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

The problems with disability policy based on medical model

When disability policy was developed, disability was viewed in the medical model.  The understanding was that the person had a medical problem that was in need of fixing and that, until that medical problem could be fixed, that person was unable to work.  If the medical problem could not be fixed, the person would be considered totally and permanently disabled. 

We put physicians and other medical providers in charge of whether or not a person could work, whether or not a person receives various disability benefits and what services and accommodations a person with a disability needs. 

While we are inundating medical providers with paperwork to attest to these things, no one seems to take into consideration that they are not the ones with all the answers. 

While most disabilities have a physiological beginning, that doesn’t necessarily mean they need or will respond to medical interventions.  For example, if a person is in an accident and incurs a brain injury, the disability can be permanent.  However, the time for effective medical therapy is only for a short period after the injury.  If the person still has the disability after 20 years, what do we expect a physician to do? 

Some disabilities are the result of medical conditions that need ongoing treatment, but many do not need medical intervention.  Yet, we put them all in the same category and require that there be medical documentation of all kinds of things related to disability. 

In the meantime, since most medical providers have the same view of disability as the average population, they are responding with the viewpoint that they are supposed to be able to decide major life issues for these people.  Should the person work?  What are the person’s transportation needs?  Does a person need a roll-in shower?  What about a parking pass?  Should the person be in a nursing home?  If so, can we keep the person out with appropriate services?  What services?  (Read the last three again to note the irony.)

Removing disability issues from the medical establishment could benefit persons with disabilities, ease the burden on medical providers and reduce costs for society.  Since the medical model is now recognized as not appropriate for determining disability, let’s next consider what the basis for disability needs to be.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

The Roles of Design, Attitude and Quality Control

Comments from Niall 3

This is the third of a series of Comments from Niall. It is designed as part of a series that will hopefully raise awareness of the contribution that people with disabilities can make to the community

Design

This is the starting point to achieve accessibility and therefore inclusivity. Architects, interior designers, construction engineers etc.... These are the people that will create our future environments. Yet, how many of them are fully informed of the needs of people with disabilities?

I am certain that the vast majority of them want to get the best result that they could but lack of awareness about accessibility is the main barrier to their achieving a fully inclusive environment.

Attitude

To physically create a fully inclusive environment means little if the people that work in it, or the people that buy or live in it, are not committed to the belief that everybody is welcome. This need for a positive and indeed, creative attitude also extends to people with disabilities. Their awareness of the possible limitations to achieving a fully inclusive environment is vital if a truly harmonious outcome is to be reached.

Quality Control

This may seem obvious but there are many examples, that I have actually seen, where the best intentions of people trying to achieve inclusivity, have failed. The initial design was good, the building appeared to be broadly accessible but the actual building work was altered (due to perceived construction necessities) so as to render the final result of little use to people with disabilities. When the builders move in they are focussed on the main issues: will it stay up, are all the electrics and plumbing in the right place and will it pass the inspections to allow it to open. The needs of people with disabilities are sometimes not their first priority. And, yet, if the concept of a fully inclusive working, selling or living environment were accepted then accessibility would become automatic. Rather than be treated as an additional worry, the building would meet the needs of as wide a range of people as possible. Inclusivity would be part of the Mainstream.

How to Maintain that Inclusivity

Having achieved an inclusive environment it is then all too easy to lose it. For example, extra desks and display stands for products etc. spread onto clear routes and accessibility is then lost.

The next Comment from Niall will cover the ways to maintain Inclusivity and then promote it to all potential users.

Niall can be contacted at tarrell@btinternet.com

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Who Benefits from Inclusivity

Comment from Niall 2

This is the second of a series of Comments from Niall. It is designed as part of a series that will hopefully raise awareness of the contribution that people with disabilities can make to the community

Who benefits from Inclusivity?

First, who are these people who will benefit? The immediate answer is people with disabilities. And yet there are so many more people involved in every interaction in our modern society. What about all the family, the friends, even the representatives (such as lawyers) of those people with disabilities? All of them will also hope and indeed, expect to be able to enjoy life or work together in a fully inclusive environment.

And yet, there are also the owners and people that work in every business. In an inclusive environment everybody benefits. The service or workplace environment is available to all and then everybody is happy, or at least they all share the same experience.  This allows people with disabilities to be an expected and valuable part of the community.

Meeting the needs of people with disabilities

This is often easier than it may at first appear. Most people with disabilities are very aware of what they need to be part of the community and are therefore a main source of information. There is also a wide range of design guides available to assist when building or renovating a building. But the most important thing is common sense. Speak and listen to people that have experience in this area. Best practice and good examples are so much more effective than trying to just achieve compliance with the law.

How to achieve inclusivity – an introduction

This will be covered in more detail in the next Comment from Niall but broadly includes: Design (of a building or a space), Attitude (of builders, managers, staff and users) and Quality Control (are access elements in an environment effective and truly meet the needs of people with disabilities).

The next Comment from Niall will expand on the various ways to achieve as much inclusivity as possible. Followed by an introduction on how to maintain that inclusivity.

Niall can be contacted at niall@btinternet.com

 www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Gong on Disability No Panacea

Social Security Disability, Supplemental Security Income, Medicare and Medicaid are all in jeopardy.  The growth in recipients cannot be sustained.  However, the standards for receiving Social Security Disability and SSI have eased.  At one time, the standard was that the recipient could not engage in any substantial employment at all.  Now there are television lawyers who promise people that they are entitled to these benefits and that they will help them receive them.

What most people do not realize is that “going on disability” is not finding a pot of gold at the end of the rainbow.  In general, it means living in poverty.  Having nothing to do and no money to do it with it is a common complaint from people who are on disability.  Which brings us to the fact that working is a quality-of-life issue at least as much as a need-to-work-to-pay-my-bills issue.

At this time, people legitimately receive disability benefits for three reasons:  1)  They really and truly cannot work (this is a small percentage of recipients); 2) They are unemployed due to discrimination because of their disability (ADA needs more enforcement); and 3) They need to be on disability to receive essential services that are not available unless someone is on disability.

Clearly, we need to address how disability policy works in this country so that people are not forced to live in poverty simply because they have a disability.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude