What other excuses will researchers
come up with and doctors provide for not doing their jobs? We
constantly hear about the time factor and how doctors are not
reimbursed if they spend extra time with patients in need of physical
activity (PA) counseling. This I cannot put entirely on the doctors
as our medical insurance industry works hard to enforce time limits
on doctors. Doctors working for certain type of practices and
especially those doctors that are hospital employees are often so
tightly managed that they can be docked pay for not staying within
limitations of time spent with patients.
Before heaping too much blame on
doctors working for hospitals, we need to understand what they are
facing. Many hospitals have training areas and training programs,
they want the doctors to refer the patients to PA. So far this
sounds good, but considering that most insurance companies will not
cover this unless it is part of a therapy program for certain medical
conditions. Research has shown that physical activity reduces the
risk of all-cause mortality in coronary heart disease, hypertension,
type 2 diabetes, certain cancers and other chronic conditions. In
addition, many patients may have a membership in the local YMCA or
YWCA and cannot afford the hospital prices.
I have a difficult time with a hospital
that disciplined a doctor employee for volunteering one evening a
week to work with patients and other members at a YMCA for two hours.
This just shows how greedy the hospital is, not considering that the
doctor by volunteering his time may be bringing more patients to the
hospital. The hospital was only concerned that he was not
volunteering his time for the hospital therapy area where they could
charge people for using the facility.
The study pointed out that lack of
knowledge and training in health promotion also was a barrier causing
a lack of effective physical activity counseling in the primary care
setting. In many areas of the USA, there are few areas for people to
be able to have exercise programs twelve months of the year. Summer
heat in many states and winter snow in northern states make for
restrictions to physical activity. Not everyone has room in their
homes for exercise equipment or the ability to afford the equipment.
Yet in many communities, schools that
have the facilities are underutilized and in general are off limits
to the communities to use. Other communities have what used to be
dance halls or roller rinks that would work but many are being
demolished for lack of use and to make way for commercial buildings
or houses. Sometimes there are people that have the training to work
with people to assist them in getting physical activity, but the
doctors are either unaware of them or prohibited from working with
them by their employer or in a few instances the local medical
association, because heaven forbid, anything that might take money
away from the doctors is not allowed.
I do understand doctors not providing
counseling when they will not be reimbursed for it, but to restrict
what a doctor does during his off duty or after office hours on a
voluntary basis is the height of greed by hospitals and some group
practices. In November 2011, the Centers for Medicare and Medicaid
Services added coverage for preventive services to reduce obesity.
This covers counseling to promote weight loss using intense
interventions on exercise and diet. What is stopping this from
succeeding? It is the restrictions and guidelines that must be
followed before the primary care provider will receive reimbursement.
There are too many hoops to jump through for many to have incentives
to make this succeed.
For those interested in the article,
here is the link. If you are interest in finding a program that will
not penalize a doctor or can afford a gym, YMCA, YWCA, or other
activity center membership do this. Ask your doctor if he has the
training and knowledge to assist. Some will find a way even if they
will not be reimbursed, or you may need to find a doctor that can
assist. Some do exist through telemedicine, concierge practices, and
other types of medical practices. Even some specialty doctors are
involved.
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