Editor’s Note: We hope you enjoy the video above. If you’d rather just listen to the podcast, click the button below to Apple Podcasts: The Common Bridge. It is also available on all other podcast platforms. We have included the transcript to this program below. We offer this program in it’s entirety to our paid subscribers, and welcome all to subscribe below.
You can also help the show by contributing in any of these methods:
• Shop. https://thecommonbridge.com/subscribe-shop/
• Zelle. rich@richardhelppie.com
• Buy Me a Coffee. buymeacoffee.com/RichHelppie
You can also send an email to Editor@TheCommonBridge.com
Thanks!
Nate Kaufman
This is Nate Kaufman from the Healthcare Bridge, part of Rich Helppie’s Common Bridge podcast. We’re here today talking to the one and only Rich Helppie about healthcare access. What usually happens in these podcasts is, while I am the host, Rich begins to ask most of the questions. So we’ll start with you, Rich. What do you want to know about access?
Rich Helppie
Well, I’ve found that these little 15 minute quick hitters are very popular. People stop me and say your Medicare Disadvantage show was really informative, for example, and why drug prices are so high. You and I talk about the triple aim of cost, quality and access; people can get their heads around what cost is and what quality is, we know it when we see it, but what about access? From a healthcare point of view, how would we tell an audience that is not familiar with healthcare - not from the inside - what would we tell them that access is and why it’s important?
Nate Kaufman
Let’s talk about my friend. My friend had a infection in his arm, and he went to his primary care physician who did a bunch of blood tests, and he said to my friend, there’s a chance here that you may have leukemia. Well, when you hear that, the next day you want to be in with a hematologist oncologist to find out if, in fact, you do. Well, the next appointment he could get was about 30 days away, so he called me, and I was able to get him in by that Friday. And sure enough, he does have leukemia. But the average person, when they find out they have a particular problem, access to specialists, neurologists, it’s 40 days for their first appointment. Just another fun fact, it almost takes an entire year for a hospital or a physician group to recruit an oncologist when they know they need one to go into their practice. The net result is that we are seeing a mal-distribution of specialists, especially out of rural areas and into urban areas. And even in urban areas, the problem is not whether those specialists have enough patients, it’s that they have too many patients. So the real challenge that I see out there today is what are we going to do with this physician shortage that nobody is dealing with.
Rich Helppie
It’s beyond specialists. It’s just access to primary care, access to obstetrics, labor and delivery mal-distributed as well. And the painful part of this - of being a data guy - is because your friend said, yeah, I’ll take that next available appointment, even though it’s a scary 30 days away, that would be coded as no wait, and lay media outlets would report that as they’re very, very efficient, and nobody’s waiting for care. And if he was in other systems, like the VA, it would be a year out, but it would be coded the same way. So I caution people about reading summary statistics. Here’s the way I think of this, Nate. We have a population that wants health care services, particularly with the graying of America; we need more, old people like us. We also have an amazing amount of diagnostics and treatment facilities. We have lots of doctors and nurses and allied health professionals, and yet we can’t seem to get them in the same place. I think it bears discussing a little bit, and let’s use coffee as an example. In my little town here, there is a Starbucks, there is a local chain called Biggby’s, and there is at least one really good quality independent coffee place. They know that there’s demand out there for people that want to buy coffee and they want their doors open, they would not look at a long line of people waiting as a good thing. But the situation you just described with your friend, that long line out the door, nobody inside is really concerned about it because their appointment calendars are full. Am I on the right track, or is this not a great analogy?
Nate Kaufman
No, it’s a good analogy. There’s a big difference between a Starbucks and a hematology practice. It takes 12 additional post graduate years to make a hematologist. While we’ve seen hematology oncologists increase in terms of supply - there’s 25% more than there was maybe a bunch of years ago - the demand is up 40%. And then what’s happened is many physicians, especially in primary care, say Medicare and Medicaid are not paying us sufficiently, we’re going concierge. We’ll have a less busy practice with people paying us more money. And by the way, I recommend that if you can possibly afford it, either get a primary care physician who’s got a concierge practice, or they now have these things called direct primary care, where you pay a small monthly fee for membership. But lock your primary care doctor in, otherwise, I just don’t know where people are going to find primary care physicians in the future.
Rich Helppie
Well, I can tell you this, we have a provider that recently decided to leave Medicare and Medicaid. The provider said I don’t get paid enough, the paperwork is too much, I’ve got enough patients that can pay. But we know the problem is that if providers say they’re not taking Medicaid patients, by way of example, people that are on that end of the socioeconomic strata aren’t going to get care. They’re not going to have access. They’re going to become sicker, and when they become sicker, they’re going to end up in the ER. They’re going to be treated for the most dreadful of conditions in the highest cost place possible, at a price far greater than what preventive care from a primary care doctor would have cost. So I think it’s imperative on us as a just society to make sure that people can get to a doctor when they want to.
Nate Kaufman
And it’s no surprise, by the way, that over 40% of all emergency visits are from Medicaid patients. But to give you an example, a Medicaid patient may pay a doctor $70 - Medicaid may pay them $70 - a visit. Well, after the overhead, paying for the nurse and everything, there may be $10 or $20 left for that physician to take responsibility for that person’s care and that’s just not enough. So what’s happened? The other thing that’s happened - which is a conspiracy theory, but is not true - is because of Medicare and Medicaid under-funding physician services the physicians have gone to the health systems and said, you benefit from our surgeries and our referrals, you need to improve our compensation so we can make a living after spending 12 years post graduate to get this degree. And, oh, by the way, we’re in short supply, so if you don’t want to do it, we’ll just go to your competitor. There’s this arms race that’s going on. One other thing about my friend, the next question is, okay, so you probably have leukemia and you may need a bone marrow transplant. Now, do you think he’s looking for the cheapest bone marrow transplant when, under the best circumstances, the survivor rate is maybe 75%? Where do you get that data on where should you go for a bone marrow transplant where you have the best chance of success? I mean, the system is just so broken. The healthcare policymakers, nothing that they’re saying is making any sense, to me at least, because they’re not recognizing the fact that we have people in our system that make up the cost, and these people expect to be compensated well, and nobody’s willing to take a cut in pay.
Rich Helppie
You just summed it up right there. The demand is there. It takes 12 years of additional training. I want to be paid for that if I’ve gone through that 12 years. As a patient, I want the best and brightest. I want people that are going into that field to compete for that role and be highly qualified, and I want them to be highly compensated so they’re not worried about their car payment while they’re doing a bone marrow transplant. You don’t want that. But let’s go back to the coffee analogy. People want to buy coffee, they’re willing to spend several dollars for fancier coffees, and there can be an arms race, but you’re going to expand capacity. And now watch this. I don’t go into my neighborhood coffee store to hear them say who’s your coffee plan with? I don’t pay a third party ten dollars so that I can go into my coffee shop. Instead of paying the coffee shop five dollars, I only pay four and they charge me ten for this third party. But that’s where we’re at with primary care. Primary Care is basically a retail business, and by having it under insurance, it’s a distortion of what the word insurance is. Insurance is an unanticipated financially catastrophic event like leukemia. Let’s insure for that. But insuring for primary care is insane. Once again, all it does is enriches that insurance company. Am I right about that or wrong?
Nate Kaufman
No, I don’t think you’re wrong. I think the issue is... let’s go back to your coffee analogy. You have three different coffee shops in town. What happens is like this, if there are three different oncology groups in town, the insurance companies play one off against the other to say, okay, we’ll send all our patients to you if you give us a better rate. Eventually the oncologists say, this is crazy, let’s join up and create one oncology group. We don’t have to work as hard, and we can demand better rates because we are the only group in town. And so again, this whole idea that we’re going to get costs down under our current system, I just don’t see it. Keep in mind that ten percent of the population consumes over 80% of the cost of health care, and that’s not just Medicare, that’s in the commercial as well. Unless we address that issue and focus on those people and reduce the care from those people, we’re not going to get the cost down. In addition, what we’re doing is we’re burning out and driving physicians to practice concierge medicine, go part time, or look for an administrative job, and now we have an access crisis.
Rich Helppie
We do have an access crisis, and it’s not just specialists, it’s geographic, it is cultural. It is, of course, financial. We need to create supply and make it accessible to the people that need it but here’s our system today. Nate, you and I have talked about the pharmaceutical empires and those businesses. You have one big for-profit arm trying to create demand to sell you stuff for the rest of your life, whether you really need it or only marginally need it. On the other side, you have this big for-profit insurance business whose job is to deny you care and not buy any of the stuff from the pharma company and not let you go to the doctor or the hospital. Coming back to the coffee analogy, I can’t go to the counter at Biggby and hear them say, hey, sorry, but your your coffee plan was denied, you don’t get any coffee today. It’s like, no, I’m here, I’ve got money in my hand, I want a cup of coffee. We need to make that available to all people for primary care. But because of the way that we’ve tax subsidized the insurance companies, they’re scraping billions for the purpose of not letting people get to the doctor, and when they get to the doctor, paying the doctor less money. You’ve just illustrated an example with the oncologists playing one off the other, and I’ve demonstrated on the primary care side that until we get reform to deal with that I think we’re going to suffer this access problem.
Nate Kaufman
We should probably leave this with this concept: it’s not going to get solved. And the reason it’s not going to get solved is the biggest healthcare benefit company in the world is the United States government. It’s the biggest healthcare benefit company in the world. It spends $1.8 trillion on healthcare. And every four to eight years, the entire executive team is wiped out, and a new executive team comes in, and they may or may not have the competencies to deal with the healthcare crisis that we have. So I don’t see us making a lot of progress. I see change happening, but the impact of change is as Thomas Sowell says, there are no solutions, only trade offs. If we get costs down, we’re going to have an access crisis. If we bring costs up, people aren’t going to be able to afford healthcare. Nobody has come up with a solution.
Rich Helppie
Well, you and I have; we have come up with it a couple of times. Maybe we ought to shoot a short segment on the insanity at the federal level. I’ll just leave with the teaser. You remember we reformed health care 15 years ago: you can keep your doctor if you like your doctor and you’re going to save $2,500. We called it out at that time, that was not going to happen, and here we are today in desperate need of reform.
Nate Kaufman
So our advice is lock yourself in to at least the concierge or a direct primary care physician, because when you need one, they may not be accessible to you, so good luck.
Rich Helppie
And if you don’t possess the resources to get into a concierge medicine, try to develop a relationship with a primary care physician that will take your insurance. There are providers out there, fewer and further between, but just understand you’re suffering from the crisis of access. It’s a Healthcare Bridge segment, Nate, so do you want to read us out?
Nate Kaufman
Oh sure, this is Nate Kaufman and Rich Helppie ranting about healthcare. Again, access is a problem. Make sure you try to get a provider that you can depend on. And by the way, if you get sick like my friend did, you don’t want to focus on the cheapest care, you want to look for outcomes. And the only way to find out who are the best is you have to find an insider. That’s one of our jobs, to provide an insider’s perspective on healthcare. So signing off with Rich Helppie, thanks a lot, Rich.
Rich Helppie
Thanks, Nate.
