Patients and referring physicians may wonder about our policy of not participating with Medicare, Medicaid, and other managed care organizations (MCO’s). We feel we owe you an explanation regarding our motivation behind this decision, to clarify understandable confusion.
RSI’s mission is to provide patients with safe, effective, and minimally-invasive musculoskeletal care that harnesses the body’s own natural capacity to heal and regenerate. Our goal isn’t to just treat your symptoms—we strive to heal the root cause of your pain, so that you can go back to living your life free of limitations and doing what you love.
Our objective is to provide what we, as physicians, believe are the most effective procedures available on the market. In our experience, regenerative therapies—such as platelet-rich plasma and autologous stem cell injections—are the most effective treatments for many of the musculoskeletal injuries our patients suffer from.
This brings us to a crossroads. On one hand, we know what is best for our patients. On the other hand, this does not currently line up with what insurance companies are willing to cover. At the time of writing this blog post, regenerative treatments are not covered by insurance because it takes time for novel treatments to become accepted as standards of care.
This is the dilemma we face.
Either we could “accept” what insurance companies say is the best care and offer our patients treatments that are more affordable (but which we believe are not as effective). Or we can stay true to our values and offer our patients what our research and experience has confirmed will likely reduce their pain and improve their condition the fastest and to the greatest degree.
Ultimately, we have chosen to do what we believe is the right thing for our patients; sticking true to our values always outweighs whatever backlash it might provoke. And while the argument could be made that it is important for physicians to offer the most patients the most care (quantity)—regardless of whether it is the best care—we are committed to preserving our integrity and holding ourselves accountable to the highest standards of care around (quality). At the end of the day, this is the code we live by.
All this being said, we understand and appreciate the difficulty that this presents for patients who are unable to afford our procedures. One of the reasons we are so invested in performing research at RSI is because we are fighting to legitimize regenerative treatments in the public eye, hoping that insurance companies will eventually catch on and make these therapies more affordable for more patients.
Preserving our integrity as physicians and our freedom to choose what procedures we offer to patients is just one of the reasons we’ve chosen not to participate with government and corporate payors. Another reason has to do with diagnostic tests. Many insurance companies require an X-ray of the spine prior to an MRI, which we feel is redundant and exposes our patients to unnecessary radiation and unnecessary expenses. Additionally, the insurance approval process for obtaining diagnostic tests can be onerous and often delays diagnosis and subsequent treatment, prolonging patients’ suffering.
We want our patients to receive only the tests that we feel are actually required to diagnose effectively, not what patients’ insurance companies dictate. Going directly to an MRI and skipping the X-ray, is in most cases more diagnostic and does not expose the patient to any radiation. RSI offers all these diagnostic and therapeutic services on-site, so that patients can receive treatment right away and not wait weeks until they are treated.
Another reason we’ve chosen to opt out of working with insurance companies is because we want to avoid putting ourselves in a position to be financially incentivized to perform certain procedures or order certain tests. At the time of writing this blog post, RSI physicians and staff are paid as employees; they receive moderate (not lavish) salaries and no profit-sharing. This further instills our culture and ethos of integrity and transparency—physicians are not incentivized by the volume or type of tests they order, or the number or type of procedures they perform. Our physicians are truly incentivized to provide the highest quality of care, be innovative, perform research, and serve as team players. Our patients should take comfort in knowing that their clinical care is strictly based on what our physicians think will be best for them only.
Finally, we opt out of insurance because we want to create a sustainable model of healthcare that is not vulnerable to the whims and politics of government and corporate payors, which may adversely affect patient care in the long-run. It is important to us that we maintain our autonomy by agreeing not to participate in payors’ restricted fee schedules and rationed care models.
Healthcare is in need of higher-integrity, patient-oriented, physician-led, alternative models of healthcare whose very foundations are built upon complete alignment of patients’ interests with those of their healthcare provider. RSI is unlike any other available model for musculoskeletal care in most parts of the US, and even the world, for that matter. Our success is defined not on the basis of financial profit or the quantity of patients we see, but instead on social profit—how much can we improve the lives of our patients?
We believe that every time we open an RSI office in a community, the musculoskeletal health and well being of that community will be greatly improved. Any decision that leads us away from our core values—e.g. participating in a payor model that is outdated, inefficient, and not sustainable, in our opinion—is something we must avoid. We feel this is the only way we can offer our patients the highest quality of care.