8.5 Problems: Solutions, Closing Thoughts, and Song

[00:00:00] Here Taylor and I try to turn our attention to solutions, including solutions to the systemic

[00:00:07] problems, solutions for physicians, and ultimately specific solutions for patients to help fight

[00:00:16] the high costs of United States healthcare. And as always we have a closing song. Enjoy!

[00:00:23] So, ultimately on the solution front what I would love to see is to be able to incentivize

[00:00:43] doctors to provide good care, including preventive care and have it in a merit-based system

[00:00:50] based on outcomes, based on the demographics and the lab values of patients coming in to see you,

[00:00:57] and the demographics and lab values of patients who have seen you for six months and a year

[00:01:04] and long-term outcomes. If we could create a system that incentivized doctors to provide good care,

[00:01:11] incentivized systems done the right way usually work pretty well. And I think really

[00:01:18] shifting focus from treating these acute issues to focusing on prevention, distributing more of

[00:01:24] that funding to primary care is one of those solutions. And changing the way our healthcare system

[00:01:31] in general is set up on prevention because right now the things that make the most, are probably

[00:01:36] the hardest things to get done, a lot of those things and the world prevention fall on the patient.

[00:01:42] And we could argue our education system as well, like how much health literacy does the average

[00:01:48] person have? In high school I took one health course over four years. It seems like out of all

[00:01:54] the things I learned in high school that might have been one of them more important things and maybe

[00:01:58] having that class more than once over the course of four years to teach people what is proper living,

[00:02:03] what is proper eating, how much exercise, and what are the consequences of not doing those things?

[00:02:08] I always say we should have a class in high school or in middle school for kids about

[00:02:14] what is your mind and how does your brain operate as a whole? Maybe if we could address what

[00:02:21] that negative voice that really comes on strong after puberty is, then we'd be better capable of

[00:02:27] managing it and dealing with it and wouldn't have to medicate 20% of our kids.

[00:02:32] There's a lot of room for some formal education in that they could greatly help people in the long run.

[00:02:37] Yeah another big thing that I think systematically has to change is this could be in medicine or

[00:02:43] this could be in politics. We got to put conscientious physicians or people in positions of power,

[00:02:49] people who value legitimate progress in terms of learning more about medicine,

[00:02:55] understanding different diseases and the nuances of treating them as opposed to looking for silver

[00:03:03] bullets or promoting treatments at the expense of American's health because it is

[00:03:09] remanterally financially beneficial for you or the company or people that you work with.

[00:03:15] You definitely see that on the political level but it happens all throughout medicine as well.

[00:03:20] Yeah anything we can do to get the business out of medicine because as a business its main

[00:03:26] goal is going to be profits but I don't think that should be the main goal in something like medicine

[00:03:31] where you're dealing with people's health and lives on the line. I know that we've recently

[00:03:35] repealed one of the amendments of the Affordable Care Act that says doctors cannot own hospitals

[00:03:41] but I do think people will benefit if doctors are in power in healthcare and situations where

[00:03:50] they're making large decisions about healthcare policy, how hospitals should be run

[00:03:56] and they may not be the money making machines they are but I think that there'll be a greater

[00:04:01] emphasis on treating patients what the overall goal of healthcare should be.

[00:04:07] Defensive medicine is something that is I think commonplace and I think that leads to a lot

[00:04:12] of ordering of unnecessary tests or overly relying on lab values when you can get good information

[00:04:21] from a physical exam something that doesn't cost you or the patient and with what we were talking

[00:04:26] about earlier with end of life we've got to be better about managing patient expectations,

[00:04:32] setting those things up early in the course. Now that doesn't mean letting people go

[00:04:38] that means being very realistic and setting up the options if this treatment is not helpful for you

[00:04:45] then yes we do need to talk about end of life and it's not a comfortable conversation to have but

[00:04:51] whether you're working in palliative care or not everybody needs to be able to broach this subject

[00:04:57] to some degree. I know with what I do, I got to talk to people about difficult shit all the time

[00:05:03] and when you need to bring something up that's hard for somebody to hear it always helps that

[00:05:08] they're a little bit prepared in this case it would be the non palliative care provider who says

[00:05:14] hey this may not get better. Yeah some of that rule definitely falls on the primary care doctors

[00:05:20] too to bring those subjects up. Do you have a living will? Do you have a POA in case of emergency?

[00:05:27] We're not saying that's going to happen but in case anything bad happens who do you want making

[00:05:31] medical decisions for you if you can't make it yourselves and do you want to be on a ventilator

[00:05:36] and if you do how long? I need guardianship and you have people who don't have any advanced

[00:05:42] directive or living will they bounce back from nursing home to the hospital to nursing home

[00:05:48] and they really don't have any quality of life aren't able to communicate in any meaningful way.

[00:05:54] They aren't able to move on their own yet they cannot be allowed to die in any graceful manner

[00:06:01] because they don't have a legal document that says do not resuscitate. It might be beneficial.

[00:06:07] At certain age the US you have to create a legal document or sign something saying what your wishes

[00:06:13] would be so at least we have a baseline. Those can always change based on your wishes

[00:06:18] but at some point having something is better than having nothing.

[00:06:22] I always say we could stop spending a trillion dollars a year on defense and maybe utilize

[00:06:27] some of those funds for more government sponsored healthcare. I don't have a lot of faith in the

[00:06:33] government but I think the benefit of having a nationalized healthcare system is that

[00:06:39] the records are not an issue anymore. You can follow data trends over time a lot easier and know

[00:06:45] what is beneficial and what's not but like we've been saying that is not necessarily

[00:06:49] very motivating for some of the business entities that are making some of these decisions

[00:06:56] because they do I think thrive on a lot of this chaos. If you had a master price list

[00:07:02] like you talked about or a national price schedule or at least a regional schedule things that

[00:07:09] are already done in countries where we respect their healthcare system, Germany, Japan, Belgium

[00:07:15] that have lower prices more efficient care but again is there the motivation or the incentive

[00:07:21] at the biggest levels of government to do that and business to do that?

[00:07:25] Probably not unless this healthcare spending continues to get out of hand until it all

[00:07:30] eventually burst but there's a lot we can learn from our other Western countries. The national fee

[00:07:36] schedules we have standard fees that for procedures that obviously can change here and there based

[00:07:43] on specifics but as long as there's a standard out there because there is none right now for

[00:07:48] any procedure or any surgery you get in America and that goes more along with the transparency too.

[00:07:55] When you get a bill it should be an itemized bill. Here is everything that happened to you in

[00:08:00] the hospital and here's where all of your costs come from. For my daughter, from her hospitalization

[00:08:07] from being born for three days. Initially they just sent us a bill that said $900. We had to call

[00:08:14] and request an itemized receipt. They know what they're doing. There's going to be some suckers

[00:08:20] out there that get a bill and they just pay it. That might honestly be the most important part of

[00:08:26] high school health classes. How do you deal with health insurance companies? That's ultimately what's

[00:08:32] going to probably financially benefit you. To give listeners some very specific solutions,

[00:08:38] when you are in the hospital you should ask for a price list, ask for how much things are going

[00:08:43] to cost because right now there's this situation where and I'm sure you've heard this,

[00:08:48] I've heard this. People are essentially goaded into getting as much care as possible told,

[00:08:55] don't worry about the cost. Your health is more important. When in reality the costs can absolutely

[00:09:02] cripple you and your family financially and ultimately worsen your health. I would encourage

[00:09:08] anyone that's going into the hospital ask for an itemized list of everything that's going on.

[00:09:13] The doctor will definitely not be able to get you that but he can alert someone and the administration

[00:09:20] is lawfully obligated to get you that. Will things be covered? Will you refer me to only in network

[00:09:26] providers, in network labs? Don't let a hospital put you in your own private room if you don't

[00:09:32] request it. Ask about the identity of every unfamiliar person who appears at bedside. What they're

[00:09:38] doing and who sent them? It is crazy how many people come in and out of a hospital room. Sometimes

[00:09:46] patients will see a provider that they didn't even know was a provider. It's not like everybody is

[00:09:54] clearly labeled as to who they are and what they're doing there but you may be consulted for

[00:10:00] something that you maybe didn't need a consult for and you're never actually told about the

[00:10:06] consult. You didn't actually agree to the consult again because if the doctor misses something

[00:10:11] they're thinking they might get sued but the reality of this is that every single person that comes

[00:10:17] to see you and evaluate you, that's another chance for the hospital to bill you. We certainly want

[00:10:23] people to get the care that they need but if you don't need it or if you need more information

[00:10:31] about whether or not you need it then you should absolutely be able to get that information

[00:10:36] before you stack additional charges onto your in bill. Yeah a lot of in hospital care understanding

[00:10:47] what's going to happen and controlling your bill, it falls to the patient. If you're in one of those

[00:10:55] situations, one of your family members in those situations, it helps to be present

[00:11:00] and asking questions because if you don't say anything all those charges are going to rack up

[00:11:04] and you're going to see at the end and say I can't believe this is how much this is costing.

[00:11:09] If you see something, say something. The last bit I'll put in there is when you get the bill,

[00:11:16] first things first wait because a lot of the times get the initial bill from the hospital before

[00:11:23] they've ever sent it to your insurance company. When you actually do get that bill, you request a

[00:11:28] complete itemization of everything that you're being charged for. You request everything that your

[00:11:33] insurance company has paid. You fight anything that you disagree with or you think was either not

[00:11:40] provided to you or unnecessarily provided to you without your knowledge. And when you fight,

[00:11:46] you should be fighting and writing so there is a paper trail of documentation that's saying this.

[00:11:52] You write everybody's name and title down that you speak with. You can always file complaints with

[00:11:58] the state insurance commissioner or consumer protection bureau. You can on the phone continue

[00:12:04] to ask to speak to a supervisor. It's honestly, I remember in college, me and my roommates would

[00:12:09] all be sitting around and it'd be like, all right, who's going to call the cable company this month

[00:12:14] because our bill went up again and you call and you end up the long events, the longer you spend

[00:12:21] on the phone with them and the more supervisors you ask to speak with, the more your bill gets

[00:12:26] reduced until a few months later. You start to see it goes up again. Remember, you are protected by

[00:12:32] HIPAA. Your health insurance information is protected by HIPAA but you don't owe the billing company

[00:12:38] anything. So if you're being taken advantage of, use social media to call people out, to call

[00:12:46] entities out. Spread the word that you're being taken advantage of and other people who are being

[00:12:51] taken advantage of. I think ultimately in order to see the healthcare reform that we think will be

[00:12:59] very beneficial and actually allowing us to make progress in healthcare, we've all got to be

[00:13:05] louder and we've got to be consistent with being loud and demanding change and demanding politicians

[00:13:13] in office either be part of the change or get the fuck out of the way. Definitely and if you're

[00:13:22] dealing with really high drug prices, there is a good app on your phone that you can use called

[00:13:28] GoodRx. Down in the app you can go online to that website and it actually looks at all the pharmacies

[00:13:33] in your area and shows you where the cheapest version of that medication is it can save you hundreds

[00:13:40] of dollars, especially if you're on chronic medications. I use it for all my patients and they

[00:13:44] very much encourage my patients to use it as well. A couple of things that you've got to look out for

[00:13:49] moving forward. One is, and I am a stickler about this even though I get asked all the time working

[00:13:55] in private practice and now about to go work for a hospital system in patient addiction is pharmaceutical

[00:14:03] reps everywhere. Hey, let me bring you lunch, let me do this, let me do that. In healthcare workers

[00:14:09] eat it up. They're like, oh, you know, I'm going to stay neutral. But psychologically if you've

[00:14:13] ever seen madman or know about the history of marketing in America, they have their own databases

[00:14:20] of research on marketing and they know if they deliver you lunch and talk about a drug,

[00:14:26] it makes an impact on people subconsciously even though you may have a conscious motivation to say

[00:14:32] I'm not going to be influenced. When you let those people into the clinic and they're giving you

[00:14:38] gifts, then you are being influenced and you are more likely to prescribe their medication than

[00:14:45] you would have been otherwise. The other thing I don't think that I'll ever be able to hold a job

[00:14:51] where my income is based on RVUs. RVUs are relative value units and are attached to different

[00:15:02] procedures and different treatments depending on how you're billing and what procedures you're doing.

[00:15:10] You get a different number of RVUs as a individual physician within a hospital system and a lot

[00:15:16] of these hospital systems incentivize physicians to get more RVUs. And you're talking about a group

[00:15:23] of people who are some of the most competitive people in America competing for good grades,

[00:15:29] competing for people within certain programs to like you and want you to come work for them or train

[00:15:35] with them. And then you bring up RVUs, you and me if we're both going into cardiology and we're both

[00:15:41] working at the same hospital, I want to make sure I get more RVUs than Taylor does not just because

[00:15:46] the financial incident but because of the competitive nature of that. So it's something that I want no

[00:15:52] part of a job that incentivizes me to see more patients. The last thing, so my wife works in physical

[00:16:02] therapy and she works for a big corporation we figured out the numbers one day. She is a physical

[00:16:09] therapist that is a three year graduate program that you got to do after undergraduate of each

[00:16:16] patient that she sees whatever their build somewhere around like 80 or 90 dollars for an hour.

[00:16:23] She gets 9% of that on top of that. She also does not receive any extra money as a physical

[00:16:32] therapist whether she sees one patient an hour, two patients an hour, or sometimes she's even

[00:16:39] triple booked. So this corporatization of medicine it is not just restricted to classical medicine

[00:16:45] hospital systems clinics. It's pervasive throughout all of health care. If think it is

[00:16:52] more of a sickness as these conglomerates get larger and larger because when you have your own practice

[00:16:59] you personally know all these patients, you become emotionally invested in their lives and care

[00:17:05] but as you are larger and larger in a needy you become so detached from everything if you're sitting

[00:17:09] on a board you don't meet anybody. You're strictly there seeing the profits coming in out and that's

[00:17:15] all you care about. You're not getting to know the hospital staff, you are not emotionally or in any

[00:17:21] way besides financially invested in this company no matter what it's doing and in health care

[00:17:26] that's a dangerous thing because in order for health care to succeed the people working in it

[00:17:32] have to be emotionally invested in what they're doing. Somebody get this guy some help!

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[00:18:10] Stick around after the disclaimer for a listen to a local Louisville artist Jared Fuz

[00:18:17] with his unreleased single it's all good. Disclaimer this podcast is for informational purposes only

[00:18:23] the information provided in this podcast and related materials are meant only to educate

[00:18:26] this information is not intended as a substitute for professional medical advice while I am a

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[00:18:40] medical or psychological advice diagnosis for treatment all listeners should consult with a

[00:18:44] medical professional licensed mental health provider or other healthcare provider if seeking medical

[00:18:48] advice diagnosis for treatment or put more simply need help like this guy call your own doctor