I read with great interest this blog post from the Office of Management and Budget’s director Peter Orszag about tough questions from healthcare including how expansion will be paid and what types of innovation needed to be pursued.
Thankfully, Mr. Orszag not only read Dr. Guwande’s great article regarding the excessive cost of healthcare in McAllen, Texas, he pursued additional information as well. Why does McAllen spend almost twice the national average per medicare enrollee ($15,000) and almost $3000 more than their per capita income? Overutilization driven in large part by physician self-interest particularly their “business” interests. There is also no doubt that overutilization is also driven by defensive medicine and aggressive attorneys coupled with a fee for service system that encourages more over better.
Mr. Orszag’s blog lists categories of innovation that will be part of changes including IT, “effectiveness” research, prevention and wellness, and changes in incentives that assures best care and not more care.
My hope is that as PT’s we don’t get sucked into trumpeting ourselves as the “prevention and wellness” profession. Let’s not kid ourselves, that would not position us in a major way in reform and attempts to do this should be challenged. Instead, we ought to push a proven model of PT’s as important provider via extenders in musculoskeletal medicine.
If we are to put an additional 50 million people in the system, we need proven models and deregulation that allows PTs to be used as force multipliers as the current system due to physician shortage cannot handle this additional load. We ought to be trumpeting the exemplars of PT-namely the US Military System as THE model for healthcare. We don’t need to look to socialized countries or any other “experiment”-the best example is right in front of us.
Military medicine works off of the theory that there are too many people who need care and not enough providers. PT’s have been providing direct access, primary musculoskeletal care for years in the military settings for both active duty, retirees, and dependents. In some cases they are granted prescriptive authority for both meds and imaging. It’s a system that works in large part because the government absolves themselves of all the rules they place on us in the medicare system.
As debate unfolds, be leery of the trap to push us forward as “wellness and prevention” experts. Our best position in reform is our efficacy, cost-effectiveness, and expertise is in musculoskeletal medicine.
Thoughts?
