July 3, 2012

Barriers to PA Counseling in PCP Setting

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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