Monday, September 28, 2009

Cloudy with a chance of ... pine cones?

Here is a picture of the wheelchair ramp on the front of the building. Thanks to a particularly unstable weather cell in our area we had violent winds this morning. While working with a small group of four year old children we heard THUNK THUNK THUNK THUNK outside the building and I immediately thought that I was hearing hail. When you are an adult it is sometimes reflexive to think about boring things like repair bills for damage - the noise was extremely LOUD and I was envisioning the dents all over the roof and hood of my car!

Thankfully I don't work in the world of adults and so the self pity over potential repair bills didn't last long. The children were curious so we all ran to the window and they were amazed at what we all saw. "OH MY GOODNESS IT IS RAINING PINE CONES!!"

The contextual world of children is currently rich with movie metaphors for odd rain events and so it all made very perfect sense to them. The kids were very excited to return to our pre-writing activity and modify the pictures they were working on by adding "pine cone rain." It was grand fun this morning!

Monday, September 21, 2009

How the health insurance industry is price gouging to its own demise

Here is an interesting anecdote of how the private health insurance market is killing itself:

Our health insurance costs (premiums + deductibles) for the plan we offer to employees have risen over 20% each year for the past five years. Some years our costs have risen as much as 45% when we were forced into the high-deductible product line.

There has been no accompanying increase in reimbursement rates for occupational therapy or physical therapy, by the way.

Aside from that, I was interested when I was informed three months ago that our current plan was being discontinued because the letter that we were sent said very specifically:

" In the short term, the impact of these changes will not be seen in premiums. Encouraging preventive care and providing new products and programs to empower members to take a greater role in their health care and will help address rising costs. Rest assured that XXX Health Insurance Company knows that the current pace at which health care costs are rising is unsustainable. We are working on a number of initiatives and programs to deliver better care to the community, as well as the country."

Well anyone reading that might expect that costs would not change! Of course they held off on telling us the new plan and the new rates, citing federal mandates for mental health parity - which actually don't apply to our company and a great many other employers because of the '50 employee rule' but that fact seems to be lost on the insurance companies. Undoubtedly, they model their price structure on total costs they incur and don't try to separately pool small from large employers. In this way the fact that there is an exemption for very small businesses really doesn't matter because the costs get applied in the global model anyway!

For the record (and as a provider) I believe that mental health parity should be a given - and I understand how that could increase costs. The problem is that insurance companies are using this as a smoke shield for ratcheting up premiums across the board, again - and that the whole model that burdens small businesses with these costs does not work. There has to be a better way!

OK well I received the new plan and rates today and they amount to ANOTHER 20% increase in premiums and deductibles with accompanying increases in co-pays and prescription costs - so of course I call the XXX Health Insurance Company and am given the run around that the increases are due to the mental health parity law (which we were supposed to be exempt from). After I point out the illogical statements being made I then referenced the letter that I was sent on June 30th and asked him to read from it. This is what he read:

"Rest assured that XXX Health Insurance Company knows that the current pace at which health care costs are rising is unsustainable. We are working on a number of initiatives and programs to deliver better care to the community, as well as the country."

In other words, the insurance company is now claiming that 'their' version of the letter doesn't make a statement about costs not increasing. They asked me to fax them a copy of the letter that I got - which I did - but I won't be holding my breath for that to change anything. I can't believe that they are trying to lie about what their own letter said.

I am a free market capitalist and I think that people have the right to make as much money as they can - but there is something wrong with our health insurance system that has so much profiteering in it, with such restriction of benefits to people, and with such restrictive reimbursements to most providers. The money and benefits need to flow to the patients and their health care providers (with some reasonable opportunities for profit but NOT price gouging). Again, this could all be solved with open market competition.

End game: we are competitive shopping for health insurance - again - and costs would most certainly be easier to manage if there was cross-state competition as there is in other insurance markets. I am terrified about handling health insurance over to the government because I have very little faith that the government will run a fair and competitive product (again, costs will simply be shifted via other taxes to the whole population and the risks of rationing as in other socialized systems are just not acceptable).

The current system is broken, and the public option is a very broken alternative that is subject to the same power-broking and manipulation as our current system. There is a need for leadership on this issue that includes open private competition and tort reform as the first step at repairing the system. I do not have confidence that we will see it.

Thursday, September 17, 2009

New ABC Therapeutics website goes LIVE!

Please stop by and visit our new site:

Cut to the chase: A simple question that perplexed us today!

At the beginning of each school year I marvel at how big of a challenge it is to get everything organized. Education is not new, drawing school district lines is not new, establishing bus schedules is not new, and determining outcome measures for education is not new - but each year it is as if no one has ever done it before, and people are left floundering around trying to figure out what needs to be done and how it needs to be done!

In my own little OT corner of the universe we came upon the issue of 'what are the best scissors for preschoolers to learn how to cut with?' Well there are no shortage of opinions but there is very little evidence I could find. That was a little surprising given the length of time we have been teaching preschoolers how to use scissors.

Having practiced OT for over 20 years I have some opinions, but they are just opinions and I have no proof to offer that the way I do things is any better than any other way. I am aware of a fine book about scissors training that Marsha Dunn Klein wrote around 20 years ago - but that wouldn't qualify as 'current' information. I am also aware of some interesting book chapters and presentations by Mary Benbow that I have read and attended over the years - but again this is nothing more than expert opinion based on normal fine motor development. We have some good developmental expectations on when skills are typically attained (as per PDMS and HELP data) - but these don't specify any given teaching method or even any specific type of scissors!

I looked through the searchable AJOT database and came up empty. OT Seeker did not have anything on the topic either. So what are the best scissors for preschoolers to use? Have I missed anything out there that anyone is aware of?

This year we will try to begin to answer this question. Since we have convenience samples that essentially parallel each other in demographics and need, and since both methods seem well accepted we will simply use Benbow scissors in one set of rooms and Fiskar scissors in another set of rooms. At the end of the year we will look for some narrative perspective of the therapists and teachers and we will look at actual rates of goal attainment since so many of the kids have scissors goals. If during the course of the year it becomes evident that one scissors is clearly superior we will switch all classes to those scissors.

Or if someone can help us answer this question sooner we would love to see your evidence!