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Consumers need to drive health care reform

Guest essay: Consumers need to drive health care reform

By Marcia Miller Spoto, PT, DC, OCS

Posted Nov. 11, 2014 @ 12:24 pm by Daily Messanger 
Canandaigua, N.Y.

As a health care provider and educator in the greater Rochester area for over 30 years, I see both the promises and the pitfalls of health care reform.

The movement toward cost-effective, value-based care is very positive. A positive development is the change towards payment models that reward providers for keeping people healthy, rather than our current model that incentivizes the provision of expensive medical tests and treatments. This has had an impact on all of the players: insurers, providers, hospital systems and of course, the consumer. Accountable care organizations (ACOs) are in the process of development as the structure that will allow alternative payment methods to become a reality.

The concern is the manner in which ACOs are forming and the potential impact on costs and patient choice. Hospital systems are consolidating rapidly. In Rochester, following the recent merger of Rochester General and Unity, we now have two dominant systems: Strong UMRC and Rochester Regional Health System. These entities have been acquiring physician practices, thus physicians are becoming employees of the systems. It is increasingly difficult for consumers to move outside these systems for their health care. The potential for health care monopolies is very real. Health care monopolies eventually lead to increased costs and can compromise quality of care. The consumer no longer plays a role in determining quality, and patient choice is eroded.

We are seeing this play out right now in local physical therapy practices. Many community-based, quality physical therapy providers are struggling to compete with hospital systems engineered to keep patients within the system. Recommendations for health services are unfortunately not always being made on the basis of what is best for the patient.

In the meanwhile, insurance premiums continue to go up, co-payments for services like physical therapy are rising, high-deductible plans are shifting a greater payment burden onto consumers — yet total payment to providers is going down. For community-based physical therapists like me, this is threatening the viability of our practices. If all of this seems complicated and contradictory, it is. There are many competing interests acting behind the scenes. Consumers are often the last to know what their benefit packages really look like and how those benefits will impact their care. It is important for consumers to be informed. They should exercise their right to choose their provider and they should not relinquish their role in determining value-based care. For employer-sponsored insurance plans, they should communicate their dissatisfaction with out-of-pocket expenses that are in many cases greater than the insurer cost for services.

In the end, consumers should, and can, be the most active players in shaping the evolution of health care reform.

Marcia Miller Spoto is president STAR Physical Therapy in Perinton and is a professor at Nazareth College in Pittsford.

Read more: http://www.mpnnow.com/article/20141111/Opinion/141119924#ixzz3JQTNSeNB

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