

>

> The bottom line is that the cost of health insurance is the direct result

> of the cost of health care.

>

> Do you get it now?

>

> Please, let's not muck up the entire health care system by passing a

> universal health care plan that will not solve anything and will remove all

> competition from health care and replace it with the fiscal responsibility

> of a government-run program.

>

> It's called a single payer system - and the single payer is you. Don't be

> so gullible as to assume universal health care will keep prices down when

> all the government needs to do is keep raising taxes to meet the increasing

> cost of health care.

>

> Oh yes, some of us won't have to worry about increased taxes, as we will

> have died while waiting for our surgeries under the socialistic universal

> health care system. Check it out - it is true.

>

> Yes, I too want affordable health care, but universal health care is not

> the answer

>

> Do you get it now?

>

- Gordon of Mid-Towne Insurance Center, Inc. (an independent health

insurance agent)

Adam Jeschke

Optimal Physical Therapy, LLC

Lake Mills, WI

> One of the more successful programs we have for good coverage is

> Medicare.

> Our form of socialzed medicine.

>

> Insurance for healthcare is dependent on employment in the US. Most

> working

> class people do not get this benefit. We are already paying for their care

> through Medcaid!

>

> We have the worst statistics in the industrialized world for child

> mortality, cardiovascular disease,etc Universal care would change this!

>

> K Cllarke, PT

>

>

> Modesto CA

>

> Re: Effect of National Health Care on Private

> Practice

> Physical Therapy Clinics

>

> I agree wholeheartedly that it is selfish not to enable others to have

> access to services. But, is it the government's place to provide for such

> services or should that responsibility lie within the community. I believe

> the latter. Before the days of health insurance everyone paid for their

> own

> healthcare and those who couldn't afford it were served by the community.

> Pro bono or barter, etc. The question is truly, is it the responsibility

> of

> the government? And is it truly an inalienable right such as freedom of

> speach or should people strive to actually pay their way and then grace

> and

> compassion within the community fill the gap? What is the real and

> overarching purpose of government. I think it would behoove us to look way

> back at the original writings of the founding fathers to understand before

> we make a decision for Socialized medicine.

>

> Carroll , PT

> Chattanooga, TN

>

> Effect of National Health Care on Private Practice

> Physical Therapy Clinics

>

> Dear Group,

>

> This is more of an information gathering post than an information giving

> post, so I'll get right to it. In my research over the last few years of

> politics and political agendas, I have come to the conclusion that

> allowing

> the government to enact any plan of Nationalized Healthcare - outside of

> Medicare, Medicaid, and SCHIP as they are right now - would in effect put

> all of our private practices out of business. I believe that the lack of

> choices available to the general public, and the government being in

> control

> of yet another failing system in this country would destroy competition in

> our industry, and would be a great benefit to hospital based therapy

> services, but would be terrible for private practice. I don't know what it

> is like trying to get credentialed with HMO insurance companies outside of

> Wisconsin, but in our practice, we have been told in no uncertain terms

> that

> we will NEVER be allowed in any HMO network as long as there is a hospital

> based clinic within 20 miles of us.

>

> Consequently, there are at least 4 hospital based clinics within 20 miles

> of

> our clinic, and all of our attempts to join HMO networks, so that we might

> be able to cater to a larger range of patients, has ended in a denial from

> the insurance company for the very reason listed above. With the

> government

> possibly taking over Healthcare for everyone, it becomes easy to imagine

> that they would want to sped as little money as possible in order to cover

> as many people as possible, and HMO Health Insurance will become the norm

> in

> our industry, making it nearly impossible to serve those patients unless

> they are willing to pay out of pocket. This is severely unlikely, being

> that they could just go to the hospital based clinic down the block and

> get

> " free " Physical Therapy because it's covered under their taxpayer funded -

> and capped like Medicare - Health plan.

>

> Not only do we have to worry about the HMO issue, but we also have to

> worry

> about the hospitals and their bureaucrats being able to charge less than

> private practices to " the insurance company " than we can because they have

> so much more revenue to go around to keep them in business, and keep us

> out

> of competition just by undercutting our prices.

>

> So, with that out of the way, I'd like to know how some of you are dealing

> with the prospect of having Nationalized Health Care... By the way, if you

> can give me good, viable, verifiable reasons why Nationalized Health Care

> might actually benefit Private Practices, I might be swayed, but as yet,

> the

> best argument anyone can come up with is that the cheapest insurance pool

> is

> one where everyone is enrolled. I often hear the same poor arguments, and

> then I look to countries that have had National Health Care programs for

> years like Great Britain and Canada, who's patients are literally flying

> to

> the United States in droves just to get their healthcare NOW instead of

> having to wait up to 6 months for a CT scan when cancer is the likely

> diagnosis. In most cases, if a patient has a possible brain cancer

> diagnosis, 6 months could very well be too late. I don't want to have that

> risk here in this country... it scares me.

>

> Adam Jeschke

> Optimal PT

> Lake Mills, WI

>

>

>

[Guest guest]

Dear Listserve,

Great discussion. This has been a topic of great interest for me as

a father and a business owner. The one thing I do know is that we

cannot include a 50% tax issue in the argument if we dont also

discuss the current cost of health care premiums. Those of you who

are covered by your employer or your spouses employer may not think

that you are currently being taxed for your healthcare but you are.

When we look at what we can afford to pay someone we must look at

the whole wage/salary/benefit package. The cost of our employees

healthcare is included in that package, it comes out of your

potential salary. If the cost of your healthcare coverage goes up

25% annually and reimbursement goes down 1-5% annually do you think

that your salary will continue to rise? Do you realize that what I

as an employer pay out annually to cover the health insurance of my

employees significantly limits what I am able to pay into their SEP

IRA's and profit sharing bonuses. YES IT DOES! If their is no

profit, there is no profit to share!!! YOU ARE CURRENTLY BEING

TAXED AND YOUR COVERAGE MAY STILL STINK!!!

I dont know the answers but I do know that the current system is

broken and it starts with the insurance companies. They have had

their chance and they were too greedy to realize just how good they

had things. They were more concerned about taking care of their

shareholders than their customers and they need to suffer the

consequences. I have friends who are insurance agents who make six

figure salaries, high school to four year degree graduates who do

nothing more than sell insurance that make more than the providers

of the care they sell. Remember, these people are not insuring

anybody, they take no risk, they simply sell the stuff and they take

home a bigger piece of the pie than we do. The current system is

out of order.

Keep up the discussion, thanks!

E. s, PT, DPT, OCS, FAAOMPT

www.douglasspt.com

> >

> > > In reference to Mr. Jeschke's comments I actually believe

there

> are

> > > advantages and disadvantages in both a socialized healthcare

> environment and

> > > in a capitalistic healthcare environment. The bottom line

depends

> on whom it

> > > benefits. It is in the best financial interest of the average

> consumer to be

> > > in an environment where healthcare is delivered in a

socialized

> manner as in

> > > most industrialized nations, but it is in the best financial

> interest of

> > > myself and other busienss owners/executives (e.g. private

> practice owners,

> > > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

> etc.),

> > > hospital executives, SNF owners and executives, Home Health

> Agency owners

> > > and executives, contracting agency owners, and physicians who

own

> PT

> > > practices and CORFs) to do business in capitalistic

environments

> where we

> > > can " capitalize " on opportunties created by healthcare.

> > >

> > > If we don't change our business philosophies and policies,

then

> others

> > > will. Although, many business owners are willing to offer

> employment

> > > opportunities to physical therapists, assistants, athletic

> trainers, etc...

> > > to capitalize on the opportunites described above, few are

> willing to share

> > > ownership. To prevent non-physical therapists from OWNING

physical

> > > therapists and physical therapy assistants we MUST empower our

> colleagues

> > > with partnership/ownership opportunites. When we understand

and

> share the

> > > rewards and losses of owning a physical therapy business, only

> then we will

> > > be able to truely understand the implications associated with

non-

> physical

> > > therapists having control of our present and future (e.g.

impact

> of

> > > hospital based clinics).

> > >

> > > Dr. Sumesh , PT, DPT, OCS

> > >

> > > P.S. Most of my patients wait longer than expected before

being

> able to

> > > see specialists or undergo imaging studies, and a few become

non-

> compliant

> > > with their prescribed medications due to cost and other

insurance

> issues. In

> > > addition, although I have family and friends in many counties

with

> > > socialized healthcare none of them have expressed a desire to

> come to the US

> > > for healthcare.

> > >

> > >

> > > Effect of National Health Care on Private

> Practice

> > > Physical Therapy Clinics

> > >

> > > Dear Group,

> > >

> > > This is more of an information gathering post than an

information

> giving

> > > post, so I'll get right to it. In my research over the last

few

> years of

> > > politics and political agendas, I have come to the conclusion

that

> > > allowing

> > > the government to enact any plan of Nationalized Healthcare -

> outside of

> > > Medicare, Medicaid, and SCHIP as they are right now - would in

> effect put

> > > all of our private practices out of business. I believe that

the

> lack of

> > > choices available to the general public, and the government

being

> in

> > > control

> > > of yet another failing system in this country would destroy

> competition in

> > > our industry, and would be a great benefit to hospital based

> therapy

> > > services, but would be terrible for private practice. I don't

> know what it

> > > is like trying to get credentialed with HMO insurance

companies

> outside of

> > > Wisconsin, but in our practice, we have been told in no

uncertain

> terms

> > > that

> > > we will NEVER be allowed in any HMO network as long as there

is a

> hospital

> > > based clinic within 20 miles of us.

> > >

> > > Consequently, there are at least 4 hospital based clinics

within

> 20 miles

> > > of

> > > our clinic, and all of our attempts to join HMO networks, so

that

> we might

> > > be able to cater to a larger range of patients, has ended in a

> denial from

> > > the insurance company for the very reason listed above. With

the

> > > government

> > > possibly taking over Healthcare for everyone, it becomes easy

to

> imagine

> > > that they would want to sped as little money as possible in

order

> to cover

> > > as many people as possible, and HMO Health Insurance will

become

> the norm

> > > in

> > > our industry, making it nearly impossible to serve those

patients

> unless

> > > they are willing to pay out of pocket. This is severely

unlikely,

> being

> > > that they could just go to the hospital based clinic down the

> block and

> > > get

> > > " free " Physical Therapy because it's covered under their

taxpayer

> funded -

> > > and capped like Medicare - Health plan.

> > >

> > > Not only do we have to worry about the HMO issue, but we also

> have to

> > > worry

> > > about the hospitals and their bureaucrats being able to charge

> less than

> > > private practices to " the insurance company " than we can

because

> they have

> > > so much more revenue to go around to keep them in business,

and

> keep us

> > > out

> > > of competition just by undercutting our prices.

> > >

> > > So, with that out of the way, I'd like to know how some of you

> are dealing

> > > with the prospect of having Nationalized Health Care... By the

> way, if you

> > > can give me good, viable, verifiable reasons why Nationalized

> Health Care

> > > might actually benefit Private Practices, I might be swayed,

but

> as yet,

> > > the

> > > best argument anyone can come up with is that the cheapest

> insurance pool

> > > is

> > > one where everyone is enrolled. I often hear the same poor

> arguments, and

> > > then I look to countries that have had National Health Care

> programs for

> > > years like Great Britain and Canada, who's patients are

literally

> flying

> > > to

> > > the United States in droves just to get their healthcare NOW

> instead of

> > > having to wait up to 6 months for a CT scan when cancer is the

> likely

> > > diagnosis. In most cases, if a patient has a possible brain

cancer

> > > diagnosis, 6 months could very well be too late. I don't want

to

> have that

> > > risk here in this country... it scares me.

> > >

> > > Adam Jeschke

> > > Optimal PT

> > > Lake Mills, WI

> > >

> > >

> > >

[Guest guest]

Good points ... but switching to a Single Payer system (the Single Payer

being you) would not solve any of our rising costs of health care. What

WOULD solve the problem is opening up the industry to the free market. As

of now, everything is regulated, taxed, audited, and controlled by Corporate

Insurance... In the days before Blue Cross, WPS, Aetna, Humana, and

Medicare, churches ran hospitals, and those that couldn't afford care were

seen pro-bono... This is why we have names like St. Luke's, St. Help of

Christians, St. 's, etc. as names for hospitals... In all this

discussion, I never said it would be good to stay in the current system,

just that nationalizing it, and allowing the government to control it is NOT

anywhere close to the solution.

Adam Jeschke

Optimal Physical Therapy

Lake Mills, WI

> Dear Listserve,

>

> Great discussion. This has been a topic of great interest for me as

> a father and a business owner. The one thing I do know is that we

> cannot include a 50% tax issue in the argument if we dont also

> discuss the current cost of health care premiums. Those of you who

> are covered by your employer or your spouses employer may not think

> that you are currently being taxed for your healthcare but you are.

> When we look at what we can afford to pay someone we must look at

> the whole wage/salary/benefit package. The cost of our employees

> healthcare is included in that package, it comes out of your

> potential salary. If the cost of your healthcare coverage goes up

> 25% annually and reimbursement goes down 1-5% annually do you think

> that your salary will continue to rise? Do you realize that what I

> as an employer pay out annually to cover the health insurance of my

> employees significantly limits what I am able to pay into their SEP

> IRA's and profit sharing bonuses. YES IT DOES! If their is no

> profit, there is no profit to share!!! YOU ARE CURRENTLY BEING

> TAXED AND YOUR COVERAGE MAY STILL STINK!!!

>

> I dont know the answers but I do know that the current system is

> broken and it starts with the insurance companies. They have had

> their chance and they were too greedy to realize just how good they

> had things. They were more concerned about taking care of their

> shareholders than their customers and they need to suffer the

> consequences. I have friends who are insurance agents who make six

> figure salaries, high school to four year degree graduates who do

> nothing more than sell insurance that make more than the providers

> of the care they sell. Remember, these people are not insuring

> anybody, they take no risk, they simply sell the stuff and they take

> home a bigger piece of the pie than we do. The current system is

> out of order.

>

> Keep up the discussion, thanks!

>

> E. s, PT, DPT, OCS, FAAOMPT

> www.douglasspt.com

>

>

> > >

> > > > In reference to Mr. Jeschke's comments I actually believe

> there

> > are

> > > > advantages and disadvantages in both a socialized healthcare

> > environment and

> > > > in a capitalistic healthcare environment. The bottom line

> depends

> > on whom it

> > > > benefits. It is in the best financial interest of the average

> > consumer to be

> > > > in an environment where healthcare is delivered in a

> socialized

> > manner as in

> > > > most industrialized nations, but it is in the best financial

> > interest of

> > > > myself and other busienss owners/executives (e.g. private

> > practice owners,

> > > > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

> > etc.),

> > > > hospital executives, SNF owners and executives, Home Health

> > Agency owners

> > > > and executives, contracting agency owners, and physicians who

> own

> > PT

> > > > practices and CORFs) to do business in capitalistic

> environments

> > where we

> > > > can " capitalize " on opportunties created by healthcare.

> > > >

> > > > If we don't change our business philosophies and policies,

> then

> > others

> > > > will. Although, many business owners are willing to offer

> > employment

> > > > opportunities to physical therapists, assistants, athletic

> > trainers, etc...

> > > > to capitalize on the opportunites described above, few are

> > willing to share

> > > > ownership. To prevent non-physical therapists from OWNING

> physical

> > > > therapists and physical therapy assistants we MUST empower our

> > colleagues

> > > > with partnership/ownership opportunites. When we understand

> and

> > share the

> > > > rewards and losses of owning a physical therapy business, only

> > then we will

> > > > be able to truely understand the implications associated with

> non-

> > physical

> > > > therapists having control of our present and future (e.g.

> impact

> > of

> > > > hospital based clinics).

> > > >

> > > > Dr. Sumesh , PT, DPT, OCS

> > > >

> > > > P.S. Most of my patients wait longer than expected before

> being

> > able to

> > > > see specialists or undergo imaging studies, and a few become

> non-

> > compliant

> > > > with their prescribed medications due to cost and other

> insurance

> > issues. In

> > > > addition, although I have family and friends in many counties

> with

> > > > socialized healthcare none of them have expressed a desire to

> > come to the US

> > > > for healthcare.

> > > >

> > > >

> > > > Effect of National Health Care on Private

> > Practice

> > > > Physical Therapy Clinics

> > > >

> > > > Dear Group,

> > > >

> > > > This is more of an information gathering post than an

> information

> > giving

> > > > post, so I'll get right to it. In my research over the last

> few

> > years of

> > > > politics and political agendas, I have come to the conclusion

> that

> > > > allowing

> > > > the government to enact any plan of Nationalized Healthcare -

> > outside of

> > > > Medicare, Medicaid, and SCHIP as they are right now - would in

> > effect put

> > > > all of our private practices out of business. I believe that

> the

> > lack of

> > > > choices available to the general public, and the government

> being

> > in

> > > > control

> > > > of yet another failing system in this country would destroy

> > competition in

> > > > our industry, and would be a great benefit to hospital based

> > therapy

> > > > services, but would be terrible for private practice. I don't

> > know what it

> > > > is like trying to get credentialed with HMO insurance

> companies

> > outside of

> > > > Wisconsin, but in our practice, we have been told in no

> uncertain

> > terms

> > > > that

> > > > we will NEVER be allowed in any HMO network as long as there

> is a

> > hospital

> > > > based clinic within 20 miles of us.

> > > >

> > > > Consequently, there are at least 4 hospital based clinics

> within

> > 20 miles

> > > > of

> > > > our clinic, and all of our attempts to join HMO networks, so

> that

> > we might

> > > > be able to cater to a larger range of patients, has ended in a

> > denial from

> > > > the insurance company for the very reason listed above. With

> the

> > > > government

> > > > possibly taking over Healthcare for everyone, it becomes easy

> to

> > imagine

> > > > that they would want to sped as little money as possible in

> order

> > to cover

> > > > as many people as possible, and HMO Health Insurance will

> become

> > the norm

> > > > in

> > > > our industry, making it nearly impossible to serve those

> patients

> > unless

> > > > they are willing to pay out of pocket. This is severely

> unlikely,

> > being

> > > > that they could just go to the hospital based clinic down the

> > block and

> > > > get

> > > > " free " Physical Therapy because it's covered under their

> taxpayer

> > funded -

> > > > and capped like Medicare - Health plan.

> > > >

> > > > Not only do we have to worry about the HMO issue, but we also

> > have to

> > > > worry

> > > > about the hospitals and their bureaucrats being able to charge

> > less than

> > > > private practices to " the insurance company " than we can

> because

> > they have

> > > > so much more revenue to go around to keep them in business,

> and

> > keep us

> > > > out

> > > > of competition just by undercutting our prices.

> > > >

> > > > So, with that out of the way, I'd like to know how some of you

> > are dealing

> > > > with the prospect of having Nationalized Health Care... By the

> > way, if you

> > > > can give me good, viable, verifiable reasons why Nationalized

> > Health Care

> > > > might actually benefit Private Practices, I might be swayed,

> but

> > as yet,

> > > > the

> > > > best argument anyone can come up with is that the cheapest

> > insurance pool

> > > > is

> > > > one where everyone is enrolled. I often hear the same poor

> > arguments, and

> > > > then I look to countries that have had National Health Care

> > programs for

> > > > years like Great Britain and Canada, who's patients are

> literally

> > flying

> > > > to

> > > > the United States in droves just to get their healthcare NOW

> > instead of

> > > > having to wait up to 6 months for a CT scan when cancer is the

> > likely

> > > > diagnosis. In most cases, if a patient has a possible brain

> cancer

> > > > diagnosis, 6 months could very well be too late. I don't want

> to

> > have that

> > > > risk here in this country... it scares me.

> > > >

> > > > Adam Jeschke

> > > > Optimal PT

> > > > Lake Mills, WI

> > > >

> > > >

> > > >

[Guest guest]

Hi, folks!

I may not have enjoyed a discussion this much since I taught graduate

economics!

Just to clarify in the interest of Evidence Based Practice Management: The

reference to " single payer " meaning you may not be quite supported. The

single payer is a gentle way of saying " the government " .

" Single-payer is basically a way some countries use to provide its citizens

with health insurance. (Sounds very boring, I know. But keep reading!) Its

name comes from the fact that doctors and hospitals are paid by one

organization: a single payer. By having only one payer, you can simplify the

health care system enormously. " (What is single payer? Available at:

http://www.grahamazon.com/sp/what.php Accessed January 18, 2008)

Thanks to Tom Howell for his view. If you really want to see a debate on

the role of a strong central government, read The Federalist Papers. These

were written to clarify the intent of the founders, right around the time if

the Constitution.

As PTs and others anguish over how to pursue their dream, which for some

includes self-employment, we really are on the leading edge of being

impacted by the intersection of the line of rising costs with the flat to

declining line of reimbursement.

Oh yes - Health Insurance Companies are not in business for the altruistic

reasons that many PTs are. They're financial institutions, and their

shareholders expect them to spend far less (on medical expenses) than they

take in.

Best regards,

Dick Hillyer, PT,DPT,MBA,MSM

Dr. W. Hillyer

Hillyer Consulting

The Institute for Rehab Management

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Office

Mobile

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Adam Jeschke

Sent: Friday, January 18, 2008 5:05 PM

To: PTManager

Subject: Re: Re: Effect of National Health Care on Private

Practice Physical Therapy Clinics

Good points ... but switching to a Single Payer system (the Single Payer

being you) would not solve any of our rising costs of health care. What

WOULD solve the problem is opening up the industry to the free market. As

of now, everything is regulated, taxed, audited, and controlled by Corporate

Insurance... In the days before Blue Cross, WPS, Aetna, Humana, and

Medicare, churches ran hospitals, and those that couldn't afford care were

seen pro-bono... This is why we have names like St. Luke's, St. Help of

Christians, St. 's, etc. as names for hospitals... In all this

discussion, I never said it would be good to stay in the current system,

just that nationalizing it, and allowing the government to control it is NOT

anywhere close to the solution.

Adam Jeschke

Optimal Physical Therapy

Lake Mills, WI

On Jan 18, 2008 12:00 PM, s <dosrincatt (DOT)

<mailto:dosrinc%40att.net> net> wrote:

> Dear Listserve,

>

> Great discussion. This has been a topic of great interest for me as

> a father and a business owner. The one thing I do know is that we

> cannot include a 50% tax issue in the argument if we dont also

> discuss the current cost of health care premiums. Those of you who

> are covered by your employer or your spouses employer may not think

> that you are currently being taxed for your healthcare but you are.

> When we look at what we can afford to pay someone we must look at

> the whole wage/salary/benefit package. The cost of our employees

> healthcare is included in that package, it comes out of your

> potential salary. If the cost of your healthcare coverage goes up

> 25% annually and reimbursement goes down 1-5% annually do you think

> that your salary will continue to rise? Do you realize that what I

> as an employer pay out annually to cover the health insurance of my

> employees significantly limits what I am able to pay into their SEP

> IRA's and profit sharing bonuses. YES IT DOES! If their is no

> profit, there is no profit to share!!! YOU ARE CURRENTLY BEING

> TAXED AND YOUR COVERAGE MAY STILL STINK!!!

>

> I dont know the answers but I do know that the current system is

> broken and it starts with the insurance companies. They have had

> their chance and they were too greedy to realize just how good they

> had things. They were more concerned about taking care of their

> shareholders than their customers and they need to suffer the

> consequences. I have friends who are insurance agents who make six

> figure salaries, high school to four year degree graduates who do

> nothing more than sell insurance that make more than the providers

> of the care they sell. Remember, these people are not insuring

> anybody, they take no risk, they simply sell the stuff and they take

> home a bigger piece of the pie than we do. The current system is

> out of order.

>

> Keep up the discussion, thanks!

>

> E. s, PT, DPT, OCS, FAAOMPT

> www.douglasspt.com

>

>

> > >

> > > > In reference to Mr. Jeschke's comments I actually believe

> there

> > are

> > > > advantages and disadvantages in both a socialized healthcare

> > environment and

> > > > in a capitalistic healthcare environment. The bottom line

> depends

> > on whom it

> > > > benefits. It is in the best financial interest of the average

> > consumer to be

> > > > in an environment where healthcare is delivered in a

> socialized

> > manner as in

> > > > most industrialized nations, but it is in the best financial

> > interest of

> > > > myself and other busienss owners/executives (e.g. private

> > practice owners,

> > > > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

> > etc.),

> > > > hospital executives, SNF owners and executives, Home Health

> > Agency owners

> > > > and executives, contracting agency owners, and physicians who

> own

> > PT

> > > > practices and CORFs) to do business in capitalistic

> environments

> > where we

> > > > can " capitalize " on opportunties created by healthcare.

> > > >

> > > > If we don't change our business philosophies and policies,

> then

> > others

> > > > will. Although, many business owners are willing to offer

> > employment

> > > > opportunities to physical therapists, assistants, athletic

> > trainers, etc...

> > > > to capitalize on the opportunites described above, few are

> > willing to share

> > > > ownership. To prevent non-physical therapists from OWNING

> physical

> > > > therapists and physical therapy assistants we MUST empower our

> > colleagues

> > > > with partnership/ownership opportunites. When we understand

> and

> > share the

> > > > rewards and losses of owning a physical therapy business, only

> > then we will

> > > > be able to truely understand the implications associated with

> non-

> > physical

> > > > therapists having control of our present and future (e.g.

> impact

> > of

> > > > hospital based clinics).

> > > >

> > > > Dr. Sumesh , PT, DPT, OCS

> > > >

> > > > P.S. Most of my patients wait longer than expected before

> being

> > able to

> > > > see specialists or undergo imaging studies, and a few become

> non-

> > compliant

> > > > with their prescribed medications due to cost and other

> insurance

> > issues. In

> > > > addition, although I have family and friends in many counties

> with

> > > > socialized healthcare none of them have expressed a desire to

> > come to the US

> > > > for healthcare.

> > > >

> > > >

> > > > Effect of National Health Care on Private

> > Practice

> > > > Physical Therapy Clinics

> > > >

> > > > Dear Group,

> > > >

> > > > This is more of an information gathering post than an

> information

> > giving

> > > > post, so I'll get right to it. In my research over the last

> few

> > years of

> > > > politics and political agendas, I have come to the conclusion

> that

> > > > allowing

> > > > the government to enact any plan of Nationalized Healthcare -

> > outside of

> > > > Medicare, Medicaid, and SCHIP as they are right now - would in

> > effect put

> > > > all of our private practices out of business. I believe that

> the

> > lack of

> > > > choices available to the general public, and the government

> being

> > in

> > > > control

> > > > of yet another failing system in this country would destroy

> > competition in

> > > > our industry, and would be a great benefit to hospital based

> > therapy

> > > > services, but would be terrible for private practice. I don't

> > know what it

> > > > is like trying to get credentialed with HMO insurance

> companies

> > outside of

> > > > Wisconsin, but in our practice, we have been told in no

> uncertain

> > terms

> > > > that

> > > > we will NEVER be allowed in any HMO network as long as there

> is a

> > hospital

> > > > based clinic within 20 miles of us.

> > > >

> > > > Consequently, there are at least 4 hospital based clinics

> within

> > 20 miles

> > > > of

> > > > our clinic, and all of our attempts to join HMO networks, so

> that

> > we might

> > > > be able to cater to a larger range of patients, has ended in a

> > denial from

> > > > the insurance company for the very reason listed above. With

> the

> > > > government

> > > > possibly taking over Healthcare for everyone, it becomes easy

> to

> > imagine

> > > > that they would want to sped as little money as possible in

> order

> > to cover

> > > > as many people as possible, and HMO Health Insurance will

> become

> > the norm

> > > > in

> > > > our industry, making it nearly impossible to serve those

> patients

> > unless

> > > > they are willing to pay out of pocket. This is severely

> unlikely,

> > being

> > > > that they could just go to the hospital based clinic down the

> > block and

> > > > get

> > > > " free " Physical Therapy because it's covered under their

> taxpayer

> > funded -

> > > > and capped like Medicare - Health plan.

> > > >

> > > > Not only do we have to worry about the HMO issue, but we also

> > have to

> > > > worry

> > > > about the hospitals and their bureaucrats being able to charge

> > less than

> > > > private practices to " the insurance company " than we can

> because

> > they have

> > > > so much more revenue to go around to keep them in business,

> and

> > keep us

> > > > out

> > > > of competition just by undercutting our prices.

> > > >

> > > > So, with that out of the way, I'd like to know how some of you

> > are dealing

> > > > with the prospect of having Nationalized Health Care... By the

> > way, if you

> > > > can give me good, viable, verifiable reasons why Nationalized

> > Health Care

> > > > might actually benefit Private Practices, I might be swayed,

> but

> > as yet,

> > > > the

> > > > best argument anyone can come up with is that the cheapest

> > insurance pool

> > > > is

> > > > one where everyone is enrolled. I often hear the same poor

> > arguments, and

> > > > then I look to countries that have had National Health Care

> > programs for

> > > > years like Great Britain and Canada, who's patients are

> literally

> > flying

> > > > to

> > > > the United States in droves just to get their healthcare NOW

> > instead of

> > > > having to wait up to 6 months for a CT scan when cancer is the

> > likely

> > > > diagnosis. In most cases, if a patient has a possible brain

> cancer

> > > > diagnosis, 6 months could very well be too late. I don't want

> to

> > have that

> > > > risk here in this country... it scares me.

> > > >

> > > > Adam Jeschke

> > > > Optimal PT

> > > > Lake Mills, WI

> > > >

> > > >

> > > >

[Guest guest]

Dave,

You make some excellent points, and I had to chime in with some

recommended reading. In your first paragraph you mention the

epidemic incidence in North America of diseases such as heart

disease, cancer, arthritis, diabetes, MS, osteoporosis, etc. The

answer to these diseases is NOT to throw more money into developing

more drugs with side-effects often worse than the disease itself.

The answer is education regarding the undeniable link between

lifestyle (nutrition, etc) and these diseases. Colleagues, for the

sake of yourselves and your families, PLEASE get and read the

book " The China Study " by T. Colin , PHD. I have no

affiliation with him whatsoever but recognize the life-changing

information he has put together in this book. The name is somewhat

misleading as it actually contains the results of about 27 years of

research continuously funded by grants from organizations such as the

National Institute of Health and the American Cancer Society. Much

of it is published in peer-reviewed articles in the JAMA and Lancet

journals. If 25% of Americans followed the advice in this book, we

would have no health insurance crisis.

Thanks,

Loren Munson, MPT

Director of Rehabilitation

Sonora Regional Medical Center

>

> > In reference to Mr. Jeschke's comments I actually believe there

are

> > advantages and disadvantages in both a socialized healthcare

environment

> and

> > in a capitalistic healthcare environment. The bottom line depends

on whom

> it

> > benefits. It is in the best financial interest of the average

consumer to

> be

> > in an environment where healthcare is delivered in a socialized

manner as

> in

> > most industrialized nations, but it is in the best financial

interest of

> > myself and other busienss owners/executives (e.g. private

practice owners,

> > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

etc.),

> > hospital executives, SNF owners and executives, Home Health

Agency owners

> > and executives, contracting agency owners, and physicians who own

PT

> > practices and CORFs) to do business in capitalistic environments

where we

> > can " capitalize " on opportunties created by healthcare.

> >

> > If we don't change our business philosophies and policies, then

others

> > will. Although, many business owners are willing to offer

employment

> > opportunities to physical therapists, assistants, athletic

trainers,

> etc...

> > to capitalize on the opportunites described above, few are

willing to

> share

> > ownership. To prevent non-physical therapists from OWNING physical

> > therapists and physical therapy assistants we MUST empower our

colleagues

> > with partnership/ownership opportunites. When we understand and

share the

> > rewards and losses of owning a physical therapy business, only

then we

> will

> > be able to truely understand the implications associated with non-

physical

> > therapists having control of our present and future (e.g. impact

of

> > hospital based clinics).

> >

> > Dr. Sumesh , PT, DPT, OCS

> >

> > P.S. Most of my patients wait longer than expected before being

able to

> > see specialists or undergo imaging studies, and a few become non-

compliant

> > with their prescribed medications due to cost and other insurance

issues.

> In

> > addition, although I have family and friends in many counties with

> > socialized healthcare none of them have expressed a desire to

come to the

> US

> > for healthcare.

> >

> >

> > Effect of National Health Care on Private

Practice

> > Physical Therapy Clinics

> >

> > Dear Group,

> >

> > This is more of an information gathering post than an information

giving

> > post, so I'll get right to it. In my research over the last few

years of

> > politics and political agendas, I have come to the conclusion that

> > allowing

> > the government to enact any plan of Nationalized Healthcare -

outside of

> > Medicare, Medicaid, and SCHIP as they are right now - would in

effect put

> > all of our private practices out of business. I believe that the

lack of

> > choices available to the general public, and the government being

in

> > control

> > of yet another failing system in this country would destroy

competition in

> > our industry, and would be a great benefit to hospital based

therapy

> > services, but would be terrible for private practice. I don't

know what it

> > is like trying to get credentialed with HMO insurance companies

outside of

> > Wisconsin, but in our practice, we have been told in no uncertain

terms

> > that

> > we will NEVER be allowed in any HMO network as long as there is a

hospital

> > based clinic within 20 miles of us.

> >

> > Consequently, there are at least 4 hospital based clinics within

20 miles

> > of

> > our clinic, and all of our attempts to join HMO networks, so that

we might

> > be able to cater to a larger range of patients, has ended in a

denial from

> > the insurance company for the very reason listed above. With the

> > government

> > possibly taking over Healthcare for everyone, it becomes easy to

imagine

> > that they would want to sped as little money as possible in order

to cover

> > as many people as possible, and HMO Health Insurance will become

the norm

> > in

> > our industry, making it nearly impossible to serve those patients

unless

> > they are willing to pay out of pocket. This is severely unlikely,

being

> > that they could just go to the hospital based clinic down the

block and

> > get

> > " free " Physical Therapy because it's covered under their taxpayer

funded -

> > and capped like Medicare - Health plan.

> >

> > Not only do we have to worry about the HMO issue, but we also

have to

> > worry

> > about the hospitals and their bureaucrats being able to charge

less than

> > private practices to " the insurance company " than we can because

they have

> > so much more revenue to go around to keep them in business, and

keep us

> > out

> > of competition just by undercutting our prices.

> >

> > So, with that out of the way, I'd like to know how some of you

are dealing

> > with the prospect of having Nationalized Health Care... By the

way, if you

> > can give me good, viable, verifiable reasons why Nationalized

Health Care

> > might actually benefit Private Practices, I might be swayed, but

as yet,

> > the

> > best argument anyone can come up with is that the cheapest

insurance pool

> > is

> > one where everyone is enrolled. I often hear the same poor

arguments, and

> > then I look to countries that have had National Health Care

programs for

> > years like Great Britain and Canada, who's patients are literally

flying

> > to

> > the United States in droves just to get their healthcare NOW

instead of

> > having to wait up to 6 months for a CT scan when cancer is the

likely

> > diagnosis. In most cases, if a patient has a possible brain cancer

> > diagnosis, 6 months could very well be too late. I don't want to

have that

> > risk here in this country... it scares me.

> >

> > Adam Jeschke

> > Optimal PT

> > Lake Mills, WI

> >

> >

> >

[Guest guest]

Loren,

Reading your post was interesting to me. I am familiar with The China Study, and

in (nearly) complete disagreement with Dr. . While he rightly points out

that modern medicine may very well be responsible for our hyper-diseased state

today, he generally blames animal food products for the mess, despite very

strong anthropological evidence that high-quality animal fats and proteins are

not only healthy, but biologically necessary (and, not incidentally, a part of

every healthy society's diet--sometimes a huge part). A review of his book more

in line with my thoughts can be found here, if you're interested:

http://www.westonaprice.org/bookreviews/chinastudy.html

The key thing for us right now, though, is that, according to today's systems,

Loren and Dave are not allowed to enjoy the fruits of their own opinions,

because the rules say that we will all be taxed and otherwise charged for

" health " care according to one particular system--the AMA system. (About the

only health advice we get there is the ever-changing, always wrong but never in

doubt, food pyramid.)

As they taught us all in grade school, each and every American has the right to

live by our own rules, up to the point that we infringe on the rights of others.

In today's healthcare world, that elegant little gem has been turned upside

down.

Dave

Dave Milano, PT, Director of Rehab Services

Laurel Health System

Re: Effect of National Health Care on Private Practice

Physical Therapy Clinics

Dave,

You make some excellent points, and I had to chime in with some

recommended reading. In your first paragraph you mention the

epidemic incidence in North America of diseases such as heart

disease, cancer, arthritis, diabetes, MS, osteoporosis, etc. The

answer to these diseases is NOT to throw more money into developing

more drugs with side-effects often worse than the disease itself.

The answer is education regarding the undeniable link between

lifestyle (nutrition, etc) and these diseases. Colleagues, for the

sake of yourselves and your families, PLEASE get and read the

book " The China Study " by T. Colin , PHD. I have no

affiliation with him whatsoever but recognize the life-changing

information he has put together in this book. The name is somewhat

misleading as it actually contains the results of about 27 years of

research continuously funded by grants from organizations such as the

National Institute of Health and the American Cancer Society. Much

of it is published in peer-reviewed articles in the JAMA and Lancet

journals. If 25% of Americans followed the advice in this book, we

would have no health insurance crisis.

Thanks,

Loren Munson, MPT

Director of Rehabilitation

Sonora Regional Medical Center

>

> > In reference to Mr. Jeschke's comments I actually believe there

are

> > advantages and disadvantages in both a socialized healthcare

environment

> and

> > in a capitalistic healthcare environment. The bottom line depends

on whom

> it

> > benefits. It is in the best financial interest of the average

consumer to

> be

> > in an environment where healthcare is delivered in a socialized

manner as

> in

> > most industrialized nations, but it is in the best financial

interest of

> > myself and other busienss owners/executives (e.g. private

practice owners,

> > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

etc.),

> > hospital executives, SNF owners and executives, Home Health

Agency owners

> > and executives, contracting agency owners, and physicians who own

PT

> > practices and CORFs) to do business in capitalistic environments

where we

> > can " capitalize " on opportunties created by healthcare.

> >

> > If we don't change our business philosophies and policies, then

others

> > will. Although, many business owners are willing to offer

employment

> > opportunities to physical therapists, assistants, athletic

trainers,

> etc...

> > to capitalize on the opportunites described above, few are

willing to

> share

> > ownership. To prevent non-physical therapists from OWNING physical

> > therapists and physical therapy assistants we MUST empower our

colleagues

> > with partnership/­ownership opportunites. When we understand and

share the

> > rewards and losses of owning a physical therapy business, only

then we

> will

> > be able to truely understand the implications associated with non-

physical

> > therapists having control of our present and future (e.g. impact

of

> > hospital based clinics).

> >

> > Dr. Sumesh , PT, DPT, OCS

> >

> > P.S. Most of my patients wait longer than expected before being

able to

> > see specialists or undergo imaging studies, and a few become non-

compliant

> > with their prescribed medications due to cost and other insurance

issues.

> In

> > addition, although I have family and friends in many counties with

> > socialized healthcare none of them have expressed a desire to

come to the

> US

> > for healthcare.

> >

> >

> > Effect of National Health Care on Private

Practice

> > Physical Therapy Clinics

> >

> > Dear Group,

> >

> > This is more of an information gathering post than an information

giving

> > post, so I'll get right to it. In my research over the last few

years of

> > politics and political agendas, I have come to the conclusion that

> > allowing

> > the government to enact any plan of Nationalized Healthcare -

outside of

> > Medicare, Medicaid, and SCHIP as they are right now - would in

effect put

> > all of our private practices out of business. I believe that the

lack of

> > choices available to the general public, and the government being

in

> > control

> > of yet another failing system in this country would destroy

competition in

> > our industry, and would be a great benefit to hospital based

therapy

> > services, but would be terrible for private practice. I don't

know what it

> > is like trying to get credentialed with HMO insurance companies

outside of

> > Wisconsin, but in our practice, we have been told in no uncertain

terms

> > that

> > we will NEVER be allowed in any HMO network as long as there is a

hospital

> > based clinic within 20 miles of us.

> >

> > Consequently, there are at least 4 hospital based clinics within

20 miles

> > of

> > our clinic, and all of our attempts to join HMO networks, so that

we might

> > be able to cater to a larger range of patients, has ended in a

denial from

> > the insurance company for the very reason listed above. With the

> > government

> > possibly taking over Healthcare for everyone, it becomes easy to

imagine

> > that they would want to sped as little money as possible in order

to cover

> > as many people as possible, and HMO Health Insurance will become

the norm

> > in

> > our industry, making it nearly impossible to serve those patients

unless

> > they are willing to pay out of pocket. This is severely unlikely,

being

> > that they could just go to the hospital based clinic down the

block and

> > get

> > " free " Physical Therapy because it's covered under their taxpayer

funded -

> > and capped like Medicare - Health plan.

> >

> > Not only do we have to worry about the HMO issue, but we also

have to

> > worry

> > about the hospitals and their bureaucrats being able to charge

less than

> > private practices to " the insurance company " than we can because

they have

> > so much more revenue to go around to keep them in business, and

keep us

> > out

> > of competition just by undercutting our prices.

> >

> > So, with that out of the way, I'd like to know how some of you

are dealing

> > with the prospect of having Nationalized Health Care... By the

way, if you

> > can give me good, viable, verifiable reasons why Nationalized

Health Care

> > might actually benefit Private Practices, I might be swayed, but

as yet,

> > the

> > best argument anyone can come up with is that the cheapest

insurance pool

> > is

> > one where everyone is enrolled. I often hear the same poor

arguments, and

> > then I look to countries that have had National Health Care

programs for

> > years like Great Britain and Canada, who's patients are literally

flying

> > to

> > the United States in droves just to get their healthcare NOW

instead of

> > having to wait up to 6 months for a CT scan when cancer is the

likely

> > diagnosis. In most cases, if a patient has a possible brain cancer

> > diagnosis, 6 months could very well be too late. I don't want to

have that

> > risk here in this country... it scares me.

> >

> > Adam Jeschke

> > Optimal PT

> > Lake Mills, WI

> >

> >

> >

[Guest guest]

Had a recent talk with a patient from Canada, as well as several in the

past. Basically what you will hear when you do this is that routine and

emergency care is prompt and appropriate. However, and this is a big one

for us, things like joint replacements, cuff repair, ect, basically any non

life threatening issue usually means a very long wait. i.e. - these

services are rationed and overall less delivered. The ramifications for PT

are obvious.

Joe Ruzich, PT

Pueblo, CO

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Dick Hillyer

Sent: Friday, January 18, 2008 6:04 PM

To: PTManager

Subject: RE: Re: Effect of National Health Care on Private

Practice Physical Therapy Clinics

Hi, folks!

I may not have enjoyed a discussion this much since I taught graduate

economics!

Just to clarify in the interest of Evidence Based Practice Management: The

reference to " single payer " meaning you may not be quite supported. The

single payer is a gentle way of saying " the government " .

" Single-payer is basically a way some countries use to provide its citizens

with health insurance. (Sounds very boring, I know. But keep reading!) Its

name comes from the fact that doctors and hospitals are paid by one

organization: a single payer. By having only one payer, you can simplify the

health care system enormously. " (What is single payer? Available at:

http://www.grahamaz <http://www.grahamazon.com/sp/what.php>

on.com/sp/what.php Accessed January 18, 2008)

Thanks to Tom Howell for his view. If you really want to see a debate on

the role of a strong central government, read The Federalist Papers. These

were written to clarify the intent of the founders, right around the time if

the Constitution.

As PTs and others anguish over how to pursue their dream, which for some

includes self-employment, we really are on the leading edge of being

impacted by the intersection of the line of rising costs with the flat to

declining line of reimbursement.

Oh yes - Health Insurance Companies are not in business for the altruistic

reasons that many PTs are. They're financial institutions, and their

shareholders expect them to spend far less (on medical expenses) than they

take in.

Best regards,

Dick Hillyer, PT,DPT,MBA,MSM

Dr. W. Hillyer

Hillyer Consulting

The Institute for Rehab Management

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Office

Mobile

_____

From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

[mailto:PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com] On

Behalf

Of Adam Jeschke

Sent: Friday, January 18, 2008 5:05 PM

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

Subject: Re: Re: Effect of National Health Care on Private

Practice Physical Therapy Clinics

Good points ... but switching to a Single Payer system (the Single Payer

being you) would not solve any of our rising costs of health care. What

WOULD solve the problem is opening up the industry to the free market. As

of now, everything is regulated, taxed, audited, and controlled by Corporate

Insurance... In the days before Blue Cross, WPS, Aetna, Humana, and

Medicare, churches ran hospitals, and those that couldn't afford care were

seen pro-bono... This is why we have names like St. Luke's, St. Help of

Christians, St. 's, etc. as names for hospitals... In all this

discussion, I never said it would be good to stay in the current system,

just that nationalizing it, and allowing the government to control it is NOT

anywhere close to the solution.

Adam Jeschke

Optimal Physical Therapy

Lake Mills, WI

On Jan 18, 2008 12:00 PM, s <dosrincatt (DOT)

<mailto:dosrinc%40att.net> net> wrote:

> Dear Listserve,

>

> Great discussion. This has been a topic of great interest for me as

> a father and a business owner. The one thing I do know is that we

> cannot include a 50% tax issue in the argument if we dont also

> discuss the current cost of health care premiums. Those of you who

> are covered by your employer or your spouses employer may not think

> that you are currently being taxed for your healthcare but you are.

> When we look at what we can afford to pay someone we must look at

> the whole wage/salary/benefit package. The cost of our employees

> healthcare is included in that package, it comes out of your

> potential salary. If the cost of your healthcare coverage goes up

> 25% annually and reimbursement goes down 1-5% annually do you think

> that your salary will continue to rise? Do you realize that what I

> as an employer pay out annually to cover the health insurance of my

> employees significantly limits what I am able to pay into their SEP

> IRA's and profit sharing bonuses. YES IT DOES! If their is no

> profit, there is no profit to share!!! YOU ARE CURRENTLY BEING

> TAXED AND YOUR COVERAGE MAY STILL STINK!!!

>

> I dont know the answers but I do know that the current system is

> broken and it starts with the insurance companies. They have had

> their chance and they were too greedy to realize just how good they

> had things. They were more concerned about taking care of their

> shareholders than their customers and they need to suffer the

> consequences. I have friends who are insurance agents who make six

> figure salaries, high school to four year degree graduates who do

> nothing more than sell insurance that make more than the providers

> of the care they sell. Remember, these people are not insuring

> anybody, they take no risk, they simply sell the stuff and they take

> home a bigger piece of the pie than we do. The current system is

> out of order.

>

> Keep up the discussion, thanks!

>

> E. s, PT, DPT, OCS, FAAOMPT

> www.douglasspt.com

>

>

> > >

> > > > In reference to Mr. Jeschke's comments I actually believe

> there

> > are

> > > > advantages and disadvantages in both a socialized healthcare

> > environment and

> > > > in a capitalistic healthcare environment. The bottom line

> depends

> > on whom it

> > > > benefits. It is in the best financial interest of the average

> > consumer to be

> > > > in an environment where healthcare is delivered in a

> socialized

> > manner as in

> > > > most industrialized nations, but it is in the best financial

> > interest of

> > > > myself and other busienss owners/executives (e.g. private

> > practice owners,

> > > > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

> > etc.),

> > > > hospital executives, SNF owners and executives, Home Health

> > Agency owners

> > > > and executives, contracting agency owners, and physicians who

> own

> > PT

> > > > practices and CORFs) to do business in capitalistic

> environments

> > where we

> > > > can " capitalize " on opportunties created by healthcare.

> > > >

> > > > If we don't change our business philosophies and policies,

> then

> > others

> > > > will. Although, many business owners are willing to offer

> > employment

> > > > opportunities to physical therapists, assistants, athletic

> > trainers, etc...

> > > > to capitalize on the opportunites described above, few are

> > willing to share

> > > > ownership. To prevent non-physical therapists from OWNING

> physical

> > > > therapists and physical therapy assistants we MUST empower our

> > colleagues

> > > > with partnership/ownership opportunites. When we understand

> and

> > share the

> > > > rewards and losses of owning a physical therapy business, only

> > then we will

> > > > be able to truely understand the implications associated with

> non-

> > physical

> > > > therapists having control of our present and future (e.g.

> impact

> > of

> > > > hospital based clinics).

> > > >

> > > > Dr. Sumesh , PT, DPT, OCS

> > > >

> > > > P.S. Most of my patients wait longer than expected before

> being

> > able to

> > > > see specialists or undergo imaging studies, and a few become

> non-

> > compliant

> > > > with their prescribed medications due to cost and other

> insurance

> > issues. In

> > > > addition, although I have family and friends in many counties

> with

> > > > socialized healthcare none of them have expressed a desire to

> > come to the US

> > > > for healthcare.

> > > >

> > > >

> > > > Effect of National Health Care on Private

> > Practice

> > > > Physical Therapy Clinics

> > > >

> > > > Dear Group,

> > > >

> > > > This is more of an information gathering post than an

> information

> > giving

> > > > post, so I'll get right to it. In my research over the last

> few

> > years of

> > > > politics and political agendas, I have come to the conclusion

> that

> > > > allowing

> > > > the government to enact any plan of Nationalized Healthcare -

> > outside of

> > > > Medicare, Medicaid, and SCHIP as they are right now - would in

> > effect put

> > > > all of our private practices out of business. I believe that

> the

> > lack of

> > > > choices available to the general public, and the government

> being

> > in

> > > > control

> > > > of yet another failing system in this country would destroy

> > competition in

> > > > our industry, and would be a great benefit to hospital based

> > therapy

> > > > services, but would be terrible for private practice. I don't

> > know what it

> > > > is like trying to get credentialed with HMO insurance

> companies

> > outside of

> > > > Wisconsin, but in our practice, we have been told in no

> uncertain

> > terms

> > > > that

> > > > we will NEVER be allowed in any HMO network as long as there

> is a

> > hospital

> > > > based clinic within 20 miles of us.

> > > >

> > > > Consequently, there are at least 4 hospital based clinics

> within

> > 20 miles

> > > > of

> > > > our clinic, and all of our attempts to join HMO networks, so

> that

> > we might

> > > > be able to cater to a larger range of patients, has ended in a

> > denial from

> > > > the insurance company for the very reason listed above. With

> the

> > > > government

> > > > possibly taking over Healthcare for everyone, it becomes easy

> to

> > imagine

> > > > that they would want to sped as little money as possible in

> order

> > to cover

> > > > as many people as possible, and HMO Health Insurance will

> become

> > the norm

> > > > in

> > > > our industry, making it nearly impossible to serve those

> patients

> > unless

> > > > they are willing to pay out of pocket. This is severely

> unlikely,

> > being

> > > > that they could just go to the hospital based clinic down the

> > block and

> > > > get

> > > > " free " Physical Therapy because it's covered under their

> taxpayer

> > funded -

> > > > and capped like Medicare - Health plan.

> > > >

> > > > Not only do we have to worry about the HMO issue, but we also

> > have to

> > > > worry

> > > > about the hospitals and their bureaucrats being able to charge

> > less than

> > > > private practices to " the insurance company " than we can

> because

> > they have

> > > > so much more revenue to go around to keep them in business,

> and

> > keep us

> > > > out

> > > > of competition just by undercutting our prices.

> > > >

> > > > So, with that out of the way, I'd like to know how some of you

> > are dealing

> > > > with the prospect of having Nationalized Health Care... By the

> > way, if you

> > > > can give me good, viable, verifiable reasons why Nationalized

> > Health Care

> > > > might actually benefit Private Practices, I might be swayed,

> but

> > as yet,

> > > > the

> > > > best argument anyone can come up with is that the cheapest

> > insurance pool

> > > > is

> > > > one where everyone is enrolled. I often hear the same poor

> > arguments, and

> > > > then I look to countries that have had National Health Care

> > programs for

> > > > years like Great Britain and Canada, who's patients are

> literally

> > flying

> > > > to

> > > > the United States in droves just to get their healthcare NOW

> > instead of

> > > > having to wait up to 6 months for a CT scan when cancer is the

> > likely

> > > > diagnosis. In most cases, if a patient has a possible brain

> cancer

> > > > diagnosis, 6 months could very well be too late. I don't want

> to

> > have that

> > > > risk here in this country... it scares me.

> > > >

> > > > Adam Jeschke

> > > > Optimal PT

> > > > Lake Mills, WI

> > > >

> > > >

> > > >

[Guest guest]

Dave,

Thank you for linking The Weston A. Price Foundation website. It has become

part of our daily lives through research, cooking and shopping. We no

longer " like " non-organic food, storebought milk, or processed food of any

kind. After realizing how easy it is to cook high fat, healthy foods that

actually increase your metabolism, raise your body's ability to fight

infection, and indeed, help you to lose weight and stay healthier, we've

even stopped going to fast food restaurants unless we are in a rush and need

food " right now " .

While you may disagree with Loren on her review of the book, you must admit

that proper diet, nutrition, exercise, and ending dependence on medication,

would in fact make this country less dependent on the health care system,

and thus end the " health care crisis " . We have a high deductible insurance

plan because we don't ever USE our insurance, and if we ever need it, it

would be for something like an emergency surgery or catastrophic event. A

healthy lifestyle leads to healthy individuals, and eventually, a healthy

community, and a healthy overall population. Allowing the current trends to

continue, I could see this country becoming very much like the population of

the movie " Idiocracy " , which I have already seen in certain areas of the

Health Care and Political system.

" We need Hillary because she has electrolytes!! " " What are electrolytes

good for? " " I dunno, but Hillary's got them!! "

Sounds like we're going in that direction right now, eh?

Adam Jeschke

Optimal Physical Therapy, LLC

Lake Mills WI

> Loren,

>

> Reading your post was interesting to me. I am familiar with The China

> Study, and in (nearly) complete disagreement with Dr. . While he

> rightly points out that modern medicine may very well be responsible for our

> hyper-diseased state today, he generally blames animal food products for the

> mess, despite very strong anthropological evidence that high-quality animal

> fats and proteins are not only healthy, but biologically necessary (and, not

> incidentally, a part of every healthy society's diet--sometimes a huge

> part). A review of his book more in line with my thoughts can be found here,

> if you're interested:

>

> http://www.westonaprice.org/bookreviews/chinastudy.html

>

> The key thing for us right now, though, is that, according to today's

> systems, Loren and Dave are not allowed to enjoy the fruits of their own

> opinions, because the rules say that we will all be taxed and otherwise

> charged for " health " care according to one particular system--the AMA

> system. (About the only health advice we get there is the ever-changing,

> always wrong but never in doubt, food pyramid.)

>

> As they taught us all in grade school, each and every American has the

> right to live by our own rules, up to the point that we infringe on the

> rights of others. In today's healthcare world, that elegant little gem has

> been turned upside down.

>

> Dave

>

>

> Dave Milano, PT, Director of Rehab Services

>

> Laurel Health System

>

> Re: Effect of National Health Care on Private

> Practice Physical Therapy Clinics

>

> Dave,

>

> You make some excellent points, and I had to chime in with some

> recommended reading. In your first paragraph you mention the

> epidemic incidence in North America of diseases such as heart

> disease, cancer, arthritis, diabetes, MS, osteoporosis, etc. The

> answer to these diseases is NOT to throw more money into developing

> more drugs with side-effects often worse than the disease itself.

> The answer is education regarding the undeniable link between

> lifestyle (nutrition, etc) and these diseases. Colleagues, for the

> sake of yourselves and your families, PLEASE get and read the

> book " The China Study " by T. Colin , PHD. I have no

> affiliation with him whatsoever but recognize the life-changing

> information he has put together in this book. The name is somewhat

> misleading as it actually contains the results of about 27 years of

> research continuously funded by grants from organizations such as the

> National Institute of Health and the American Cancer Society. Much

> of it is published in peer-reviewed articles in the JAMA and Lancet

> journals. If 25% of Americans followed the advice in this book, we

> would have no health insurance crisis.

>

> Thanks,

>

> Loren Munson, MPT

> Director of Rehabilitation

> Sonora Regional Medical Center

>

>

> >

> > > In reference to Mr. Jeschke's comments I actually believe there

> are

> > > advantages and disadvantages in both a socialized healthcare

> environment

> > and

> > > in a capitalistic healthcare environment. The bottom line depends

> on whom

> > it

> > > benefits. It is in the best financial interest of the average

> consumer to

> > be

> > > in an environment where healthcare is delivered in a socialized

> manner as

> > in

> > > most industrialized nations, but it is in the best financial

> interest of

> > > myself and other busienss owners/executives (e.g. private

> practice owners,

> > > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

> etc.),

> > > hospital executives, SNF owners and executives, Home Health

> Agency owners

> > > and executives, contracting agency owners, and physicians who own

> PT

> > > practices and CORFs) to do business in capitalistic environments

> where we

> > > can " capitalize " on opportunties created by healthcare.

> > >

> > > If we don't change our business philosophies and policies, then

> others

> > > will. Although, many business owners are willing to offer

> employment

> > > opportunities to physical therapists, assistants, athletic

> trainers,

> > etc...

> > > to capitalize on the opportunites described above, few are

> willing to

> > share

> > > ownership. To prevent non-physical therapists from OWNING physical

> > > therapists and physical therapy assistants we MUST empower our

> colleagues

> > > with partnership/­ownership opportunites. When we understand and

> share the

> > > rewards and losses of owning a physical therapy business, only

> then we

> > will

> > > be able to truely understand the implications associated with non-

> physical

> > > therapists having control of our present and future (e.g. impact

> of

> > > hospital based clinics).

> > >

> > > Dr. Sumesh , PT, DPT, OCS

> > >

> > > P.S. Most of my patients wait longer than expected before being

> able to

> > > see specialists or undergo imaging studies, and a few become non-

> compliant

> > > with their prescribed medications due to cost and other insurance

> issues.

> > In

> > > addition, although I have family and friends in many counties with

> > > socialized healthcare none of them have expressed a desire to

> come to the

> > US

> > > for healthcare.

> > >

> > >

> > > Effect of National Health Care on Private

> Practice

> > > Physical Therapy Clinics

> > >

> > > Dear Group,

> > >

> > > This is more of an information gathering post than an information

> giving

> > > post, so I'll get right to it. In my research over the last few

> years of

> > > politics and political agendas, I have come to the conclusion that

> > > allowing

> > > the government to enact any plan of Nationalized Healthcare -

> outside of

> > > Medicare, Medicaid, and SCHIP as they are right now - would in

> effect put

> > > all of our private practices out of business. I believe that the

> lack of

> > > choices available to the general public, and the government being

> in

> > > control

> > > of yet another failing system in this country would destroy

> competition in

> > > our industry, and would be a great benefit to hospital based

> therapy

> > > services, but would be terrible for private practice. I don't

> know what it

> > > is like trying to get credentialed with HMO insurance companies

> outside of

> > > Wisconsin, but in our practice, we have been told in no uncertain

> terms

> > > that

> > > we will NEVER be allowed in any HMO network as long as there is a

> hospital

> > > based clinic within 20 miles of us.

> > >

> > > Consequently, there are at least 4 hospital based clinics within

> 20 miles

> > > of

> > > our clinic, and all of our attempts to join HMO networks, so that

> we might

> > > be able to cater to a larger range of patients, has ended in a

> denial from

> > > the insurance company for the very reason listed above. With the

> > > government

> > > possibly taking over Healthcare for everyone, it becomes easy to

> imagine

> > > that they would want to sped as little money as possible in order

> to cover

> > > as many people as possible, and HMO Health Insurance will become

> the norm

> > > in

> > > our industry, making it nearly impossible to serve those patients

> unless

> > > they are willing to pay out of pocket. This is severely unlikely,

> being

> > > that they could just go to the hospital based clinic down the

> block and

> > > get

> > > " free " Physical Therapy because it's covered under their taxpayer

> funded -

> > > and capped like Medicare - Health plan.

> > >

> > > Not only do we have to worry about the HMO issue, but we also

> have to

> > > worry

> > > about the hospitals and their bureaucrats being able to charge

> less than

> > > private practices to " the insurance company " than we can because

> they have

> > > so much more revenue to go around to keep them in business, and

> keep us

> > > out

> > > of competition just by undercutting our prices.

> > >

> > > So, with that out of the way, I'd like to know how some of you

> are dealing

> > > with the prospect of having Nationalized Health Care... By the

> way, if you

> > > can give me good, viable, verifiable reasons why Nationalized

> Health Care

> > > might actually benefit Private Practices, I might be swayed, but

> as yet,

> > > the

> > > best argument anyone can come up with is that the cheapest

> insurance pool

> > > is

> > > one where everyone is enrolled. I often hear the same poor

> arguments, and

> > > then I look to countries that have had National Health Care

> programs for

> > > years like Great Britain and Canada, who's patients are literally

> flying

> > > to

> > > the United States in droves just to get their healthcare NOW

> instead of

> > > having to wait up to 6 months for a CT scan when cancer is the

> likely

> > > diagnosis. In most cases, if a patient has a possible brain cancer

> > > diagnosis, 6 months could very well be too late. I don't want to

> have that

> > > risk here in this country... it scares me.

> > >

> > > Adam Jeschke

> > > Optimal PT

> > > Lake Mills, WI

> > >

> > >

> > >

[Guest guest]

Joe,

I have many friends from around the world, being involved in all things

" IT " , and I have gotten the very same impression from anyone I've talked to

where the government controls or " regulates " health care. We're in for a

big drop in not only being able to get patients, but also being to

effectively treat them, and retain them for any length of time past a

government mandated " cap " on funds or " cap " on visits for PT.

Adam... Again...

> Had a recent talk with a patient from Canada, as well as several in the

> past. Basically what you will hear when you do this is that routine and

> emergency care is prompt and appropriate. However, and this is a big one

> for us, things like joint replacements, cuff repair, ect, basically any

> non

> life threatening issue usually means a very long wait. i.e. - these

> services are rationed and overall less delivered. The ramifications for PT

> are obvious.

>

> Joe Ruzich, PT

>

> Pueblo, CO

>

>

> _____

>

> From: PTManager <PTManager%40yahoogroups.com> [mailto:

> PTManager <PTManager%40yahoogroups.com>] On Behalf

> Of Dick Hillyer

> Sent: Friday, January 18, 2008 6:04 PM

> To: PTManager <PTManager%40yahoogroups.com>

> Subject: RE: Re: Effect of National Health Care on Private

> Practice Physical Therapy Clinics

>

> Hi, folks!

>

> I may not have enjoyed a discussion this much since I taught graduate

> economics!

>

> Just to clarify in the interest of Evidence Based Practice Management: The

> reference to " single payer " meaning you may not be quite supported. The

> single payer is a gentle way of saying " the government " .

>

> " Single-payer is basically a way some countries use to provide its

> citizens

> with health insurance. (Sounds very boring, I know. But keep reading!) Its

> name comes from the fact that doctors and hospitals are paid by one

> organization: a single payer. By having only one payer, you can simplify

> the

> health care system enormously. " (What is single payer? Available at:

> http://www.grahamaz <http://www.grahamazon.com/sp/what.php>

> on.com/sp/what.php Accessed January 18, 2008)

>

> Thanks to Tom Howell for his view. If you really want to see a debate on

> the role of a strong central government, read The Federalist Papers. These

> were written to clarify the intent of the founders, right around the time

> if

> the Constitution.

>

> As PTs and others anguish over how to pursue their dream, which for some

> includes self-employment, we really are on the leading edge of being

> impacted by the intersection of the line of rising costs with the flat to

> declining line of reimbursement.

>

> Oh yes - Health Insurance Companies are not in business for the altruistic

> reasons that many PTs are. They're financial institutions, and their

> shareholders expect them to spend far less (on medical expenses) than they

> take in.

>

> Best regards,

> Dick Hillyer, PT,DPT,MBA,MSM

>

> Dr. W. Hillyer

> Hillyer Consulting

> The Institute for Rehab Management

> 700 El Dorado Pkwy W.

> Cape Coral, FL 33914

> Office

> Mobile

>

> _____

>

> From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

> [mailto:PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com]

> On

> Behalf

> Of Adam Jeschke

> Sent: Friday, January 18, 2008 5:05 PM

> To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

>

> Subject: Re: Re: Effect of National Health Care on Private

> Practice Physical Therapy Clinics

>

> Good points ... but switching to a Single Payer system (the Single

> Payer

> being you) would not solve any of our rising costs of health care. What

> WOULD solve the problem is opening up the industry to the free market. As

> of now, everything is regulated, taxed, audited, and controlled by

> Corporate

> Insurance... In the days before Blue Cross, WPS, Aetna, Humana, and

> Medicare, churches ran hospitals, and those that couldn't afford care were

> seen pro-bono... This is why we have names like St. Luke's, St. Help

> of

> Christians, St. 's, etc. as names for hospitals... In all this

> discussion, I never said it would be good to stay in the current system,

> just that nationalizing it, and allowing the government to control it is

> NOT

> anywhere close to the solution.

>

> Adam Jeschke

> Optimal Physical Therapy

> Lake Mills, WI

>

>

> On Jan 18, 2008 12:00 PM, s <dosrincatt (DOT)

> <mailto:dosrinc%40att.net> net> wrote:

>

> > Dear Listserve,

> >

> > Great discussion. This has been a topic of great interest for me as

> > a father and a business owner. The one thing I do know is that we

> > cannot include a 50% tax issue in the argument if we dont also

> > discuss the current cost of health care premiums. Those of you who

> > are covered by your employer or your spouses employer may not think

> > that you are currently being taxed for your healthcare but you are.

> > When we look at what we can afford to pay someone we must look at

> > the whole wage/salary/benefit package. The cost of our employees

> > healthcare is included in that package, it comes out of your

> > potential salary. If the cost of your healthcare coverage goes up

> > 25% annually and reimbursement goes down 1-5% annually do you think

> > that your salary will continue to rise? Do you realize that what I

> > as an employer pay out annually to cover the health insurance of my

> > employees significantly limits what I am able to pay into their SEP

> > IRA's and profit sharing bonuses. YES IT DOES! If their is no

> > profit, there is no profit to share!!! YOU ARE CURRENTLY BEING

> > TAXED AND YOUR COVERAGE MAY STILL STINK!!!

> >

> > I dont know the answers but I do know that the current system is

> > broken and it starts with the insurance companies. They have had

> > their chance and they were too greedy to realize just how good they

> > had things. They were more concerned about taking care of their

> > shareholders than their customers and they need to suffer the

> > consequences. I have friends who are insurance agents who make six

> > figure salaries, high school to four year degree graduates who do

> > nothing more than sell insurance that make more than the providers

> > of the care they sell. Remember, these people are not insuring

> > anybody, they take no risk, they simply sell the stuff and they take

> > home a bigger piece of the pie than we do. The current system is

> > out of order.

> >

> > Keep up the discussion, thanks!

> >

> > E. s, PT, DPT, OCS, FAAOMPT

> > www.douglasspt.com

> >

> >

> > > >

> > > > > In reference to Mr. Jeschke's comments I actually believe

> > there

> > > are

> > > > > advantages and disadvantages in both a socialized healthcare

> > > environment and

> > > > > in a capitalistic healthcare environment. The bottom line

> > depends

> > > on whom it

> > > > > benefits. It is in the best financial interest of the average

> > > consumer to be

> > > > > in an environment where healthcare is delivered in a

> > socialized

> > > manner as in

> > > > > most industrialized nations, but it is in the best financial

> > > interest of

> > > > > myself and other busienss owners/executives (e.g. private

> > > practice owners,

> > > > > corporate executives (e.g. HealthSouth, Physiotherapy Assoc.,

> > > etc.),

> > > > > hospital executives, SNF owners and executives, Home Health

> > > Agency owners

> > > > > and executives, contracting agency owners, and physicians who

> > own

> > > PT

> > > > > practices and CORFs) to do business in capitalistic

> > environments

> > > where we

> > > > > can " capitalize " on opportunties created by healthcare.

> > > > >

> > > > > If we don't change our business philosophies and policies,

> > then

> > > others

> > > > > will. Although, many business owners are willing to offer

> > > employment

> > > > > opportunities to physical therapists, assistants, athletic

> > > trainers, etc...

> > > > > to capitalize on the opportunites described above, few are

> > > willing to share

> > > > > ownership. To prevent non-physical therapists from OWNING

> > physical

> > > > > therapists and physical therapy assistants we MUST empower our

> > > colleagues

> > > > > with partnership/ownership opportunites. When we understand

> > and

> > > share the

> > > > > rewards and losses of owning a physical therapy business, only

> > > then we will

> > > > > be able to truely understand the implications associated with

> > non-

> > > physical

> > > > > therapists having control of our present and future (e.g.

> > impact

> > > of

> > > > > hospital based clinics).

> > > > >

> > > > > Dr. Sumesh , PT, DPT, OCS

> > > > >

> > > > > P.S. Most of my patients wait longer than expected before

> > being

> > > able to

> > > > > see specialists or undergo imaging studies, and a few become

> > non-

> > > compliant

> > > > > with their prescribed medications due to cost and other

> > insurance

> > > issues. In

> > > > > addition, although I have family and friends in many counties

> > with

> > > > > socialized healthcare none of them have expressed a desire to

> > > come to the US

> > > > > for healthcare.

> > > > >

> > > > >

> > > > > Effect of National Health Care on Private

> > > Practice

> > > > > Physical Therapy Clinics

> > > > >

> > > > > Dear Group,

> > > > >

> > > > > This is more of an information gathering post than an

> > information

> > > giving

> > > > > post, so I'll get right to it. In my research over the last

> > few

> > > years of

> > > > > politics and political agendas, I have come to the conclusion

> > that

> > > > > allowing

> > > > > the government to enact any plan of Nationalized Healthcare -

> > > outside of

> > > > > Medicare, Medicaid, and SCHIP as they are right now - would in

> > > effect put

> > > > > all of our private practices out of business. I believe that

> > the

> > > lack of

> > > > > choices available to the general public, and the government

> > being

> > > in

> > > > > control

> > > > > of yet another failing system in this country would destroy

> > > competition in

> > > > > our industry, and would be a great benefit to hospital based

> > > therapy

> > > > > services, but would be terrible for private practice. I don't

> > > know what it

> > > > > is like trying to get credentialed with HMO insurance

> > companies

> > > outside of

> > > > > Wisconsin, but in our practice, we have been told in no

> > uncertain

> > > terms

> > > > > that

> > > > > we will NEVER be allowed in any HMO network as long as there

> > is a

> > > hospital

> > > > > based clinic within 20 miles of us.

> > > > >

> > > > > Consequently, there are at least 4 hospital based clinics

> > within

> > > 20 miles

> > > > > of

> > > > > our clinic, and all of our attempts to join HMO networks, so

> > that

> > > we might

> > > > > be able to cater to a larger range of patients, has ended in a

> > > denial from

> > > > > the insurance company for the very reason listed above. With

> > the

> > > > > government

> > > > > possibly taking over Healthcare for everyone, it becomes easy

> > to

> > > imagine

> > > > > that they would want to sped as little money as possible in

> > order

> > > to cover

> > > > > as many people as possible, and HMO Health Insurance will

> > become

> > > the norm

> > > > > in

> > > > > our industry, making it nearly impossible to serve those

> > patients

> > > unless

> > > > > they are willing to pay out of pocket. This is severely

> > unlikely,

> > > being

> > > > > that they could just go to the hospital based clinic down the

> > > block and

> > > > > get

> > > > > " free " Physical Therapy because it's covered under their

> > taxpayer

> > > funded -

> > > > > and capped like Medicare - Health plan.

> > > > >

> > > > > Not only do we have to worry about the HMO issue, but we also

> > > have to

> > > > > worry

> > > > > about the hospitals and their bureaucrats being able to charge

> > > less than

> > > > > private practices to " the insurance company " than we can

> > because

> > > they have

> > > > > so much more revenue to go around to keep them in business,

> > and

> > > keep us

> > > > > out

> > > > > of competition just by undercutting our prices.

> > > > >

> > > > > So, with that out of the way, I'd like to know how some of you

> > > are dealing

> > > > > with the prospect of having Nationalized Health Care... By the

> > > way, if you

> > > > > can give me good, viable, verifiable reasons why Nationalized

> > > Health Care

> > > > > might actually benefit Private Practices, I might be swayed,

> > but

> > > as yet,

> > > > > the

> > > > > best argument anyone can come up with is that the cheapest

> > > insurance pool

> > > > > is

> > > > > one where everyone is enrolled. I often hear the same poor

> > > arguments, and

> > > > > then I look to countries that have had National Health Care

> > > programs for

> > > > > years like Great Britain and Canada, who's patients are

> > literally

> > > flying

> > > > > to

> > > > > the United States in droves just to get their healthcare NOW

> > > instead of

> > > > > having to wait up to 6 months for a CT scan when cancer is the

> > > likely

> > > > > diagnosis. In most cases, if a patient has a possible brain

> > cancer

> > > > > diagnosis, 6 months could very well be too late. I don't want

> > to

> > > have that

> > > > > risk here in this country... it scares me.

> > > > >

> > > > > Adam Jeschke

> > > > > Optimal PT

> > > > > Lake Mills, WI

> > > > >

> > > > >

> > > > >