$677 For A Session Of Acupuncture Or Physiotherapy!!

Posed picture 

Recently I had a patient who rang me up saying he had right shoulder pain and he wanted to go for a MRI scan to rule out anything sinister. He asked if I can recommend him a doctor to hospitalize him and then do whatever necessary tests that was required. I told him that for a MRI he need not be warded. Then he said that if he was not warded he would have to pay for the investigations in full .....

I had to politely decline as I thought it wasn't right to make insurance pay for the scan if a patient does not want to foot the bill.

So I'm not surprised to read that there are mercenary physiotherapists, chiropractors etc who take advantage of the insurance system to bill excessively.

In New Jersey, school employees are covered by the state's School Employees' Health Benefits Program. This plan covering school teachers covers virtually anything the "out-of-network" providers charge.

In 2018, the teachers' plan paid out an average of more than USD $600 per visit to an acupuncturist or physiotherapist! This is even higher than out-of-network fees of psychiatrists and gynecologists.

As a result, more than 70 acupuncturists and physiotherapists earned more than USD $200,000 in 2018 from their teacher clients alone. Data also showed that one acupuncturist earned more than USD $1 million dollars!!

To further sweeten the deal, some of these providers are suspected of waiving a co payment by the teachers so there is no out of own pocket payment by the teachers.

The same state fund paid out USD $11.2 million dollars to a clinic -Thompson Healthcare and Sports Medicine for providing chiropractic services, acupuncture and physiotherapy to teachers.

Thompson Healthcare and Sports Med during a school visit

Investigations by the state showed that these payments consumed hundreds of millions of dollars in the last four years. This has possibly affected all residents in New Jersey as homeowners in towns where the schools are located are all paying higher property taxes.

Six people (half are union members) make up the state panel overseeing the benefit plan have not done anything to stop the runaway costs. This is despite meeting transcripts showing discussions regarding this since 2014.

All these data and documents, along with interviews with state officials show this is what happens when savvy (and mercenary) health care practitioners find lucrative loopholes in a loosely designed employee health plan.

As expected, the teachers' premiums have increased by 8 and 13 percent in the last two years. The most popular family premium plan cost in excess of $36,000 a year. This is nearly twice the cost in other parts of the country.

I dare say that if the teachers realized the exploitation of the plan, they will definitely think twice about how they use their health care benefits.

Back in in Singapore, there was an article in the Today online paper regarding some physiotherapists in private practices paying doctors and surgeons kickbacks to get patients referred to them.

You can also read our other blog, where we have previously written about these kickbacks in our Singapore healthcare system too. Needless to say, private medical clinics and MRI / X-ray companies  in Singapore are implicated as well.

It is bad practices like this that will lead to increases in our health care visits, insurance premiums and Medisave-approved Integrated shield plans.

You can read the read I referenced here.

Breakthrough Performances And Hot Streaks

A few fellow physiotherapists that I've treated recently commented that they were quite amazed that I've gotten them (and patients) better so quickly that it almost seems difficult to believe.

To which I'd always say that nothing really improves in a straight line. Except our age, nothing really goes up in a straight line. Just like the stock market gyrations, there are days when it rises, some days it drops like a rock or days where it moves sideways.

Success in getting a breakthrough performance (or getting a patient better) is similar. It is almost never about a single monumental shift.

Think of a glass of water that you put in the freezer.  The water starts to freeze when it goes under zero degrees celsius (or 32 degrees Fahrenheit). This does not mean that the energy needed to lower the temperature from three degrees, two, one degree and zero isn't important. In fact, you will never get the water to freeze if all the prior work to cool it down isn't done.

Similarly, breakthrough moments are often the result of many previous actions, which slowly accumulate to unleash a major change.

In order to make a significant change, you need to work persistently to break through inevitable plateaus. Just like the water gradually turning into ice, you are gradually changing and improving as you slog along.

A patient (who used to race aquathlons) recounted the following experience. He and a fellow team mate were stuck at swimming 1:40 minute for the 100 meter swim intervals for a very long time. Without any real change in training, they suddenly got it down to 1:30 minute.

A patient of mine who runs got his kilometer repeats down from 4 minutes to 3:45. Or another athlete shared that he was squatting 100 kg for three months suddenly improved to 120 kg.

Many of my patients are now done with their racing season, while some are tuning up for their last race of the year. For those preparing for the year end Singapore Marathon, remember it's almost time to taper. When you resume training after your break and perceive no change, remember that just like water that is slowly beginning to freeze, you too are putting in the work for your breakthrough performance.

Back to my conversation with the physiotherapist I treated recently. My "hot streak" on getting good results treating patients definitely rest on a foundation of prior work, during which I try to become a better physiotherapist every year (since I can probably not get faster as an athlete).

In a journal, Nature, which was published recently, researchers found that most people have a "hot streak" in their career - a specific period during which an individual's performance is substantially better than his or her typical performance although the timing is somewhat unpredictable.

Talking it through just 2 days ago

Thanks to my wife and fellow colleagues, we regularly discuss and break down segments of courses we've gone for to make it unique to us. We will strive to make sure this "hot streak" of getting patients better as quickly as possible continues.

Putting it all together

Reference

L Lu, Y Wang, R Sinatra et al (2018). Hot Streaks In Artistic, Cultural, And Scientific Careers. Nature 559: 396-339. DOI: 10.1038/s41586-018-0315-8.

Tensegrity Of The Spine

Lining up half the participants to compare their necks and backs

After Aized and Rachel did Arches and Legs last week, it's the turn of the three amigos this this two days as we do "Tensegrity of the Spine" over the next two days.

Range of movement in the spine

This course is very intense and heavy going as there's a lot of rationale behind the theory involved. Everyone (yes, you read correctly) got lost at some point today, including yours truly.

Let's hope we get a clearer picture tomorrow.