75-year old man runs marathon with 'bone-on-bone' arthritis

Just this weekend I attended the Running Conference at the University of Florida Orthopedics and Sports Medicine Institute in Gainesville.

There, one of the presenters claimed to have helped his patient, a 75 year-old runner, continue marathon training and racing despite Grade IV 'bone-on-bone' knee arthritis with bi-annual injections of hyaluronic acid (chicken cartilage) into the knee joint space.

Irrespective of testosterone-laden "atta-boys!" or of wry head-shaking at old ages' folly I still want to know this:

How was it paid for?

75 year-olds generally have Medicare.

Medicare usually pays for one course (3 or 5 injections) of viscosupplementation every six months in Florida.

Hyaluronic Acid (aka viscosupplementation) pays fairly well for the course of treatment: ~$250 for specialist surgeons and ~$150 for non-specialist physicians.

I, as a physical therapist, have to show that my 75 year-old patients need physical therapy to prevent progressive disablement, loss of independence or institutionalization.

For example, I can't say that one of my patient's goals is to...

1. Run a Marathon!

Marathon running is not "functional".

That is, racing marathons wont necessarily keep grandpa out of the old folks home.

Why (apparently) does Medicare pay orthopedic and sports medicine doctors to keep 75 year-olds running marathons when Medicare wont pay physical therapists to keep 75 year-olds running marathons.

Is there some evidence that chicken cartilage is more cost effective than physical therapy?

$100 Lumbar MRI in the USA?

Get a lumbar magnetic resonance image (MRI) for less than $100?

Is that possible?

In Japan, it is.

If the United States imports this feature of Japan's model in these changing health care times what implication does that hold for physical therapy?

$25 visits in outpatient physical therapy clinics?

Japan's system is called social insurance.

Japan is the world's second richest economy and, arguably, one of its most capitalistic.

Some other features of the Japanese system include the following:

• everyone is covered (rich people cannot 'opt-out').
  
  
• most care (80%) is provided by private doctors (not 'socialized medicine' like in Canada and England).
  
  
• no gatekeeper (you can see an allergist or orthopedic surgeon on your own).
  
  
• costs half as much as in the USA
  1. 8% of GDP in Japan
  2. 16% of GDP in the USA
  .
  
• Japanese people visit their doctor 3x as often as Americans do for simple procedures like blood pressure checks.
  
  
• insurance companies are non-profit and aren't allowed to 'cherry pick' - if you have a history of cancer they still have to insure you.
  
  
• zero medical bankruptcies.
  
  
• $280 per month health insurance premiums - and the employer pays half of that!

Will the Japanese model happen in the USA?

Should it?

What do you think?

Should we privatize the PQRI program?

Here's a business model you should try: Government!

They want to monopolize health care but they have trouble introducing new products that people want.

Example: PQRI.

I just sat in on the Physician Quality Reporting Initiative (PQRI) in 2009: 2.0% Bonus Payment for Physical Therapy audio conference from the American Physical therapy Association (APTA).

You can buy the DVD of the seminar here.

Some past history

For 2007 only 16% of eligible professionals participated in Medicare's voluntary program with only one-half of those participants earning a bonus payment (56,722 providers).

Wow, if my results were that bad I'd be out of business!

Anyone ready to privatize the PQRI program?

Some future predictions

Here are some possible future uses of the data from PQRI:

– Contracting

– Tiering of providers ("I'm good, you're bad")

– Payment differentials ("I make more, you make less)"

– Network participation ("More dough based on who you know")

Should you participate in PQRI?

Full disclosure: I have yet to make a dime from PQRI and I've been doing this since July 2007.

But, I'm going to keep on.

Why?

Because 'Quality Measure Reporting' will soon be mandatory and if you don't participate you may see a 2% discount on your reimbursements.

Certain aspects of Medicare claims administration are already privatized: Recovery Audit Contractors are one successful example that still gives me sleepless nights.

Should government privatize the PQRI program?

United States physical therapists not alone in health care crisis

Physicians, and possibly physical therapists judging from the 'sports medicine' reference, in Canada are innovating their way out of another Medicare mess.

Private businessmen in Canada have opened several private-pay clinics in Calgary that treat patients with services that Medicare does not provide.

"The new Calgary clinic, the company's second location, will offer an "elite program" of medical care for its members, including a full health assessment and a preventative health plan."

The clinics are opposed by the Friends of Medicare, a pro-consumer organization that calls the expensive, private arrangements 'queue jumping'.

A queue is a line that refers to the way Canadians (and British) ration their health care services.

Canada rations health care according to age. Older folks go to the back of the 'queue' while younger folks with jobs get treated first.

The United States rations health care by wealth.

Wealthier people get treated first. In some areas of the United States Medicare is the best and fastest third-party payer which means that younger people with jobs are frequently treated last.

Arguments against this answer to Canadian Medicare?

"It sucks," said Noreen Branagh. "I can't afford the $4,000, and there are no family doctors in Calgary."

Arguments for this answer to Canadian Medicare?

"Primary care is in a crisis. At least I've gotten up and done something about it." says Don Copeman, the Vancouver businessman who founded the clinic.