Well the path that led healthcare providers to this point has been occuring for over a decade now.   The significant cut in the fee schedule was put into law by Congress as part of a larger 1990s budget cutting act.   That is it has not been a secret & it’s been on the horizon for over a decade.  Fortunately, Congress has routinely waived the schedule cuts & implement minor increases over the years.   Every six to twelve months our “leaders” in Congress overwhelmingly support a bill & talk about how we need a PERMANENT FIX to the unintended consequence of a budget cutting act passed over a decade ago.   For example, President Obama in signing the latest legislation quipped “Kicking these cuts down the road just isn’t an adequate solution to the problem.  The current system of recurring cuts and temporary fixes was passed into law more than 10 years ago.  It’s untenable.”  Low and behold the temporary fix expiration dates come & go and we’re back to square one.

I thought this was just a problem within healthcare, however, earlier this year I had the opportunity to do a Fly In to the US Chamber of Commerce.   Several issues were discussed and I was frustrated to learn that many issues facing transportation, education, etc face these same temporary fixes.  It appears this is ”business as usual” in Washington.   Perhaps I’m a bit naive, but why are our politicians afraid to make a decision.   Shouldn’t twelve years be enough to fix a minor flaw in a formula that was part of a larger bill.   Legislating in this temporary reactionary way is an unsustainable way of running a country (sound familiar?).   How about Legislative Reform?

I had the opportunity to visit my Congressman’s Office on Capital Hill recently to educate his staff on the impact a 21.2% cut in the fee schedule would have on the access to care overtime.   The impression was that Medicare was only a percentage (albeit a fairly significant one in our case) of our insurance mix and that providers could survive on payments from our other private payers.   What they did not realize is that most private insurance contracts over the past decade or so have been pegged to the Medicare Fee for Service (Part B) Schedule.  That is, a majority of private insurers pay a percentage of the Part B Medicare Fee Schedule.   Thus, a 21.2% cut at the Medicare trickles down to providers’ entire revenue stream, significantly impacting the ability to operate a business. 

 Ironically, several weeks ago a local Primary Care Practice, Haymarket Medical Center, abruptly closed it’s doors after providing care to the community for over 25 years.   They claimed that in the local paper that finances ultimately led to the practice’s demise.   The point here is that no matter how you slice the delivery of healthcare is a business & if those professionals delivering care cannot remain in business all the promised coverage in the world will not guarantee better care.

The new healthcare law promises to expand coverage to the uninsured & surely earned some political capital for those who made campaign promises, but no law can actually deliver the care that is promised.  The same macroeconomic argument that healthcare spending is unsustainable applies to a microeconomic level at your local doctor’s office.   Meaning your physician’s ability to provide care is unsustainable if the expenses of operating the practice consistently outweigh the revenue received from providing care.   In fact, this economic truth applies to any business.

• Don’t forget to warm up first – Just as with exercise, make sure your body is ready before jumping in full bore.   Take a short walk & do some light stretching to limber up.
• Don’t overdo it – Set a reasonable pace.   You do not have to get everything done in one day, especially that first day.
• Kneel versus bend – When possible, choose kneeling over bending.   This puts much less stress on your back.  To protect your knees you can pick up an inexpensive pair of knee pads at your local Home Improvement Store.
• Forgo imitating a Lawn Jockey – Avoid staying in one position for too long.   Try to move or shift your body around at least every 10 minutes.  Staying in one position for too long can put undo stress on your muscles & tendons.
• Use Proper Lifting Techniques – Avoid bending & twisting, instead move your feet.   Keep items close to your body.  Lift with your legs & if an item is too heavy find help.
• Wear Sunscreen – at least 15 SPF.   Sure it seems like commonsense, but it is often overlooked.   Wear a wide brimmed hat as well to keep the sun from beating down on your face.

With that said accidents can happen, thus if you pull or strain a muscle during exercise, remember the acronym RICE, Rest, Ice, Compression and Elevation.

• Rest your Injury
• Ice the injured body part to lessen swelling, bleeding and inflammation
• Apply a compression bandage to limit swelling
• Elevate the injury above heart level to reduce the swelling

You may also use a non-steroidal anti-inflammatory medication such as ibuprofen to help with the pain.  Of course if you have severe pain, cannot move the injured body part, or suspect you may have a fracture see you doctor immediately.  Additionally, if your symptoms persist it would be wise to see your physician for a full workup.

To that end, here are some tips compiled by the National Safety Council to help ensure a day of safe & fun sledding.

• Be sure your equipment is in good condition.   Broken parts, sharp edges, cracks and split wood increase the chances of injury.
• Be sure to dress warm enough for the conditions.  You should wear thick gloves or mittens and protective boots to help minimize the potential for injury.
• Find a spacious, gently sloping hill that has a level run-off at the end to allow your sled to come to a stop safely.  Avoid steep hills located near roadways.
• Before taking that first run, check the slope for bare spots, holes or other obstructions hidden in the snow.  Be sure to avoid these areas or wait until conditions are better.
• Make sure the sledding path does not cross traffic and is free from hazards such as fences, large trees or rocks.
• Avoid sledding on or around frozen lakes, streams or ponds as the ice may be unstable.
• Sit or lay on your back on top of the sled with your feet pointing downhill.  Sledding head first increases the risk of head injury and should be avoided.  Wearing a helmet is encouraged.

Keep these guidelines in mind and you should have a great day of sledding rather than a long wait at the emergency room. 

Fortunately, there is some good news in the midst of all the shouting occurring in Washington.  The good news is that we all own our own health.  Not to say that many do not fight to survive with horrible diseases we had no choice in living with or that that many struggle to taking better care of ourselves on a daily basis, but rather we can control how we choose to care for our own bodies.   By no means am I arguing that health care reform is unnecessary, but why must we rush to fix a system that has been in need of reform for decades simply to check something off the “To Do” list of our elected officials.

I strongly believe that some measure of consumerism needs to be part of meaningful reform.   I feel this will help restore the physician patient relationship that has eroded over the years as well as encourage one another to take control of our own health.  Slowly over the past several decades we’ve let others influence our decisions about our own health based on whether or not a service will be covered by insurance.   We need a paradigm shift to occur where we take ownership of our health and along with our licensed providers decide what is best for us.   Certainly, these decisions have financial implications and I by no means think the ability to receive the proper care should bankrupt an individual, but we as owners of our own health have to make choices about how we spend our hard earned money.  The paradigm shift I speak of involves us owning the maintenance portion of our health and purchasing high deductible coverage to cover catastrophic incidents related to our health.   This shift has started in part with the adoption of Health Savings Accounts by many employers and individuals, however, these plans are at risk in the current health care reform proposals.   Our auto insurance policies do not cover oil changes or new tires and our homeowner’s policies do not cover a depleted water heater or worn out carpeting.  Yet, we’ve grown accustom to our health insurance covering most every ailment under the sun.   We should take steps to maintain our bodies much like we maintain our material things in our lives and realize that we have to budget and pay for our health, just like our cars and homes.

Food for thought if nothing else.  No matter what happens when the dust settles in Washington, remember YOU own your health.   Personally, it has taken me quite a while to arrive at this conclusion, but my health is the most valuable possession I own.

With all the benefits of exercise, I was surprised to read that only 4 out of 10 doctors talk to their patients about the importance of exercise.   Talk about the need for healthcare reform.   Dr. Robert Sallis sums up the benefits very pointedly when he states “if there was a drug with the same benefits of exercise, it would instantly be the standard of care.”   With the larger healthcare debate raging, you hear very little about prevention, but clearly prevention needs to be a part of any reform if it will truly succeed.   While we cannot control the political grandstanding accompanying the healthcare debate or the timing of government imposed healthcare reform, we can control our own behavior. 

So if you’re like millions of others that have resolved to exercise more in 2010, I encourage you to “take the exercise pill” and improve your overall health!

1. If you experience pain of any kind, stop immediately and seek assistance.

2. Choose a snow shovel that is right for you.  Be sure that your shovel has a curved handle, as this enables you to keep your back straighter when shoveling.  The length is correct when you can slightly bend your knees, flex your back 10 degrees or less and hold the shovel comfortably in your hands at the start of your shoveling stroke.  Sometimes a smaller blade is better than a larger blade.  Although a small blade can’t shovel as much, it avoids the risk of trying to pick up a too heavy pile of snow.

3. When possible push the snow, do not lift it.  Pushing puts far less strain on your body than lifting.

4. Be sure your muscles are warm before you start shoveling.  Cold, tight muscles are more likely to sprain or strain than warm, relaxed muscles.

5. When you grip the shovel, make sure your hands are at least 12 inches apart.  By creating distance between your hands, you increase your leverage and reduce the strain on your body.

6. Your shoveling technique is very important.  If you must lift snow, squat with your legs apart, knees bent and back straight.  Lift with your legs & do not bend at the waist.  Move your feet rather than twisting.

7. Never throw snow over your shoulder.

8. Remember that wet snow can be very heavy.  One full shovel load can weigh as much as 25 pounds.

9. Pace yourself by taking frequent breaks to gently stretch your back, arms and legs.

10. For those who are able bodied, its always worth remembering neighbors on your block who may not be physically able to remove snow from their sidewalk and driveways.  A few minutes of help can make a world of difference to the well being of a less able bodied person as well as make you a good neighbor.