US Health Care: The Good News on PBS. GRATE if you ask me!

Here's a link to watch a snippet/trailer about this show OR the show at their website.  WELL worth the 52 minutes of your time.  Tell your providers about it too, maybe you'll inspire and plant the seed for change, or help encourage a sprout that's taking root in your community!  http://video.rmpbs.org/video/2198039605

Tonight, PBS will air "U.S. Health Care: The Good News."  Grand Junction, where I moved eight years ago, and several local doctors/organizations are featured prominently in the new Rocky Mountain PBS documentary.  I'm pleased to say I've worked among and within the organizations which have lead to Grand Junction being one of the top-ranked communities in the US for providing quality care while lowering costs simultaneously. To some extent, my 'inspiration' to create Lumigrate came about because of my time 'under these organizations roofs.'   

Nearly 40 years ago local doctors and community leaders created a nonprofit "Rocky Mountain Health Maintenance Organization", which later rebranded as "Rocky Mountain Health Plans." My years of home health experience came within their home health department, the only one of it's kind in the US, if I recall correctly.  I always thought of it as a GOOD version of 'robbing Peter to pay Paul', as the saying goes.  

I did home health 'PRN' (as needed/on call) for "Rocky" part to full time when I started my outpatient therapy contract business providing occupational therapy services at the PT clinic within the Primary Care Partners building. I give them credit as an insurance company -- they were the fastest to reimburse us for our charges and in the three years of seeing MANY patients with RMHP as their payor source, they never did the 'hassley' things that many other insurance companies do.  Medicare was the worst, and they took the longest to reimburse us.  

I received revenue for TEN MONTHS after I quit seeing patients, that is how bad the lag-time is; Rocky was always prompt. If a clinic is 100% booked and doing things 100% efficiently, you can stay in business on what they reimburse for occupational therapy services.  Some insurances reimburse so poorly, others better, so if you have a good 'mix', you can stay in business.  But that's just not 'right' to be underpaid for your services.  I would let the patients who had those insurances know to let their businesses they work for know that, because it will impact their treatment overall.  Some clinics do not take Blue Cross for that reason: I was surprised when my insurance was accepted at Stedman Hawkins Clinic in Vail when the workers at Hallaburton could not go there using their insurance, because it was a problematic reimburser.  

When I worked home health for Rocky, I was assigned some difficult cases for wheelchair and bed and lounge chair positioning, sometimes entailing skin breakdown and always including it's prevention, and increasing comfort/decreasing pain and anxiety from pain. Coming from many years of doing w/c positioning for skilled nursing homes, where it was unacceptable to say 'this patient needs a $2,000 wheelchair due to their complex issues', I was very concerned when the patient I was working with's wheelchair 'spec-ed out' (as in specifications) at over $10,000.  

"We do what is right for our members." And the patient got the wheelchair.  I even asked for management 'ride along'/site supervision and was given the impression that wasn't necessary. On another occasion, the solution for a woman's skin breakdown was a more expensive overlay on her bed, I thought, and they approved my recommendation. They have a process to review if what is being requested makes sense to their management/panel, if I  understand correctly.  I just know it was the most beneficial insurance/therapy situation I had ever worked in from the corporate/policy/setup standpoint.   

In that same timeframe, I was intensively working with PT on my very serious neck issues, and had made good progress in the 20 sessions my insurance at the time provided for therapy/year.  My MD at Stedman Hawkins, one of the most esteemed orthopedic clinics in the US wrote a letter stating why it would benefit me to have more therapy visits approved; my PT did as well, and had very good visual / objective data reports/graphs to show of my increasing neck strength.  When I called to check on how to submit the documents and let the woman know I was also a medical worker/therapist, she said that in her many years working every facet of the company, they had NEVER approved one patient for anything in all the requests that had been made. Since I have a fibromyalgia diagnosis, I am 'uninsurable' so was paying for the CoverColorado insurance (for uninsurable, we pay a normal rate but the state pays for taking us 'high risk/expensive' people).  

I was happy to learn that Rocky won the contract the next year for CoverColorado and has maintained it; I can only hope that those who have CoverColorado have had a better outcome than I had when it was under UnitedHealth.  My health made huge improvements in that timeframe, not only because of what my insurance paid for but things I was able to pay for 'out of pocket'.  

It was under the roof of the Primary Care Partners building, watching a presentation I had arranged to have in their basement at a time when medical professionals could come, related to medication strategies for chronic pain/fibromyalgia, that I had the idea to create a website in order to make information available to providers and the public if they could not get to a live presentation when it was being given.  A doctor who wanted the information had asked me to record it with their camera and tripod, and as I sat there next to it, I thought "how hard and expensive would it BE.... I've outfitted a video/graphics studio and staffed it when I worked for the Air Quality program for the National Park Service at CSU.... things are so much cheaper now with electronics .... lots of people have websites now, it can't be that expensive.... I wish I had the money....."  And little did I know, there was a check arriving at that very moment to my post office box which I saw the next day which would allow me to do that.  And 15 months later, Lumigrate.com 'went live' in March of 2009.  

I hope that you have enjoyed reading this piece and that you consider watching this program at the link I provided, above.  As always, YOU can help spread the word and create health care reform little by little with us.  Thank you in advance.  "Live and Learn.  Learn and Live Better!" ~~ Mardy

www.gjfreepress.com/article/20120203/COMMUNITY_NEWS/120209969