Linda Stanley recently interviewed with Business Innovators Radio in a segment that shines light on the importance of researching and shopping around for healthcare treatments. In the interview, Ms. Stanley explains the cost benefits, in addition to the more personalized care, associated with choosing to visit a private practice versus a hospital-based practice.
As an Occupational Therapist, Certified Hand Specialist, and the owner of The Institute for Hand and Upper Extremity Rehabilitation, Linda Stanley has been a working therapist since graduating from Temple University in 1984. She became a Certified Hand Specialist in 1991 after passing the first Hand Therapy Certification Exam offered by the Hand Certification Commission. The Institute for Hand and Upper Extremity Rehabilitation specializes in the rehabilitation of injuries and related conditions that cause impairment of function in the shoulder, elbow, wrist and hand. Patient input is valued and deemed necessary in achieving positive outcomes and the practice has a solid relationship with physicians and referral sources to aid with communication for optimal care.
With the changes in healthcare plans, most notably the increasing in healthcare premiums, more consumers are left with no choice but to opt for higher deductible plans. For the customer, this means that out of pocket minimums are significantly increased before the insurance companies pay for required healthcare services. In the interview, Ms. Stanley explains the financial benefits in choosing to receive therapy at a private practice, such as her own, in comparison to big corporation or hospital-based practices. She points out that often patients are unaware that they have a choice in deciding where to seek medical treatments and often go to the emergency room for trauma and then to referred physicians for on-going treatments. What patients fail to realize when scheduling these follow up appointments is that, often times, physicians are expected to make in-house referrals to keep the revenue within the health network they are working for. The financial disadvantage to the patient is that reimbursement rates or allowable amounts are significantly higher for hospital based practices in comparison to private practices. For example a hospital may charge $800 for a one hour evaluation but the insurance company may only have an allowable amount of $600. That $600 is what the patient will be charged before the deductible is met. At private practice such as The Institute for Hand and Upper Extremity Rehabilitation, that one hour evaluation would range from $90-110 because of the insurance company’s allowable amount. The difference is also significant for ongoing treatments.
Linda also answers why there is such a significant cost difference in her interview. Insurance companies rely on hospitals for revenue. That is where patients habitually go whether it is for the emergency room, x-rays, surgery, etc. The hospitals hold leverage with the insurance companies as the insurance company needs the contract with the hospitals to appeal to the consumer. It is quite the opposite with small practices. Private practices need the insurance company and therefore the insurance company and therefore the insurance company holds the leverage and does not have to compensate the small practice as much.
The long-term problem with the way healthcare is operating is that many private practices can no longer stay in business because of the lower fees and therefore are being bought out and owned by hospitals, in addition to the in network referrals that are received at the hospital based services.
For the patient, the effect is financial. That doctor visit that used to cost eighty dollars will now cost one-hundred and fifty dollars. As private practices go out of business, hospital-based practices can monopolize the healthcare industry and the low cost option for the consumer is gone. It is almost inevitable that private practices will disappear unless patients wake up to the fact that they have a money-saving choice.
Aside from the financial benefits to utilizing private practices, patients can expect a more personalized treatment plan. An unfortunate side-effect of being owned by a large corporation is that physicians are required to meet patient quotas, leading to revolving door appointments. In a private practice setting, patients can expect to be seen and heard as their livelihood is dependent upon their patients. As Ms. Stanley said in her interview, “I’m vested. My name is on the door. It’s not just a job for me. It’s what I do and who I am… I wake up in the middle of the night thinking about my patients because I do care about them and I think that they get a true connection with me”.