Parkinsons and Exercise

Anyone with decades of experience in health care knows that the focus is no longer on TLC, patient-health worker partnership or prevention. Instead the system has become a beaurocratic mess with guidelines for care established by Medicare and private insurance companies. Control by insurance managers and health institution administrators has health care professionals degraded to technician status to function only to keep the assembly line moving and trouble free. Health professional’s autonomy and creative thinking skills have been weakened. Ideas or programs to enhance patient health are not valued if immediate profits can not be generated. I was asked to leave my job because I saw value in programs that improved patient health but the facility saw a loss of revenue. I saw ways to improve job satisfaction and efficiency. I saw
programs handed to me which were poorly designed and needed revision prior to implementation. But my role was not to think or be creative. I was to comply with the system and its pitfalls because it produced a steady revenue. Innovative pilot projects and new programs would require an inital expenditure but health care savings could be realized in the future. Where are the professionals and health care facilities that are willing to take a risk and investigate whether proposed pilot projects would be cost effective? If effective, these programs should be paid for my Medicare and private insurance.

Therapists (PT or OT) initially conducted a group exercise class for Parkinson’s Disease patients. The group met twice weekly for 40 minutes and patients paid $30/month for the classes. Medicare B does not pay for group classes. The patients were challenged and functional gains were evident; comaraderie and group spirit were high. Therapists were pulled away from this role because we could generate more revenue by treating a patient individually through Med B. Our charges for evaluation, exercise, gait or whatever on one patient far exceeded the nominal out of pocket expense for the group class. The new instructor was a clerical assistant with no education, no exercise training and basically no interest. Anecdotally, the group has lost function and spirit. But the therapy department has won by adding dollars to the kitty!

Many of the residents in the large retirement facilty have functional declines due to boredom, lack of effective activity programs, depression or laziness. Med B will pay for “skilled” therapy services to get them to a higher baseline. This means I act as a cheerleader and phys ed instructor to get them moving again. If the patient fails to maintain their gains when therapy has finished, I can treat them again for the same.

Medicare doesn’t care how often this cycle is repeated as long as gains are being made. Why not have therapists or exercise specialists supervise patients in an exercise facility like a Y to maintain their fitness?

Because Medicare won’t pay for seniors to attend such a program. But if a regular fitness program was more cost effective than multiple Med B billings, could we not convince Medicare to pay for such programs? Only if more people see value in this and take a risk.

Companies have demonstrated the value of employee fitness programs but efforts by senior residential care communities to maintain the health and well being of their residents is lacking. The impetus is to build a bigger therapy staff to repeatedly pull from Medicare’s pockets rather than try a wellness approach. The impetus is for nearly all residents to have therapy so the bonus checks of middle and upper managers stay

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