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What other excuses will researcherscome up with and doctors provide for not doing their jobs? Weconstantly hear about the time factor and how doctors are notreimbursed if they spend extra time with patients in need of physicalactivity (PA) counseling. This I cannot put entirely on the doctorsas our medical insurance industry works hard to enforce time limitson doctors. Doctors working for certain type of practices andespecially those doctors that are hospital employees are often sotightly managed that they can be docked pay for not staying withinlimitations of time spent with patients.
Before heaping too much blame ondoctors working for hospitals, we need to understand what they arefacing. Many hospitals have training areas and training programs,they want to doctors to refer the patients to for PA. So far thissounds good, but considering that most insurance companies will notcover this unless it is part of a therapy program for certain medicalconditions. Research has shown that physical activity reduces therisk of all-cause mortality in coronary heart disease, hypertension,type 2 diabetes, certain cancers and other chronic conditions. Inaddition, many patients may have a membership in the local YMCA orYWCA and cannot afford the hospital prices.
I have a difficult time with a hospitalthat disciplined a doctor employee for volunteering one evening aweek to work with patients and other members at a YMCA for two hours. This just shows how greedy the hospital is, not considering that thedoctor by volunteering his time may be bringing more patients to thehospital. The hospital was only concerned that he was notvolunteering his time for the hospital therapy area where they couldcharge people for using the facility.
The study pointed out that lack ofknowledge and training in health promotion also was a barrier causinga lack of effective physical activity counseling in the primary caresetting. In many areas of the USA, there are few areas for people tobe able to have exercise programs twelve months of the year. Summerheat in many states and winter snow in northern states make forrestrictions to physical activity. Not everyone has room in theirhomes for exercise equipment or the ability to afford the equipment.
Yet in many communities, schools thathave the facilities are underutilized and in general are off limitsto the communities to use. Other communities have what used to bedance halls or roller rinks that would work but many are beingdemolished for lack of use and to make way for commercial buildingsor houses. Sometimes there are people that have the training to workwith people to assist them in getting physical activity, but thedoctors or either unaware of them or prohibited from working withthem by their employer or in a few instances the local medicalassociation, because heaven forbid, anything that might take moneyaway from the doctors is allowed.
I do understand doctors not providingcounseling when they will not be reimbursed for it, but to restrictwhat a doctor does during his off duty or after office hours on avoluntary basis is the height of greed by hospitals and some grouppractices. In November 2011, the Centers for Medicare and MedicaidServices added coverage for preventive services to reduce obesity. This covers counseling to promote weight loss using intenseinterventions on exercise and diet. What is stopping this fromsucceeding? It is the restrictions and guidelines that must befollowed before the primary care provider will receive reimbursement. There are too many hoops to jump through for many to have incentivesto make this succeed.
For those interested in the article,here is the link. If you are interest in finding a program that willnot penalize a doctor or can afford a gym, YMCA, YWCA, or otheractivity center membership do this. Ask your doctor if he has thetraining and knowledge to assist. Some will find a way even if theywill not be reimbursed, or you may need to find a doctor that canassist. Some do exist through telemedicine, concierge practices, andother types of medical practices. Even some specialty doctors areinvolved.
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