Primary Care and Healthcare Access

Another healthcare issue for persons with disabilities is physical access. 

Physical access goes beyond ramps and elevators.  It includes restrooms, exam rooms and any other room or space that is ordinarily accessed by patients.

There are standards for all accessible bathrooms put out by the Federal Access Board.

More recently, this same Federal Access Board has published guidelines for accessible healthcare facilities.  These guidelines include adequate space between and in exam rooms, accessible exam tables, lifts, scales and other equipment.  Almost no healthcare facilities meet these guidelines.

Primary care providers are the ones who see persons with disabilities the most, since they are in charge of coordinating all the other care.  Yet, these very same providers are paid the least and so are least able to afford the equipment needed by persons with disabilities.  This puts all of us who need this type of equipment at a disadvantage.

This is one more reason that this country needs to address the issues related to primary care.  No healthcare system, managed care, fee-for-service, or any other configuration, will work until we can provide stable, quality, accessible primary care.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

High Cost of Low Pay for Primary Care

Something for insurers to consider when setting reimbursement rates is that the shortage of primary care physicians plays a role in raising the cost of healthcare.

When there is no primary care physician available, people tend to go to the more expensive provider – emergency rooms.  While walk-in centers fill the gap for some, many walk-in centers do not take Medicaid, so persons with disabilities usually have to opt for the most expensive service available, simply because it is available.  This should be a real cause for concern since it means that people who use healthcare services the most are using the most expensive services.

This problem is not resolved by health centers and health systems if they have do not retain the same primary care providers.  This is because coverage and continuity of care are not interchangeable.  Coverage may be provided by new primary care physicians, but the time needed to develop the relationship that assures continuity of care is not there.  So, even with new good primary care physicians, the default option for some people will still be the emergency room.

Consider this – a person with a disability feels ill.  This person has not yet really connected with a  new primary care physician after his or her previous one has left a practice.  This person then faces the choice of calling a stranger (new but not yet established primary care doctor), and wait for a call back, with no certainty of whether or when that stranger will be available, or going to an emergency room where he or she will certainly be seen, even by a stranger.  For some disabilities, a minor problem can escalate to a major one quickly so the certainty of care will be the choice in almost every case.  This problem does not get resolved by the instant transfer of medical records either, since that transfer does not establish the relationship that is necessary for true continuity of care.

So, if paying primary care physicians less causes poorer healthcare delivery at a higher price it seems logical that Medicare, Medicaid and all other insurers should re-evaluate the reimbursement structure, looking at the bigger picture.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Shortage of Primary Care Doctors

The United States Department of Health and Human Services Health Resources and Services Administration has designated more than half the states in the U.S. as Primary Care Health Professional Shortage Areas.  Does this scare you?

While the reasons for this shortage are many and complex, one reason for this shortage is that health care providers in this group are paid significantly less than specialists.  The low pay leads to fewer physicians going into primary and the need for some primary care providers to move to other practices more frequently in order to earn more money.

This is a problem for all healthcare consumers, but it puts persons with disabilities in a particularly difficult position. 

Optimal healthcare is usually achieved through a partnership between the patient and healthcare provider.  This partnership takes time to establish.  This partnership then directs the tone and direction of other services.  Then, of course, it is left up to the primary care provider to write referrals and prescriptions and letters of necessity for these other services.  When a person cannot connect with a primary care physician or when primary care physicians come and go, this relationship is disrupted, sometimes for several years at a time, leaving a significant gap in needed continuity of care. 

Persons with disabilities often have to manage several some complex healthcare needs.  With a primary healthcare provider that has become a trusted partner in this management, it’s possible to stay ahead of these needs to set up contingency plans for dealing with them before they get out of hand.  Losing a trusted partner in this management can lead to problems that would be otherwise preventable.  This gets even more complicated when a person with a disability needs a referral to a specialist in order to satisfy some insurance requirement and getting a referral from a stranger who has not had the chance to understand the need is delayed. 

This shortage then sets up a bad relationship since the person with a disability needs to push to get needs met before problems get worse.  Nobody wins.

I will comment on the cost implications of this shortage in another post.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

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Placing Blame Doesn't Work

Don’t you just love it when you find out that gaining your own civil rights puts everyone else’s in jeopardy?  The if-we-give-you-this-it-will-ruin-it-for-everyone-else attitude is alive and well.

I cannot count how many times this excuse is given when dealing with access issues.  How many times do we get told that, if accommodations are provided, the costs will be so high that everyone else will suffer?

A recent example is in New York City, where there is a civil suit filed by the U.S. Attorney’s office against the city because of the lack of accessible taxis.   Mayor Bloomberg claims that the suspension of accessible taxis is bad so other riders will be uncomfortable.  Shame on us for making others uncomfortable so that we can be included.

Another claim that the mayor has made is that it will raise costs because of the cost of the modifications and the increased gas costs.  There we go again, making costs higher for everyone else.  He insists that the drivers won’t like them because the larger size makes it more difficult for the driver to communicate with the rider, leading to lower tips.  We really kill the economy with that one. 

Bloomberg also stated that it is too difficult for wheelchair users to hail taxis and that drivers don’t want to pick them up.  Well, it’s good to know that he’s looking out for us.  Right.

If were not enough, Governor Cuomo also got on the bandwagon, stating that having accessible taxis could jeopardize allowing street hails in the burroughs and upper Manhattan. 

So, it’s really clear that we wheelchair users are a royal pain and will cause the collapse of the New York transportation system. 

Their solution is that residents use designated transportation.  Of course, that will not work for tourists visiting New York.  Separate but equal?  Go to the back of the bus?  Does anyone recognize this rhetoric as blatant discrimination? 

It’s time for people to recognize that persons with disabilities are real people, living real lives, contributing to the economy like everyone else.  This is not charity or compassion, but thinking like a smart businessperson.  Include us and you will benefit.  In this case, it would mean that those of us who use wheelchairs, whether as residents and employees or as tourists, add much more than we take.

In the meantime, it’s just great to know that we are to blame for all the troubles of the world. 

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude