Somatic bodywork

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"Fascia land" by Beth Scupham
“Fascia land” by Beth Scupham

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Several therapeutic movement-based treatments work with massage, or separate from it, to improve the body’s alignment, and through that, other physical complaints from bad posture to pain. Rolfing, Feldenkrais and the Alexander Technique have that in common, but differing approaches to getting there. Actors, musicians, computer users, athletes — both professional and recreational, and those of us whose bodies are changing as we age, have all claimed to get relief from these approaches.
Some massage therapists study them to supplement the health benefits of massage with the tools for patients to help themselves, on or off the massage table, including exercises and increasing mind-body awareness.
Repetitive movements, say, like that of a cello player, hunching over a computer, holding the body in an awkward positions due to laziness, habit, stress, emotional blockage or other psychological issues, all can contribute to pain, discomfort and inefficiency of the body. Proponents and practitioners of these therapies make claims of good health through improved behavior of the muscles and muscle systems, leading to better posture and more balanced body alignment, less discomfort and pain and reduced mental stress. The patient is guided, through hands-on body work and/or exercise instruction, to go beyond being just a passive recipient and re-think old movement habits, making changes in the way they carry themselves and move that will lead to looking and feeling better. Some people claim that their chronic pain fades, their hunched back straightens, and that others tell them they look taller and slimmer or more graceful and confident.
Rolfing was founded by Dr. Ida Rolf, a physiologist and biochemist in early 20th century New York City. Her approach used hands-on, deep tissue manipulation of muscles to reposition tissues in order to improve postural misalignments and sagging caused by pent-up emotions. Her technique separates opposing pairs of muscle fibers, which take turns contracting, and was originally called Postural Release, then Structural Integration, and finally Rolfing. Done as a “recipe” of ten sessions, it is mostly hands-on, although exercises are also involved, like arcing and pelvic tilts. Both passive and active movement retraining are used with the goal of creating a vertically aligned body that will stand up better to the forces of gravity.
Some have considered Rolfing more painful than other modalities of bodywork and others say much less so than it used to be. Many claim relief of stress, pain, headache and improved balance and flexibility. Certified Rolfers can be found at www.rolf.org/find.

Pioneer practitioners

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The independent nurse practitioner with her or his own business is a rare breed. Though most of these professionals work for others, change is looming. Large numbers of baby-boomer-aged family physicians are poised to retire in coming years. The Physicians

Foundation says nearly half are over age 50, so a shortage of primary-care doctors is predicted.

It seems that nurse practitioners may step up to fill the gap. Luckily their numbers are rising. In the past five years the yearly number of NP licenses issued has increased from 946 to 1383.

For five years Linda LaRocco, who has a master’s and a doctorate in nursing, has been seeing patients at her Pine Bush office. She has five examining rooms, a staff of two and a collaborating physician who reviews her patient charts quarterly. While insurance billing first had to be done through the collaborator as well, now it goes directly to her office. It is also performed now by an outside billing company rather than staff, which streamlines paperwork further.

Many people still aren’t sure what a nurse practitioner is exactly. “People don’t know how it works,” LaRocco told me, “who we are and what we do.” She’s trying to change that. “I’ve spent five years trying to get the word out,” she added. “I’m a doctor but not a physician.”

She has a doctorate, a Ph.D., not unlike other advanced medical practitioners who go on for advanced study, such as nurse anesthetists or nurse midwives. “One patient calls me ’noctor,” she said. By state law, she told me, she can’t just put “DNP” on her shingle. She has to spell it out: Doctor of Nursing Practice.

The profession began in the 1960s in Colorado, initially to treat medically underserved children. Dr. Loretta Ford and Dr. Henry Silver, a nurse and a pediatrician, started the first educational program at the University of Colorado.

These professionals start with a registered nurse license, and then go back to school for a master’s degree before they are eligible to sit for the NP licensing exam. Some, like LaRocco or those required to do so for teaching, return yet again for a doctorate. Once licensed they practice with a philosophy that stresses prevention, care and cure, and can perform physical exams, diagnose and treat illnesses both acute and chronic, interpret lab tests, prescribe medications, counsel patients on health and illness issues and refer them to specialists.

“I’ve developed relationships with them,” said LaRocco. “I’m colleagues with many specialists. I refer people to them and they are just a phone call away.”

The degree of physician involvement varies state to state. In a minority of states — 11 to 19, depending on the source — NPs can practice absolutely autonomously with no collaborators needed. New York is not one of these states, hence the quarterly reviews by LaRocco’s collaborator.

Holistically yours

[wide]holistic[/wide]They say there’s no such thing as a free lunch, but there is such a thing as free care. Dozens of local practitioners of holistic and alternative treatment methods have been giving it away for years, under the name Health Care is a Human Right.

Each month, the collective of healers holds clinics in a number of places — the Darmstadt Shelter and Kirkland Hotel in Kingston, the Parish Hall on Main Street in Phoenicia and the Woodstock Community Center. (The Darmstadt clinics are open only to shelter and Family Inn residents and staff; all others are open to the public. The next one at the Kirkland, 2 Main St. Uptown, will be next Thursday, Aug. 8, from 4-7 p.m.)

According to Susan Weeks, RPA-C, who co-founded the group 10 years ago and now serves as its director, the group’s mission is “to provide holistic health care to all regardless of ability to pay.”

The providers, or “faculty” of Health Care is a Human Right cover a broad span of disciplines: acupuncture, nutrition, homeopathy, massage therapy, reiki, energy work, hypnosis and more. All told, there are about 60, who all work pro bono, and more are being interviewed all the time, said Weeks.

Money truly is no object: insured or not, anyone seeking holistic care will be helped, for free. A triage procedure which involves the filling out of some forms and releases is done on each client but that’s about it. Which is not a bad deal at all, considering holistic and alternative care is not always covered by insurance or if covered, not very well, and can be expensive. “It gives people an opportunity to experience modalities that they normally wouldn’t be able to,” said acupuncturist and group managing director Julia Rose of Phoenicia.

The idea, said Weeks, is to bring healing back to its true basics: helping someone who needs help. “I think we have an amazing faculty of healers who are an example of what healing should be — people who are experts in their field and give of themselves selflessly to help others,” Weeks said, noting that it includes some of the most experienced practitioners in the area. “I’m really proud of them and I think they deserve a tremendous amount of credit.”

Last month’s clinic at the Kirkland featured a number of these providers treating a steady stream of people who appeared to be from numerous walks of life. Every nook and cranny of the hotel’s public interior space seemed to be in use — one room hosted massage, while a hypnotist set up in the landing between flights of stairs.

Here comes Obamacare

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Seventeen health insurance companies have stepped up and offered New Yorkers four levels of plans (plus an ominous-sounding “catastrophic” category) with standardized contract terms and product offerings. Consumers can now comparison-shop among them. Enrollments for New York’s health exchange marketplace, one of the most important early stages of the federal Affordable Care Act (Obamacare), will begin October 1, and coverage will become effective on the first day of 2014.

How much will eligible persons in the Hudson Valley pay for health insurance? According to the healthbenefitsexchange.com website, premiums for individual New Yorkers for the most comprehensive plan, “platinum,” will range depending on the vendor chosen from $446.25 to $994.34 monthly. Premiums for the plan with the lowest of the four levels of benefits, “bronze,” will be offered from $265.89 to $589.91 per month. Multiply those premiums by 1.70 for the inclusion of children, 2.00 for spouses and 2.85 for families. The rates approved are subject to final certification of the insurers’ participation in the exchange.

The new premium rates do not affect a majority of New Yorkers, who receive insurance through their employers, only those who must purchase it on their own, an article in the July 16 New York Times explained. Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State. State officials estimate that as many as 615,000 individuals will buy health insurance on their own in the first few years the health law is in effect. In addition to lower premiums, about three-quarters of those people will be eligible for the subsidies available to lower-income individuals.

The marketplace has been a long time coming. Governor Andrew Cuomo attributed the expectation that the expensive private insurance rates for individuals will decrease at least half to the influence of the newly constructed competitive marketplace. “New York’s health benefits exchange will offer the type of real competition that helps drive down health-insurance costs for consumers and businesses,” said Cuomo.

Crain’s New York Business provided perhaps the most animated reaction. “When the Cuomo administration gave word last week that individual health-insurance premiums offered through the state exchange to launch in October would be at least 50 percent cheaper than what some New Yorkers pay now, it was like tossing food pellets into a pond of starving fish,” said a Crain’s editorial last Friday. “Groups supporting the Affordable Care Act celebrated the news in TV ads, seeking to beat back Republican efforts to repeal Obamacare. Critics of the law fought back, arguing that the numbers were deceiving or downright false.”

New York has required insurers to cover everyone regardless of pre-existing conditions, but did not require everyone to purchase insurance — a feature of the new health-care law — and did not offer subsidies so people could afford coverage. With no ability to persuade the young and the healthy to buy policies, the state’s premiums to individuals have long been among the highest in the nation.

Medical markup

[wide]dollar health[/wide]The cost of medical care to consumers is nothing short of outrageous. A Houston cancer center billed a patient $7 each for alcohol prep pads used for injections, while a box of 200 is $1.91 online, according to a Time report published in February. And that’s just the tip of the iceberg of bill padding and fattening from both profit-making and so-called nonprofit institutions. Hospital administrators make multi-million-dollar annual salaries, and the labs and the manufacturers of medicines, medical supplies, devices and diagnostic equipment are getting rich from the high price of health care, all at the patient’s expense.

Even people who think they have good insurance can get hit with eye-popping amounts of money owed after medical care. Staggering bills from the briefest of hospital stays are based on nickel-and-diming everything that was provided. The charges for each line item are based on a huge computer file called a chargemaster — unique to every institution. Bills that are exorbitantly inflated to make up for all kinds of payers and non-payers are presented to all patients, regardless of their insurance status.

What Medicare pays for things gives us an idea of just how high that is. A hospital might bill a patient $333 for an x-ray while Medicare only pays $23.83 for the same thing, a very sizeable difference. On another bill described in the Time report, a patient was charged $6538 for three CT scans that Medicare would have paid $825 for. On another, a CT scan with radioactive dye to the tune of $7997.54 would have been paid only $554 by Medicare.

Online prices for medical supplies are telling as well. A patient having surgery may be billed $39 for the surgeon’s gown, or $32 for the use of a reusable blanket that goes for $13 new on eBay. Medicare either won’t pay for blood and urine tests or will pay $7 to $30 for them, but patients are billed $30 to $333 for them. Medicare won’t pay for incidentals that are part of other costs, but patients are billed for them anyway. It’s common for double- and triple-billing to occur, like when saline solution and oxygen or something normally included in the daily room charge are billed separately. An ICU kit can be billed as a unit and then each tool in it billed again.

Niacin tablets that cost about five cents each in drug stores go up to $24 when they appear on a hospital bill, and a Tylenol pill is billed for $1.50 when 100 pills go for $1.49 on Amazon, and often hospitals receive them for free from the maker.

IV solutions that you can buy online for $5.16 a bag are billed to patients at $84 to $134 per. Online you can get a box of diabetes test strips for about 55 cents each that hospitals bill $18 for. A patient was billed $13,702 for a dose of Rituxan that cost the hospital about $3000 to $3500. It cost the manufacturer only $300 to make it, test it and ship it to the hospital, a manufacturer whose CEO made a salary of over $11 million in 2011.