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Culture & Society, Doctors, Featured, Health Policy, Healthcare Reform, Medicine, Politics, What's New

America Out Loud PULSE: Medical Care Is About Patients, Not Politics

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From my America Out Loud Pulse podcast: Medical Care Is About Patients, Not Politics with Dr. Richard Amerling - https://www.americaoutloud.com/medical-care-is-about-patients-not-politics-w-dr-richard-amerling/

Several years ago the Association of American Physicians and Surgeons publish a Patient Bill of Rights. In this age of more government and corporate control of medical care, it’s time we remembered those rights.

“All patients should be guaranteed the following freedoms:

  • To seek consultation with the physician(s) of their choice;
  • To contract with their physician(s) on mutually agreeable terms;
  • To be treated confidentially, with access to their records limited to those involved in their care or designated by the patient;
  • To use their own resources to purchase the care of their choice;
  • To refuse medical treatment even if it is recommended by their physician(s);
  • To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;
  • To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians;
  • To receive full disclosure of their insurance plan in plain language, including:
    • CONTRACTS: A copy of the contract between the physician and health care plan, and between the patient or employer and the plan
    • INCENTIVES: Whether participating physicians are offered financial incentives to reduce treatment or ration care;
    • COST: The full cost of the plan, including copayments, coinsurance, and deductibles;
    • COVERAGE: Benefits covered and excluded, including availability and location of 24-hour emergency care;
    • QUALIFICATIONS: A roster and qualifications of participating physicians;
    • APPROVAL PROCEDURES: Authorization procedures for services, whether doctors need approval of a committee or any other individual, and who decides what is medically necessary;
    • REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
    • APPEALS: Grievance procedures for claim or treatment denials;
    • GAG RULE: Whether physicians are subject to a gag rule, preventing criticism of the plan.”

Culture & Society, Doctors, Featured, Health Policy, Healthcare Reform, What's New

America Out Loud PULSE: The Physician Shortage and Quality Care for All

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From my America Out Loud Pulse podcast with Nicole Johnson, MD – https://www.americaoutloud.com/the-physician-shortage-and-quality-care-for-all/

As Bain Capital put it, 2021 was a “banner year” for private equity’s healthcare acquisitions. In addition to hospitals and nursing homes, physician practices have become hot targets. Over the past 10 years, private equity firms have moved on from buying physician staffing companies for hospital based practices, such as emergency room physicians, anesthesiologists and radiologists. They are broadening their net to include dermatology, ophthalmology, urology, and orthopedics, women’s health, gastroenterology.

The private equity firm’s main focus is on efficiency, productivity, and short term profits, not patients. Many physicians left independent practice to seek relief from the administrative aspects of private practice but found they became fungible, income-generating drones in a health care “system.” And patients are paying more and more out of pocket for their care with less choice and in some cases, lower quality.

A new study looking at 1,400 acquisitions from 2014 to 2019 found that compared to non-acquired dermatology, ophthalmology, and gastroenterology practices, the acquired practices not only replaced more physicians, but many were replaced with non-physician clinicians. For example Kaiser Health News reported that American Physician Partners, a medical staffing company owned by private equity investors. employs fewer doctors in its ERs as one of its cost-saving initiatives to increase earnings, according to a confidential company document obtained by KHN and NPR. The question arises whether this improves access or decreases quality or a little of both.

Among many reasons, commitment to science and helping patients heal is why we wanted to be physicians. Sadly, with this new landscape, physicians are becoming less satisfied with the practice of medicine. Nurses, nurse practitioners, physician assistants are all valuable parts of the health care team. But does this mean they have the requisite skills to practice without physician supervision and are the primary answer to physician shortages?

My guest today is a fierce advocate for patients and physicians. We’ll discuss solutions to the physician shortage and access to quality medical care for everyone.

Doctors, Featured, Health Policy, Healthcare Reform, Politics, What's New

America Out Loud PULSE: Getting Back to the Oath of Hippocrates Is the Way Forward

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From my America Out Loud Pulse podcast with Dr. Elaina George - https://www.americaoutloud.com/getting-back-to-the-oath-of-hippocrates-is-the-way-forward/

Written in about 400 B.C., the Oath of Hippocrates embodies the guiding ethical principles of the practice of medicine. The Oath focuses on individual physicians treating their individual patients. All of our actions must be for the benefit of the patient; we must keep all of their information—“holy secrets” as the Oath states—confidential. Our duties attach whether the patients were “free or slaves.” If we actually paid attention to these principles, we would not need Big Brother’s rules.

The bloated bureaucracy is only getting worse with electronic records, prior authorizations before treatments, and various other payment barriers. There are now 10 administrators to each physician. Physicians and patients alike feel like they are helpless pawns on the corporate chessboard. Perhaps the Affordable Care Act meant well, but in my view, it was another tool to impose more government controls on us. The overall costs are higher and patients find themselves with less choice of physicians.

Is more technology the answer? An unbelievable, but—thanks to cell phone video—verifiably true news report detailed how a robot rolled into a patient’s Intensive Care Unit cubicle and a physician’s talking head appeared on the robot’s “face” and told the patient the sad news that he had a terminal illness. While remote medicine is reasonable in rural areas where access to medical care is limited, telling a patient he is going to die from a TV screen is a crime against all medical ethical principles.

Telemedicine certainly has its place but not only does it decrease the patient-physician face to face contact, but according to a study of 76 million claims, it might not even save money. To be fair, telemedicine is convenient and improve accessibility. However, the convenience could lead to overuse of services.

Is single payer health care the panacea that its proponents claim? According to Sky News, under the National Health Service, there are 7.2 million British citizens awaiting medical care, or almost 11% of the entire British population. It’s estimated that between 300 and 500 people are dying each week because of delays and related problems in the delivery of emergency medical care. More bureaucracy causes delays in care.

So many of us are burned out on politics at this point. We witness so much corruption and two-tiered justice for the “chosen ones”. Nonetheless, we have to work together to change things.

My guest and I will discuss all things medical care and what we can do to improve costs sand access to care while maintaining the principles of good medicine.

To find an independent physician go to the Association of American Physicians and Surgeons website, https://aapsonline.org/direct-payment-cash-friendly-practices/.

Culture & Society, Doctors, Featured, Health Policy, Healthcare Reform, Medicine, What's New

America Out Loud PULSE: Some Truths About Rural Healthcare with Dr. Edwin Leap

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From my America Out Loud Pulse podcast with Dr. Edwin Leap - https://www.americaoutloud.com/dr-edwin-leap-some-truths-about-rural-healthcare/

Approximately 20 percent of the U.S. population is spread across 97 percent of the vast U.S. land area. Yet rural hospitals and patients have been largely neglected in articles about medical health and health care policy. We mainly hear about the disproportionate number of opioid problems in rural communities. But rural residents are about more than the opioid epidemic. These “flyover” citizens have families, jobs, heart disease, kidney problems, anxiety and depression – just like people who live in the cities. But what they often don’t have is access to medical care.

Between 2008 and 2018, an estimated 500 out of more than 4,500 rural nursing homes closed or merged. Consequently, some 10 percent of rural counties had no nursing homes. This is a significant loss given that 17.5 percent of the rural population was 65 years and older compared to 13.8 percent in urban areas.

According to the CDC, since 2010, more than 137 rural hospitals have closed, generally due to lack of money as many of the rural patients are uninsured or are on Medicare or Medicaid, resulting in less revenue than with commercial insurance. These closures force patients to travel as much as 2 or 3 hours for advanced medical care. During the peak of the COVID-19 pandemic and continuing today, many emergency departments needed to transfer the sicker patients but there were no beds at the larger, distant hospitals.

We hear about government programs “to apply a rural lens” to health policies but the patients in the countryside continue to lack care. What is going on? We will discuss lives how to tackle these issues with Dr. Edwin Leap who has worked in rural hospitals for over 20 years.

Featured, Health Policy, Healthcare Reform, What's New

America Out Loud PULSE: What Can a Truly Free Market Do for Medical Care?

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From my America Out Loud Pulse podcast with Charles Sauer - https://www.americaoutloud.com/what-can-a-truly-free-market-do-for-medical-care/

Health Insurance is not the answer to health care costs. Ninety-one percent of Americans have health insurance but “the system” still presents problems to many. According to Kaiser Family Foundation data, about half of U.S. adults say they have difficulty affording health care costs. About 40 percent of U.S. adults say they have delayed or gone without medical care in the last year due to cost. About one-third of adults with health insurance worry about affording their monthly health insurance premium, and 44 percent worry about affording their deductible before health insurance kicks in.

Private equity firms have entered the health care arena, promising savings and efficiency but this trend may have added to the cost. For years, health policy experts have been warning about the dangers of private equityand consolidation in medical services. Five for-profit insurers now control 43 percent of the market, more than 60 percent of community hospitals belong to a health system. A large California study found that consolidation of the hospital, physician, and insurance markets increased prices of services as well as ACA premiums.

A new Congressional Budget Office report confirms that one factor keeping insurer costs high is that “markets have become more concentrated than they would be otherwise because of barriers to entry.” What these barriers have in common is that they limit competition and patient access to care. Removing them would promote competition among providers and ultimately reduce costs.

My guest today will talk about some solutions to high medical costs that do not include government control of our medical care. Medicare, Medicaid, and the Affordable Care Act are strong evidence that government involvement does not save money overall.

Featured, Health Policy, Healthcare Reform, Medicare, What's New

America Out Loud PULSE: The Truth About Medicare and How to Improve It

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From my America Out Loud Pulse podcast with Steve Cohen, JD - https://www.americaoutloud.com/the-truth-about-medicare-and-how-to-improve-it/

Medicare accounts for 20 percent of health care expenditures and is 13 percent of total federal spending. Medicare is the second largest program in the federal budget ($767 billion), second only to the Social Security program ($1.151 trillion).

In 2021, Medicare provided benefits to 19 percent of the population. By 2030, one in five Americans will be older than 65. The expenditures will most certainly rise due to increased enrollment, rising Medicare prices, increased use of care as people with chronic conditions live longer. Accordingly, it is imperative that policymakers arrive at viable changes to the program that do not sacrifice seniors at the altar of cost savings. (You all know I’m a fan of cash – but most people currently are not prepared to go that route. Health Savings Accounts take time to grow.)

Medicare is funded mainly from general revenues (43 percent), payroll taxes (36 percent), and beneficiary premiums (15 percent). And the well is running dry. We have gone from 41.9 workers per retiree to 2.8 workers paying into the fund. In 2020 Medicare’s trustees reported that the trust fund, which pays for hospital and other inpatient care (Part A), would start to run out of money in 2026.

People say we can’t agree on anything these days. They say we are too divided. (In my view, most of us want the same goals but have different ideas on how to achieve them.) One thing we all want is for seniors to not struggle in retirement after working hard for so many years. Another is that we don’t want to kill off our seniors with rationing of medical care. Treatment decisions regarding withdrawing or limiting medical care must be open and transparent and follow the patient’s wishes.

The rationing going on with seniors on Medicare is more subtle and behind the scenes. More and more seniors shifted to the Medicare Advantage managed care program with its fixed allotments to medical professionals and restricted prescription medications. Moreover, the Affordable Care Act decreased payments to this program by $156 billion. Will the program make up the difference by cutting services?

My guest today will discuss Medicare’s general rules, pitfalls for patients, and his ideas on how to improve it.

 

Doctors, Featured, Health Policy, Healthcare Reform, Medicine, What's New

America Out Loud PULSE: Is Cash King for Medical Care?

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From my America Out Loud Pulse podcast with Dr. Kathleen M. Brown - https://www.americaoutloud.com/kathleen-m-brown-md-is-cash-king-for-medical-care/

Governments, doctors, and patients are looking for ways to improve health care quality and lower costs. Legislators have made attempts with the No Surprises Act and Health Care PRICE Transparency Act. But these laws do not get to the core of the perverse medical care pricing system. Insurers bargain for prices with various health systems and hospitals. The negotiated price can be up to double the price offered to “self-pay” patients, that is patients who offer to pay cash even if they have insurance.

Additionally, insured patients are on the hook for more costs mainly because many employers have shifted to high-deductible insurance plans to lower their costs. According to the Kaiser Family Foundation, annual deductibles in 2021 were as high as $2,378, an amount that steadily increased over the last 10 years. Moreover, the insureds must pay a copayment when they see the doctor. This can be a fixed amount (average $25 for primary care and $42 for specialty care) or a percentage (generally 20 percent) of the cost of the visit. And remember, this percentage is based on the insurance rate—which is higher than the cash rate.

What is a patient to do to save money while still getting good medical care? When patients choose to receive care from a physician or other health care professional who has a cash-based practice, the fees can be very low. Why? They have cut out the middleman—the insurer. That means no salary for an office worker to sit on the phone all day with an insurance company trying to extract payments. Dealing with a cash-based practice also leads patients to other areas with reduced fees: X-rays, CT scans, MRIs, laboratory tests, and pharmaceuticals.

I urge you to take a look at websites that list folks who publish cash prices, such as the Free Market Medical Association, Association of American Physicians and Surgeons and sites that offer discount coupons such as GoodRx and Blink Health. The savings are well worth the time. Consumer Reports secret shoppers found the cost of 5 commonly prescribed medications cost $66 at HealthWarehouse.com, $105 at CostCo and a shocking $900 at CVS and RiteAid.

And why should physicians be more like veterinarians? The vets love their patients and many have this sign like this in their offices: You are invited to discuss frankly with us any question regarding our services or fees. The best medical services are based on a friendly mutual understanding between the patient and doctor.

My guest today has operated a caring, compassionate cash based medical practice and we’ll discuss how she got there. And we’ll also touch on human behavior and politics and how they influence the practice of medicine.

Doctors, Featured, Health Policy, Healthcare Reform, Medicine, What's New

America Out Loud PULSE: Health Cost Sharing Ministries - An Alternative to Health Insurance

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From my America Out Loud Pulse podcast with Katy Talento - https://www.americaoutloud.com/health-sharing-ministries-an-alternative-to-health-insurance/

Health insurance as we know it is a relatively new phenomenon. Accident insurance existed in the United States since the mid 1800s, becoming more prevalent as the industrial revolution brought more on the job injuries. Companies had onsite doctors who were paid by deductions from the employees’ pay checks.

In 1929 a group of teachers at Baylor University in Dallas formed the first modern group plan by contracting with a nearby hospital to receive care in return for a monthly fee. Under this “hospitalization policy” teachers would get two weeks of paid hospital care for 50 cents a month. This benefited both parties. The patients had relief from high hospital bills they were unable to pay and the hospital wouldn’t lose money on unpaid bills. With the onset of the Great Depression in the 1930s, many other hospitals followed the model of the Baylor Plan, and medical insurance became much more widespread. By 1963 more than 900 companies were offering health insurance products.

During World War II, the federal government imposed wage freezes. Consequently, employers were unable to attract workers through higher wages, health insurance was offered as an benefit and became linked with employment to this day. Over the years, the insurance products became more comprehensive and covered the cost of routine, preventive, and emergency health care procedures, and most prescription drugs. During the 1980s and 1990s, footing the bill for policies covering everything under the sun, along with diagnostic and treatment advances, the cost of health care rose rapidly. To save money, and the majority of employer-sponsored group insurance plans switched from “fee-for-service” plans to the cheaper managed care plans.

Even with the managed care model, according to Kaiser Family Foundation data, about half of U.S. adults say they have difficulty affording health care costs. About 40 percent of U.S. adults say they have delayed or gone without medical care in the last year due to cost. The Affordable Care Act so far has done nothing to contain medical costs or make health insurance more affordable for everyone.

Health sharing ministries have been an alternative to health insurance. Recently, more and more people are taking advantage of this option to pay for medical services. The concept of health sharing ministries is reminiscent of the early English-speaking American settlers who addressed social concerns through self-reliance and voluntarism.

My guest today will fill us in on the nuts and bolts of this type of medical cost sharing.

 

Doctors, Featured, Health Policy, Healthcare Reform, Medicine, What's New

America Out Loud PULSE: Direct Primary Care: Where Physicians Put Patients First

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From my America Out Loud Pulse podcast with Dr. Kim Corba - https://www.americaoutloud.com/direct-primary-care-where-physicians-put-patients-first/

Many consider medical care in the United States as the best in the world. Potentates from multiple and disparate countries come here for treatment. On the other hand, efforts to create a “healthcare system” have been a failure. While necessary for major medical expenses, the health insurance industry has drained the life out of the patient-physician relationship and the pocketbooks of patients. Despite the promises of the ACA, many patients do not have access to good medical care and a stable relationship with their doctor.

Five for-profit insurers now control 43 percent of the market, more than 60 percent of community hospitals belong to a health system, and less than half of physicians own part of a private practice. Many of these former private practitioners became corporate employees and another cog in the hamster wheel of 7-minute patient visits.

Some physicians have taken another route. More and more are leaving their insurance-based private practice and taking the leap into a cash-based practice. One such model is called Direct Primary Care (DPC). The key word is “care.” With DPC physician’s office is dedicated to patients, not health insurers – where patients are a bean counter’s data points. Under the DPC model, physicians can maintain a small, independent practice with less time on paper (computer) work and more time with their patients. In addition to time and individual attention, patients can rest assured that their private medical information stays within the walls of the doctor’s office.

We can stop the corporate-government takeover of medicine. We can seek out private practices where you are treated as an individual human being, not an income generator.

My guest tonight will discuss her Direct Primary Care practice. And we will delve into the particular relevance of a strong, private patient-physician relationship as Covid lockdowns, masking, and economic issues take their toll on our mental health.

Current Events, Featured, Health Policy, Healthcare Reform, Politics, Socialized Medicine, What's New

More Red Tape Does Not Provide Better Health Care

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The Affordable Care Act’s hundreds of pages of mandates and thousands of pages of regulations could not provide what we Americans want: more choice, lower costs, and better care. The premiums and deductibles continue to rise. Patients are finding fewer “in network” doctors, leading to surprise medical bills. 

While some were busy pontificating about how much they care about patients, the President was busy working to make our medical care great again. There was a time when there were hundreds of insurers offering a variety of individual health insurance plans tailored to an individual’s needs. Just as we do with the variety of products that we buy every day, we can use our purchasing power to compare costs and value. This includes using our tax-free health savings accounts to pay to day-to-day medical care out of pocket. 

Back in 2017, the President started the road to put patients in charge of their own money and medical care. After ensuring that the ACA’s mandate tax was repealed, his administration increased insurance options that cost up to 60 percent less that the lowest price ACA plans. The President launched a rule to broaden the availability of association health plans for small businesses which are projected to cover up to 400,000 previously uninsured individuals for on average 30 percent less cost. He expanded health reimbursement arrangements that allow consumers to use tax-free dollars to pay for some medical costs. 

The President signed a law banning “gag clauses” that prevented pharmacists from telling customers when it would cost less to directly purchase a medication, rather than through their health insurance. He continues to make rules to lower prescription drug prices in federal programs.

Speaking of caring about real patients, the President expanded choice to our veterans by allowing them to seek care from private physicians. And after many years of work by advocates, the President signed the Right to Try Act so critically ill patients could have access to life-saving treatment. The President’s latest executive order promises that he will not sign any law that does not cover patients with pre-existing conditions.

Medical care is one of the most personal aspects of our lives. A government bureaucracy by its very nature is one size fits all—or more realistically, one size fits none. The ACA has shown us that more government control is not the answer. It’s time for the President’s plan rooted in patient control. 

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