Healthcare reform

At my job we try to be "efficient" and try to see the patient for as few visits as possible. This makes us look better with insurance companies and most patients have high co-pays these days anyway.

But there are always those patients who need more- who I keep on for a while. They might have had a CVA, RSD, a tendon repair, or just a really stiff hand because of an injury with swelling and weren't sent to therapy in a timely manner. And some hand surgeons want their patients seen more often.

Well we have a new policy at work. When a patient reaches 15 visits, 20 visits, and then 25 visits, I have to discuss their case with my supervisor. (I wonder what happens if I reach 30!) And it has me really mad.

First, I feel like my clinical judgement is not being respected. If I can convince an insurance company to let me keep a patient for 20 visits, I don't know why I should have to convince my supervisor. Secondly, I feel like we are being pressured NOT to give the harder cases what they need. And finally, what happens if my boss thinks someone should be discharged and I do not? Do I tell my patient that I am discharging them because my boss says so?

Perhaps we should tell patients up front, on the phone, when they call to schedule an appointment- if  you are going to need more than 15 visits you should look elsewhere. This seems to be the way that healthcare is going. The difficult cases require more care and make you look bad to the insurance companies and Medicare, so you can't take on too many of them. The insurance companies might cut you out of their network if you do. Medicare might audit you.

I tell myself that if healthcare becomes too awful I will become a massage therapist.