"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness ..."
Charles Dickens' first 24 words of his opening paragraph of "A Tale of Two Cities" described the novel's era. He could just as easily have been foreseeing the future of health care in America. Ok, I'm stretching it a bit, but we are at a crucial crossroads.
We have the most powerful technology ever to diagnose, treat and cure diseases. But are we truly any better off? Would Dr. Marcus Welby approve of the disintegrating relationship between health care providers and patients? I think not. But this is not a discussion about the Affordable Care Act, affectionately called "Obamacare." I want to tell you about 17 incredibly talented professionals and their efforts to preserve the personal aspect of patient care in their corner of the health care world.
Everyone who has followed me these past 10 months knows I love to cook and that the time spent in restaurant kitchens delights me. What you don't know is after those long 12-hour shifts on my feet, I spend days recovering from back pain. I greatly admire career chefs who have to work day after day with pain. So with that in mind, before I begin my winter experiential research behind the scenes in the valley's restaurants, I thought it would be interesting to spend a day with my physical therapist, Neil Masters, at Axis Sports Medicine in Avon. Given physical therapy is a licensed profession, I wasn't able to actually work as I usually do in restaurants. But it was intriguing to be the fly on the wall, observing firsthand what it takes to open a clinic in the new reality of the Affordable Care Act.
This autumn, Vail Valley Medical Center made a strategic decision to bring the Howard Head Sports Medicine clinics under its umbrella and direction. Seventeen veteran Howard Head physical therapists then made their own strategic decision to establish a therapist-owned entity, Axis Sports Medicine. Together in Axis, these therapists can focus on preserving the patient-therapist relationship and respect patients' individuality, be sensitive to the economic reality facing many in our community and be nimble enough to find creative solutions to the challenges ahead. Although the economic hardships due to new regulations are pushing health care providers into hospital systems, the owners of Axis decided to buck the trend. Together, they can now control their own destiny to the extent possible in their increasingly regulated industry.
We're an active community with renowned orthopedic surgeons, so there's a big demand for therapists to help those of us who play too hard get back to doing the things we love. "Mainland" Eagle County, as I refer to the part of the county from Gypsum to Vail, is home to about 45 practicing physical therapists. To put that into perspective, the county average ratio of therapists to inhabitants is double the national average. We all know Eagle County is a good place to break something, get it fixed and rehabilitate!
The eight companies that employ these therapists operate 18 clinics. Axis clinics are in Avon, Edwards, Eagle, Gypsum and one in Summit County. Masters heads the Avon clinic, his seventh to open in more than 20 years of practice. Eight years ago, Masters opened his own clinic in Avon and then the Avon Howard Head clinic in late 2011. He and his colleagues in Avon, Genchain Nuzzo and Kathy Gwin, are well-known and respected veterans of the Vail Valley health care community.
Masters' days begin around 7 a.m. and usually end 12 hours later. In the quiet hour before patients arrive, Masters completes paperwork, reviews files of the day's patients, checks the clinic's brand new equipment and inventories supplies. Updates, progress notes, doctor follow-ups and constant battles with insurance companies make up the hours of administrative work therapists deal with each day. And there's no improvement on the horizon. In Masters' 20 years of practice, there have been quantum leaps in information technology. However, instead of creating efficiencies and allowing for increased patient interaction, Masters said he has one hour per day of treatment time less than we he started.
For many one- or two-therapist practices, the added uncompensated time required to meet insurers' and governmental agencies' demands coupled with the expense of implementing electronic medical records has spelled doom. Higher operational costs, less time to see patients and lower reimbursements are not exactly keys to success. Small medical and ancillary services practices are a dying breed. It's unfortunate that at a time when competition could enhance quality and reduce cost, the industry is consolidating.
Thanks to an obsession with forms insurers and the federal government share, each patient arriving at Axis for the first time, even established patients, must be evaluated. It's great to have an increasing patient load, but the 45 minutes of paperwork, 20 minutes of administrative time and 20 minutes a patient needs to complete forms are burdensome, to say the least. And that's not even the evaluation time! At least they are compensated for that.
So what gives Axis the edge to establish a new practice when so many are disappearing? The therapist-owners are proud of the depth of experience and their emphasis on continuing education. The 17 therapists have an average of 12 years of experience, with 75 percent holding advanced credentials and degrees - quite astonishing considering the national average for physical therapy companies is 5 percent. More experience translates into better outcomes faster. And all of them are connected to the community they serve, helping to strengthen the all-important patient-therapist relationship through shared daily experiences.
Most of all, what I observed on my visit and in the seven years Masters has kept my spine healthy is a refusal to allow the tsunami of regulatory changes to alter their approach to patient care. Despite odious restrictions on the number of treatments allowed, regardless of a patient's needs, and the increasing interference of insurers and the federal government on treatment plans, Masters and his Axis colleagues are dedicated to their calling. As a collection of experienced clinicians with the same vision, Axis appears well-positioned to help patients maneuver the changing health care environment.
Suzanne Hoffman is a local attorney, wine importer and the Chambellan Provincial of the Southwest Region and Bailli (president) of the Vail chapter of the Chaine des Rotisseurs. She is passionate about all things gastronomique. For more background information on her "Behind the Scenes" series, go to www.facebook.com/vailvalleysecrets. Email comments about this story to firstname.lastname@example.org.