Proration Sucks!

Get ready for some confusion as we learn about the way the government pays me (or doesn't) to do my job...

As many of you know, I am a massage therapist (if you don't know, get thee to my about Vertigogirl page and read up!). Most of my client base is people referred to massage therapy by their doctors for a medical reason. In this province, massage therapy is covered under our provincial health care system. This means that the majority of my income comes from the government. And that means that I get to deal with a whole lot of bureaucracy. My least favorite form of bureaucracy comes in the form of proration.

Proration: As of August 15th of this year until the end of March 2000 massage therapists are having their incomes prorated. This is the Government of BC's idea of controlling health care spending through the Medical Services Plan (aka. MSP). This is a rather complicated procedure so in order to make it a little more understandable, I will try to explain how I get paid by the government to do massage therapy. For a single visit I get paid a base amount - call that "b" (everyone loves variables!) - which is for treating one area of the body referred by the physician, such as the neck. Plus a potential extra payment for up to 3 additional areas of the body mentioned on the all-powerful referral - call them "1x", "2x" and "3x". So, for a session in which I treat the neck, shoulders (they count as 2 areas) and upper back (equalling 4 areas), I can bill the government 1b and 3x. If only 2 areas are on the referral, I can only bill for 1b and 1x even though I spend exactly the same amount of time with the client, since MSP treatments are all 20 minutes long. Confused yet? Just wait. During proration, the government cuts back how many x's we can bill, so that (this time around) although we are still treating the same number of areas, we are only getting paid the base and 1x. This means I am potentially (it all depends on the number of areas mentioned on the referral) losing $4.35 - $8.70 per treatment each day, for exactly the same work. Multiply that by approx 10 clients a day, 3 days a week and you realize that this isn't exactly pocket change.

Now, I understand that the budget for massage therapy is only so big (because they need all the extra for conflict of interest investigations and those useless superferries) but their justification for the need for proration is an increased strain on the budget by increased utilization by the public. I may be biased, but isn't increased utilization of preventative health care a good thing, and a sign that the public, aka. taxpayers, think it is a valuble thing to spend money on? As well, is it not a sign of serious mis-management if the budget can only sustain full payment for massage therapy services rendered for 4½ out of 12 months? This goes far beyond a little over-budget.

There are several ways that the government could save money in other areas of healthcare and funnel that income into the massage therapy budget. The first is to get rid of the MD referral requirement. So much money is wasted by patients going into their MD for 2 minutes, asking for a slip of paper to allow them to receive massage under MSP. We are trained to assess many physical conditions, as well as know contraindications for massage. No referrals are required for Physiotherapy or Chiropractic treatments. Even the MD's themselves want to get rid of the referral requirement - they voted in favour of abolishing it last year but nothing has been done about it. MSP seems to fear that all of a sudden, everyone in BC would be rush to massage therapy, costing even more money. Comparing what I make to what the MD does, I don't think that would be a worry.

Another solution would be to pay a flat rate for massage therapy services which is less than if we billed "3x" but more than if we billed "b" on its own. This makes a lot of sense since we are paid to do 20 minute treatments of hands on time with only one patient at a time - unlike Chiropractors and Physiotherapists - and more areas don't really create more work since they have to fit into the time frame, we should be paid a flat rate per visit rather than varying rates. The biggest barrier to this is the Physios/Chiros. They get paid in the same sort of area-based way, which makes more sense in either of their cases, and since they have more education than us, they are not willing for our flat rate to be more than their base rate even if we cannot then bill for extra areas the way they can. It would also save a whole lot of time and money because no one would have to take the time to: calculate how much and for how long proration will last; program the computers that respond to our billing (since we are asked to bill as usual even though we aren't being paid for much of it); chart how much over budget we would have gone if they hadn't prorated etc.

None of these solutions are perfect for all concerned. But anything has to be better than having proration rear its ugly head nearly every year. At least they are being consistent this year, though. Some years it is head spinningly complicated - we can bill "2x" from September to December 15th, then only "b" until the 31^st, then 1x until February 9th, then "1x" on every 2nd Monday... okay, it isn't quite that bad, but it isn't that far off either. I guess I can be thankful that it isn't a really complicated year... or not, since anyway you slice it, proration SUCKS!