Insurance-Driven Health Care and Chronic Pain — How Can I Heal and Recover?
In the United States, insurance companies typically dictate the quality and quantity of the health care we receive; to obtain in-network care, we are told where we can go, who we can see, and how many visits are covered.
In-network health care providers face constant pressure to limit treatment sessions to even less than the covered number of visits; it's not uncommon for a provider to be informed that they must discharge patients more quickly in order to retain their contract with an insurer. For example, while an insurance plan may allow 20 visits for treatment of low back pain, a provider may be advised that 6 visits is the maximum that will allow them to remain competitive with another clinic, where patients are discharged after only 4 visits.
This race to discharge occurs whether the problem is acute (i.e., 3 months or less since onset of symptoms), or chronic. Not every problem develops instantly after an injury; some develop over time, or may be an issue that the patient has been suffering with for years. After 4 or 6 visits, has a patient healed and recovered from a chronic problem? No, what has happened is that the insurer has saved money, the provider couldn't adequately care for the patient, and the patient didn't get the care they needed.
There exists a movement toward 'pay for performance' in the health care industry; the basic idea behind this movement is to financially reward or penalize providers based upon their ability to achieve optimal outcomes in the least amount of time. While quality improvement is obviously important, I'm concerned that this model will reward only those who care for patients with uncomplicated, localized, and acute problems, the kind that can be easily and quickly resolved. Providers may simply avoid patients likely to lower their performance scores, focusing instead on those with the type of simple problem that can be effectively treated in the 15 to 30 minutes of one-on-one care that an in-network provider is allocated.
15 to 30 minutes is an adequate amount of time to address, for example, a simple stiff joint problem, using exercise instruction and joint mobilization techniques, but it's not enough time to address soft tissue dysfunction. In a pay for performance model, what happens to those patients who deal with chronic, complicated, or widespread problems? Many of the patients who have sought me out have suffered not only from chronic back pain; they've also struggled with neck pain, headaches, or chronic pain in many areas of their body, preventing them from moving well and enjoying life.
Is a treatment plan of discharge after a handful of visits to an independent home program, without a decrease in pain or an increase in mobility, a good outcome for that person? Does it meet their goals of healing and recovering from their problem? Should they just have to learn to live with their pain, and accept an insurance-driven model of health care that tells them nothing further can be done to help their problem? NO!
I offer a different perspective and specialized treatment approaches to people struggling with chronic pain; I am able to provide this kind of care by being a highly trained out-of-network provider.
For treatment of soft tissue dysfunction, a common cause of chronic pain, I specialize in a type of manual therapy called Myofascial Release, spending a full hour one-on-one with each patient, addressing the underlying problems causing pain and lack of mobility. Home exercises are used to maintain and improve upon changes made during treatment sessions, not as a stand-alone treatment. Not until after spending the time needed to allow people to heal and recover are they discharged, either to an independent home program or to monthly follow-up health and wellness care.
My patients receive care that allows them to get their lives back and enjoy living again, no longer plagued with pain, moving freely and without fear.