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How Healthcare Changes May Affect You

Healthcare is changing -- how does that impact you and yours?

You have probably already noticed the major changes in terms of impact on you or a family member, but perhaps not if you don't take medication, haven't seen a doctor, or have been to the hospital. Let me mention a few things and provide my own advice regarding how to handle the changes.

Doctors as Employees:

  • Hospitalists attend to you in the hospital, which often have several different providers -- not your specific doctor.

  • Medical history, medications, and records will not be as well known by hospitalists as much as your doctor would.

  • You may see more than one doctor or physicians assistant for regular visits, instead of the same doctor every time.

  • You may spend less time with the doctor and may have to wait longer for an appointment.

  • Is someone listening to what you have to say? Does it feel like they're only slightly listening? This could affect the outcome of your visit.

  • Who is ultimately responsible for the overall care of the patient? In the past, it was your doctor, but under these changes, it often depends -- and isn't always the same person every time.

  • More cooperation & communication between healthcare providers about your medical history and care are now required by law.

  • Referrals to specialists or for tests may not be made by the doctor, but by a department in the hospital -- Do they refer you outside the hospital system, or inside the hospital system? Is there a cost and/or quality care difference?

  • Are there other options available that are more natural, versus medication and more invasive procedures? For example, to treat pain, instead of medication, injections, surgery, is physical therapy an option?

Cuts in Healthcare Costs/Services:

  • May stay in hospital a less amount of time.

  • May receive less treatment, and expected to do more treatment on your own.

  • Deductibles are higher, as well as out of pocket.

  • Overworked medical personnel in all fields.

  • May see different professionals, for example a physician assistant versus physician, or a physical therapy assistant versus physical therapist. This is not necessarily bad, but education and experience matter in the end.

  • Cooperation & communication between healthcare workers may diminish -- you may have to ensure the communication continues yourself. To help with this, ask to have your test results or specialists notes sent to your primary doctor -- don't assume it will be done without a request.. Ask for written instructions of what has been orally provided. Make sure someone is with you to listen and ask questions if you are the one not feeling well or recovering.

Increased Instances of Healthcare Identity Fraud, Billing & Insurer Errors:

  • If you have 15 visits of Physical therapy allowed and have used none, but the insurance company shows you have used 5 visits - call the insurer and find out about these 5 visits.

  • If you receive an explanation of benefit (EOB) that shows you had minor surgery, but you have not - call your insurer immediately, as someone may have stolen your medical identity, or there may be a billing error that needs to be addressed immediately.

  • New cards should be coming out to Medicare members this Spring in the mail. Make sure you get yours; check with Medicare to see when they are mailed out and then call if you don't receive it -- you don't want someone else to use it.

  • If the hospital bills you for a surgeon's visit, but when you were there and the surgeon didn't visit the entirety of the appointment, inquire about this and ensure it is a legitimate charge.

  • Medical billing is becoming increasingly complicated and extensive. Billing errors are likely to increase, so check your EOB statements that come in from the insurer. Pay most attention to the services rendered and the dates.

  • Check your EOB to ensure everything that should be paid was paid -- if you have questions, call the Insurance Department in the State of Texas for Complaints. If you don't get a sufficient answer, file a complaint.

Bottom line:

  1. You are responsible for your healthcare outcomes and those of your family.

  2. Speak up and become involved in your care. Ask questions, follow the instructions of the healthcare provider, and have someone with you if you are in the hospital. Ask questions and ensure the provider knows your medical history.

  3. Look for alternatives to traditional medication, invasive procedures or "just living with it" - you may have to do some research yourself.

  4. Read the medication forms and ask your pharmacist questions about drug side-effects, interactions, etc. Get to know your pharmacist!

  5. Try to exercise, eat right, lose weight, stop smoking, stop binge drinking - you don't have to be perfect, but just try.

  6. Your healthcare providers are not Gods -- while they know a lot about their area, medicine today is extremely complicated; coordination and communication are essential and yet healthcare providers are overworked and mistakes happen. Make sure you stay actively involved in your care. Appreciate what they do for you, but realize you are an equal partner and should ask questions; it's your health, your right! If the healthcare provider takes offense, get another provider. It is in everyone's best interest to ensure the medical decisions are right for you.

What does all of this mean to you, the patient?

You must take a more active role in your own healthcare process and those of your family members. Responsibility for ensuring coordination and communication ultimately rests on your shoulders. You have to be more knowledgeable about your healthcare benefits and not rely solely on the doctor's office or hospital administration -- and this includes reviewing your EOBs!

Healthcare has changed. Just remember: you have rights and you have choices -- ask what they are! You are also paying a lot for your healthcare, so make sure you receive what you pay for and make sure you are doing your part by following the healthcare providers' questions. Remember to always ask questions!

If you are in search of treating your pain and want a pain-free life, contact my clinic at 979-776-2225 to set up an appointment. I promise you that physical therapy can change your life for the better.

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