➡️ COVID-19 Simulation Summit Playlist: https://www.youtube.com/playlist?list=PLAJnaovHtaFR5puHCN4W_4o8cgIHdawDb. -- �� About the speaker. Eva Lee Professor and Director of the Center for Operations Research in Medicine and HealthCare at Georgia Institute of Technology, a center established through funds from the National Science Foundation and the Whitaker Foundation. The center focuses on biomedicine, public health, and defense, advancing domains from basic science to translational medical research; intelligent, personalized, quality, and cost-effective delivery; and medical preparedness and protection of critical infrastructures. She is a Distinguished Scholar in Health Systems, Health System Institute at Georgia Tech and Emory University School of Medicine. She previously served as the Senior Health Systems Engineer and Professor for the U.S. Department of Veterans Affairs. She has also served as Co-Director for ten years for the Center for Health Organization Transformation, an NSF Industry/University Cooperative Research Center.. Speaker’s Abstract: “SARs, bird flu, H1N1, Ebola crisis in W. Africa, Zika and current SARS-CoV-2 underscore the critical importance of emergency response and medical preparedness. Such needs are wide-spread as globalization and air transportation facilitate rapid disease spread across the world. Computational modeling of infectious disease outbreaks and epidemics offer insights in propagation patterns and facilitate policy makers to synthesize potential interventions. Current models include inclined decay with an exponential adjustment, SEIR (susceptible, exposed, infectious, recovered) compartmental model, discrete time stochastic processes, and transmission tree. While many of these models incorporate contact tracing to predict spread pattern, key elements on optimal usage of scarce resources and effective and efficient process performance (e.g., diagnostics and screening, non-pharmaceutical interventions, trained personnel/robots for treatment, decontamination) have not been included. This is particularly critical in the fight of COVID-19 containment due to lack of testing kits and the prevalence of asymptomatic transmission, and the long period of hospitalization required by severely sick patients.. . This work focuses on designing a system computational decision modeling framework that simultaneously i) captures disease spread characteristics, ii) incorporates day-to-day hospital and homecare processes and resource usage, iii) explores non-pharmaceutical intervention, social and human behavior and iv) allows for system optimization to minimize infection and mortality under time and labor constraints.”. -- On April 30th, 2020, the DAIA Foundation has organized an online COVID-19 Simulation Summit. The summit was focused on the use of agent based simulation models for more effective simulation of COVID-19 spread and evaluation of COVID-19 policies. Consisting of live video talks, Q&A sessions, and panel discussions, the event gathered together scientists with insight and experience in simulation modeling of complex systems (especially but not only agent based modeling) and complex systems dynamics; along with scientists and physicians with specific insight into COVID-19 and related epidemiological issues.. The agent based simulation paradigm allows a finer-grained sort of modeling, in which a region (or the world as a whole) is modeled as a specific geometry occupied by interacting autonomous agents with a diversity of specific behavior patterns. An in-depth agent based simulation of COVID-19 spreading would allow better-grounded policy choices to be made regarding how to manage, control and cope with the pandemic.. An agent based simulation, like any other model, depends on the underlying assumptions used to structure it. However, the agent based modeling paradigm provides a more flexible approach to evaluating the consequences of various assumptions, and thus exploring their validity.. -- .
Well visits are the cornerstone of every pediatric practice. They are essential to providing great care for your patients and ensuring financial success for your practice. Learn how to use people, processes, and technology to maximize your well visit rates.
Are you a consumer of behavioral health services, but are sometimes challenged to access them? Do you live in a remote area? How can you find a qualified online therapist? How do you make sure your private information remains confidential? Consumers of behavioral health services, especially those in sparsely-populated regions or those who have difficulty getting to a provider, should become aware of how this technology can improve access to care. Webinar participants will learn what kinds of issues can be safely addressed by an online therapist, how they can find a qualified online therapist, how to ensure the information they share remains confidential, and what they can expect to pay for a good online therapist.
This webinar on RHC Telehealth Medicare Part A Billing was recorded on April 26, 2020 and includes the full 55 minutes of Mark Lynn’s presentation on RHC Telehealth Billing. The webinar covers recent coding and reimbursement changes and the implementation of the distant site payment rules and guidance for independent and provider-based RHCs including the reprocessing of claims and the potential for recoupments of payments to provider-based RHCs. G2025, 95 modifier, CG modifier, and CS modifier will be discussed along with changes to the G0071 CPT Code for RHCs.
What the hell is Direct Primary Care (DPC)? Here’s why folks love it and some lessons we can learn for the full healthcare system. Warning: contains ALL the curse words, so maybe keep your kids and administrators away ;-). Join our Supporter Tribe on FB or Patreon to get CME credits on select episodes while supporting the show! http://facebook.com/becomesupporter/zdoggmd. http://patreon.com/zdoggmd. Videoshttps://ZDoggMD.com/. Facebookhttp://facebook.com/zdoggmd. Twitterhttp://twitter.com/zdoggmd. Instagramhttp://instagram.com/zdoggmd. And don’t forget to Subscribe, Comment, and CLICK THE NOTIFICATION BELL on YouTube to turn on notifications!
This is a recording of the 2-hour webinar on new Medicare Telehealth Billing for RHCs including payment for Telehphone only visits on May 1, 2020. Featured speakers include Nathan Baugh from the NARHC, Charles James from North American, Patty Harper from InQuiseek, LLC, Julie Quinn from HSA, Shannon Chambers from SCORH, Doug Swords, from Azalea Health, and Mark Lynn from Healthcare Business Specialists.
Telehealth Will Be Free, No Copays, They Said. But Angry Patients Are Getting Billed. Remote learning is costing parents a fortune America’s Cheesemakers Are in. Telehealth will be free, no copays because of the coronavirus, they said.
But angry patients are getting billed. Telehealth Will Be Free, No Copays, They Said. But Angry Patients Are Getting Billed. said it would waive out-of-pocket costs for “telehealth” patients seeking coronavirus screening. Telehealth Will Be Free, No Copays, They Said. But Angry Patients Are Getting Billed Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers.
Analysis. Telehealth Will be Free, No Copays, They Said. But Angry Patients Are Getting Billed. By Kaiser Health News | April 27, 2020. (COVID-19) Telehealth Will Be Free, No Copays, They Said.
But Angry Patients Are Getting Billed. Business of Medicine National Headlines (COVID-19) Telehealth Will Be Free, No Copays, They Said. But Angry Patients Are Getting Billed. April 27, 2020. newseditorinchief.
Telehealth will be free, no copays, they said. But angry patients are getting billed. to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay. But “they said, ‘No, it goes toward your deductible and you’ve got to pay the whole $70,’” she said. Policymakers and insurers across the country say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason.
Telehealth will be free, no copays, they said. But angry patients are getting billed. Sound Health and Lasting Wealth Telehealth will be free, no copays, they said. Telehealth Will Be Free, No Copays, They Said. But Angry Patients Are Getting Billed. Kaiser Health News.
The Mighty. 27 April 2020. many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, said Sabrina Corlette, a research professor and co-director of the Center on.
List of related literature:
Of course, patients can always seek care outside the network without approval and pay the bill themselves.
A patient with a $10 copayment must pay $10 for each instance of service provided (doctor visit, prescription refill, therapy session), with the insurance covering the remaining charge for each service.* Payers also use a variety of methods to control provider behavior.
For example, the average patient is unlikely to notice a $50 drug charge on a $1200 hospital bill, but even a $3 prescription fee may become the “last straw” if it follows charges for physician services and x-ray and laboratory studies.
However, any copay for some would prohibit their purchasing care they did need such as not filling prescriptions and/or postponing visits to healthcare providers.
An alternative is to inform the patient of the situation and then bill them for the full charges, explaining that they can use the insurance check to pay the bill.
Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.
I’m sorry that an obviously well educated person doesn’t have the ability or desire to communicate well without the constant use of vulgarities. A total turn off.
Can you talk more about how specialists or specifically women’s care can be a part of this? Would IUDs and arm implants be covered for free by this because a PCP can insert them? How would getting a vasectomy or tubal ligation be paid for? What about baby deliveries and c sections? I love the idea but it would be nice to see it done so that we can see how it works more in depth.
You say FVCK way too much,. So do I, and I fvcking love it!!!!! This was amazingly cathartic to hear! Much love from an RN who had a little more wine than she should have tonight, in order to numb the moral injury of being a floor nurse in 2019. PS “One Week” was playing as muzak while I was shopping the other day. I sang along, but I was singing “One Sikh” instead.:D:D
I totally get you Dr Z! I have practically foamed at the mouth talking about how the business sector has ruined healthcare. Licensed as an RN since 1984 with over 30,000 hours of direct care. I remember when doctors were in charge. It would be great to be a part of a series of conversations to repair our healthcare system. I have ideas and believe things can change for the better but people have to stop being afraid and get angry! The anger helps us prepare to fight rather than run from the problem. Stay angry my friend! <3
I will keep saying this as long as we have a for profit capitalist model for healthcare profit will always come before the lives of the patients it’s why Cuba has better patient outcomes than the US
Too bad you misrepresent Single Payer so badly. Single Payer is not for profit. Per Bernie’s plan, he takes on the corporate bureaucratic B’s that makes healthcare so expensive and time consuming. Your plan is more flushed out than when you were on TYT, but it still leaves too many people without care due to cost. If people can’t afford your subscription to medical access they still will not get the education and care they need.
Call the issue what it is capitalistic/opportunistic medicine. A concentration of quality care requires paying boucoup bucks to specialist and prevents people from being primary or community physicians.
What about a company that has employees spread out across the country? Is there a large enough network of direct care docs available to service an employer that wants to offer such a program?
I would love for my company to offer a catastrophic plan and then rather than sharing premiums like they do now, they just give a monthly stipend to go towards healthcare. They would then be able to reduce the amount they pay out to a managed care company and benefits coordinator because they reduce the amount of time spent handling insurance companies.
You assume people who have insurance have cash In hand to pay for primary care. M/care Advantage plan copays has gone up much faster than Social Security. On top of which all the pharmaceutical assistance program does not include us.
I had to get out of primary care specifically because of everything you said. Transferring to urgent care in 60-90 days (when my replacement gets credentialed).
Primary care is my passion and I’ve helped many take their A1c down from double digits to 5s/6s on just metformin and major diet/ exercise changes… but im crushed under all this paperwork. I can’t do it anymore. In the bay area though, it’s near impossible to start up a DPC while still paying off student loans. I feel stuck. It is a nice dream though.
A few other things: YES! We are mind, body, and spirit! It’s exactly why I only went the osteopathic route! I’ve had patients really change their anxiety/ depression around when I carefully went through each category with them during a visit. It’s amazing to see someone transform, it’s soul crushing to have to go back, jot it all down enough to reach a lvl4 visit, and find that all you’re doing every hour of every day is thinking about all the charts still not done.
Are there routes for you to go to Congress to tell them this??? I would be happy to sign anything in support of you being our voice, curses and all ��������
I never use my insurance, it doesnt cover anything anyway. I speak with my doctors and make a deal with them to pay as a cash pay patient. I can get any services i need at affordable prices. Doctors dont want insurance companies hindering them anymore. Talk to your doctors. Go zdogg!
I had my “physical” recently, it took all of maybe 15min. The doc listened to my lungs and heart, quickly looked over my skin, and checked my male parts (no prostate check). I know he couldn’t have really do a thorough check of everything that should be checked. Physicals I had in the past took around 45min. He did have a scribe listening in and doing the chart notes on the computer system, but still. It was obvious to me that the bare minimum was done and I know it is because the amount of time that is allocated to meet insurance guidelines.
3000 per panel was a dream. I had 5500 in FFS when I changed to DPC. Now I know all 600 by name and my team sees diabetes reversal every week because we have the time to invest in each one personally. #dpcftw
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I signed up for a year with a direct primary care. But there is a per visit charge and he does no labs (I did not realize this when I signed). There is no team, only one dr who doesn’t remember me when I go in and advised me to go to the ER for a minor procedure. I don’t have health insurance. There just are not enough direct care options near here. It is close to impossible to find information on what doctors are good and not (how I ended up with the one I have now). There is one doctor in the town I live who sees patients with no insurance. I agree with you on these issues but can’t really use any of these things just due to lack of availability. Just so frustrating.
Yes! Get Andrew Yang on the show to discuss Healthcare solutions! If he wins you should be the Secretary of Health or whatever the leadership position for that is.
First things first. The per capita cost of health care in the U.S. is $11,000 a year. In Germany with universal access it is $6,000. Simply moving the “who pays” food around the plate is not “reform”. Any health care reform proposal that does not explicitly reduce the per capita cost of care is bogus. BTW, DPC as voiced here with the usual vulgarian overlay conveniently avoids the obvious unintended consequences. Like given the extended visit time, what happens to all of the patients who are not seen? And at 70 bucks a month, a relatively healthy person is paying $840 a year for one or two visits. Which implies a DPC practice death spiral when the healthy patients bail out.
Pretty sure you’re my spirit animal Zdog ❤️ I’m a baby RN, 4 years of experience was going to go for FNP, held off enrollment to plan my wedding and honestly glad that I did. I realized all the parts I despise now as an RN would only get worse when I became an NP especially now that I work for a private office and I see the affects of billing and insurance a lot more than I did when I worked for a big system.
I started with a Direct Primary Care doctor and it was by far the best thing I ever done in regards to my healthcare. In the past it was like an assembly line and the doctor dictated to me which doesn’t work and rushed me out. When the bill came it was huge for the 10 minutes he spent with me and I usually ended up paying since it fell out my deductible. Finally a doctor I can partner with working towards keeping me healthy. My new DPC doctor spent over an hour getting to know who I was and for me to get to know him. During my physical everything was explained to me and he had the courtesy to ask permission before touching me. That was my first appointment and every appointment since then has been great. He actually knows my name when I walk in and he ask me how I feel and how things are going. You are so right there is no personal connection with doctors today. How can someone ever feel comfortable enough to actually be open and truthful with someone who considers you a number or a cash cow. For a low monthly membership fee I have unlimited access to my DPC doc. Everything office related is covered under that fee (except bloodwork, vaccines etc.) and it ends up being much less expensive then using insurance that covers office visits etc. I now have a very high deductible with just catastrophic coverage and my insurance premium combined with my DPC membership fee is way less then before and the care is 1000 times better. Last week I saw my doc at the grocery store and he said “hey Mark how you doing?” Not many people can say there doctors would greet them away from the office.
This in no way challenges the power that greedy insurance and pharmaceutical companies have over average working people in our country. Just another snake oil salesman. Support Medicare for All.
YES����������KEEP ON Not Giving a Fuck. ���������� So tired of corporate healthcare. All the money people pay for big healthcare: The insurance, the co pays, the out of pocket fees, the procedures that insurance doesnt pay for, the $$ expensive drugs, the donations..healthcare can charge you what they want…all that $$$….so……. …��NURSES SHOULD NOT WORK UNDERSTAFFED.�� Do not expect to get what you pay for because your hard earned cash-ish lines those soft velvety pockets and pays for corporate retreats NOT SAFE STAFFING.
Decades ago I remember my parents having medical insurance and major medical. Routine procedures were paid out of pocket, up to an annual limit and then a lifetime limit (which we all hit as teenagers). Then things changed and EVERYTHING was through insurance. More and more paperwork was added, CYA procedures were mandated by malpractice insurers, etc.
Like your oil change example, we’d be paying $200 for an oil change if we did it that way. But we need to convince people that paying out of pocket for routine care is cheaper in the long run. Too many people think it is “free” when done via insurance.
It’s a fantastic premise. I get it…the support needed just to satisfy CMS and Big Insurance is crushing and awful and totally gets in the way. I left the bedside last year, and I’m a “quality improvement nurse.” This means I’m the one who has to tell the hospital how high CMS federal and state…and Joint Commission and all the damn certifying bodies say that we should jump. I’m interested in why you are no longer doing Turntable….did it not catch on? I’d like you to talk about that.
All the money people pay for big healthcare: The insurance, the co pays, the out of pocket fees, the procedures that insurance doesnt pay for, the $$ expensive drugs, the donations..healthcare can charge you what they want…all that $$$….so……. …��NURSES SHOULD NOT WORK UNDERSTAFFED.�� Do not expect to get what you pay for because your hard earned cash-ish lines those soft velvety pockets and pays for corporate retreats NOT SAFE STAFFING.
I’ve been using direct primary care for a year now and I will never go back to the old way of traditional insurance. It’s like taking the blue pill and having your eyes open about how much we have been getting shafted by the system. Plus, best part, I never sit in a waiting room. Ever. I actually get to spend as long as I need with my doctor, no 7 minute average time we are use too. Plus prescriptions are insanely cheap because they helped me find the best place for my meds. But I love most of all the access to MY doctor, not A doctor, on my phone to text with any questions. No more Google as my side doctor. This fixes 80% of the preventable and predictable portions of healthcare. Fun story, I had a bunch of skin tags removed by my primary doctor and it was included in my monthly membership of $99, when my dermatologist wanted to charge me $500. Once you go DPC you never go back.
Didn’t catch you live but if you can have some of these policy makers on that would be great. I know how they’re going to pay for “Medicare for all” but I get zero response when I ask how are you going to change the delivery of healthcare. I wonder if this is flying straight over their heads. OK my rant over, keep preaching it.
You are solid! Thanks for being REAL when you present on Direct Primary Care. No more filters when you talk. Aa a nurse of 23 years an RN entrepreneur for twelve years, your verbal medicine is exactly what our broken medical system needs. If you need support from a home health perspective, I’ve got you! What your spitting is a soap box presentation my team and i give on a weekly basis! Stay a bad ass! DaveRN http://www.acahealthservices.com
Preventative Care how freaking NOVEL! LOL. Why the heck has the system been so slow to gravitate, navigate and actually apply the preventative pathways and functional health and wellness models that include prevention? One word: Greed. Greed from the pharmaceutical companies, and those healthcare systems that benefit from their fraternization. Greed from the companies that poison our patients. Someone’s death is another person’s dollar. That has been the perpetuating force behind the 1950’s & 1970’s based healthcare model in our country. I am surprised when people react as though preventative/functional/total health and wellness systems are something novel. They are, in fact, common sense. The flabbergastingly frustrating conundrum is the transition from greed and worshiping the dollar to valuing prevention of disease and caring for another human being more than the stock exchange.
Your “fix” screws over poor people. Most people can’t pay out of pockets for imaging or lab tests or specialty care. Catastrophic coverage insurance will just lead to more medical bankruptcies.
You have been wealthy for too long and don’t understand the finances of regular people.
So.eone please get this in front of Bernie Sanders, Mayor Pete, Trump, the rest of them. Get them to comprehend this shit instead of just trying to promise the best freebies for your vote.
Direct Primary Care sounds like a great thing for patients! Just to pay $40-60 per month and get an actual Dr to really care about your condition, so much so that they will actually do the exam and needed tests to look beyond the surface to actually what’s causing your actual symptoms!!!! Wow, what a concept!!!!!!! Take my Sleep Apnea for instance, now don’t get me wrong! I LOVE my Doctor and I know he knows his stuff for sure, but he has so much red tape and crap going on that he just has the time to put a band aid on my symptoms, here’s the machine just use it for the rest of your life!! But hey, there I’m sure is an underlying cause somewhere located in my general body which may be causing my SA and I’m sorry there must be something out there which could be done other than me having to wear this crazy mask at night for the rest of my life!!!!!!!! If only my Dr could have the time and wherewithal to delve a little more deeply into it!!!!! Anyways sorry to go on, but this I felt was a good venue to bring up my story, thanks for listening!!!
Thanks for the comment catch Dr Z! I am a seasoned EMT (12 years) in school to finish my Paramedic, and planning on PA school right after. Your health 3.0 is going to be one of my term papers on the way to Physician Assistant. I have shared your channel with a few of my first responder friends and we all would love to see a video about EMS/First responders! What can we do to help Health 3.0 as EMS/First responders? Love the channel, keep up the amazing work!
Great Summary of the changes by an innovator for many years. Very helpful practical summary on how to start doing Telemedicine in the COVID19 ERA. Here’s a Timeline: Intro
Dr. Brown Start: 2:10 History and Regulations: 5:33 Coding 11:55 HIPAA 13:30 State Regs 16:00 Commercial Insurance 19:00 Local/system 20:28
Workflow Processes 21:40
Technology Setup 25:15 Facetime/skype/Facebook
Scheduling and examples 31:00
Clinical RULE: 38:40 What would you do on Friday Night at 11:00 pm?
Changes Summary since COVID19 39:55
Questions: 42:40 Scope of practice 43:45 Insurance coverage 44:30 New Patient? 45:30 99213 w video req? 46:28 Medications Rx regs waived? 47:18 Copays 48:20 Phone vs video 49:25 Phone only reimbursement 50:36 Documentation /SOAP 51:40 Specialist visits 52:05 Time based visits 52:50 Typical visit times 53:20 Other people in the room? 54:00 Vital signs 55:10 Billing if visit is needed 56:45 Nursing home visits? 57:50 TikTok/Zoom/Social media 58:35 controlled substances 59:40 AOA resources 1:00 And a bunch of others but you can see it’s extensive.. Good luck… JB
People don’t read the details and listen to the mainstream then label it and make people fear itsocialized medicine can be good plus primary care being real humans. Kaiser was developed by Nixon who wanted to cut cost but not increase care. Kaiser ignore BP on my family for 10 yrs now heart problemsnever like them.
OMG! You absolutely made my day when you mentioned Andrew Yang!! He is the you of politics. The damage your two minds could do to the status quo would be freaking amazing! And F**K is his favorite cuss word!����. How do we make this happen?!?
Health knowledge standards should be part of the U.S. education system. Make a list of what every person should know. Submit it to every legislature. You’ll ensure that every single human being knows that Dr. Pepper in a sippy cup is going to contribute to diabetes. The whole problem with solutions like this is that the healthcare system has no incentives to make people healthier. Childhood diabetes?? CHA-CHING!!! MO MONEY MO MONEY…..I’m happy to see the anger at this reality. It’s the main fucking problem.
Clearly a smart man and doctor who loses me with his willingness to dismiss “socialized medicine” (which is a FOXnews slur against single-payer/M4A) without really acknowledging that the evil socialists throughout the rest of the developed world are somehow able to improve their medical outcomes; life-spans, quality of life, happiness, etc. with that same evil “socialized” medicine. Frankly, the plan sounds like a way to keep people paying for the right to live, while corporate money keeps access to healthcare profitably distant from those who need it. The doctor’s attitude, while refreshingly honest, doesn’t seem to allow for much room for people who maybe start from a different POV. It is my problem with libertarianism in general.
I don’t think it’s an education problem, but one that there’s so much disinformation that nobody knows what to believe. For example, the food pyramid being a total farce after years of doctors telling us that it was healthy.
Any honest and thinking person can see that Medicare-for-all (M4A) is more cost-effective and far superior in accomplishing the task of delivering public healthcare, than is the status quo private and corporate health maintenance organization (HMO). But the debate over this gets bogged down over taxation and, to put it bluntly, where the rich are concerned, whether they can still get their private cosmetic surgeries. The biggest obstacle to enacting M4A, is the private insurance companies who don’t want to give up their profits. The only solution is for the insurance companies, which are destroying public health & welfare by gouging the public, to give control of the hospitals, clinics, and laboratories over to the public; let the doctors, health workers and patients reorganize the healthcare industry. The HMOs have been exploiting that gravy train long enough, and if they won’t give it up, it will be expropriated, and they’ll have everything taken away. The only caveat being, neither the Democrats nor the Republicans will ever favor the workers over the capitalists, so the solution will require the founding of a Workers Party.
Z, I agree with just bout everything in this episode. I would like to share parts of this with my occupational therapy students but the language would get me fired. I am not personally offended but please do consider the importance of getting your message out there and the limitations to doing so because of the language you use. Keep going, keep speaking the truth, just make it easier for those of us who believe in you to share your brilliance.
There is a grass-roots movement against the US medical system because more and more of us know by traveling to other countries we can pay out of pocket there because the prices are so cheap. What Venezuela? not a chance try France the best if the best or Japan where people live for ever. But one things for sure your gonna see a single price system of rules and procedures because as a country we cannot afford to pay 20% of GDP on medicine that means that docs pay is gonna suck, Hospitals will have to tare down their Water Fountains and CEO’ have to sell their G7’s Since nobody is playing nice to The patient, surprise billing, bankruptcy, Medical errors. The system must be simplified to a single system and single National IT system so people can figure out how to allocate resources. Right now that info is proprietary and EMR’s don’t communicateFrance and Germany have a single health IT card which contains your data so you don’t regurgitate the same medical garbage to nurses and providers wasting 15 minutes each appointment.
BTW, M4A under the current fee-for-service model is a ticket to national hyper-bankruptcy. The problem with U.S. health care is not the cost of insurance it’s the cost of health care services. The only way M4A would lower the per capita cost of care is by the Government imposing massive fee cram-downs on the providers. A hip replacement that costs $80,000 in the U.S. can be had for $20,000 in Europe. An orthopedist in the U.S. takes home $500,000 a year. Primary care doctors average $250,000. How much is enough? And people don’t need a DPC provider to find cheaper drug and blood test prices. Those can be found online. In fact simply mandating that ALL prices for health care services be posted and fixed for ALL patients would at least put a dent in the pathological system that is U.S. health care. Moreover, the U.S. has a doctor shortage with little being done to increase supply. Under the current restricted supply model of physicians (i.e, low competition), DPC is a gimmick in which the average visit cost would be over $400 with many sick people not receiving any care because the number of available patient visits per day would be cut in half. Under the existing regime of Big Health Cartels, Health Care 3.0 is a half baked illusion.
Brilliant rant! Can you talk about why Turntable is no longer in business? I’ve seen several similar medical centers like Turntable in the Washington, DC area and after 2-4 years they went out of business. How can your needed primary medical vision come to fruition and be successful? Thanks!
I’m a third year family medicine resident looking for my first job after residency. How do I find a job where I can practice compassion preventative medicine without becoming a slave to the commercialized healthcare system?
I’m sorry that an obviously well educated person doesn’t have the ability or desire to communicate well without the constant use of vulgarities. A total turn off.
Can you talk more about how specialists or specifically women’s care can be a part of this? Would IUDs and arm implants be covered for free by this because a PCP can insert them? How would getting a vasectomy or tubal ligation be paid for? What about baby deliveries and c sections? I love the idea but it would be nice to see it done so that we can see how it works more in depth.
You say FVCK way too much,. So do I, and I fvcking love it!!!!! This was amazingly cathartic to hear! Much love from an RN who had a little more wine than she should have tonight, in order to numb the moral injury of being a floor nurse in 2019.
PS “One Week” was playing as muzak while I was shopping the other day. I sang along, but I was singing “One Sikh” instead.:D:D
I totally get you Dr Z! I have practically foamed at the mouth talking about how the business sector has ruined healthcare. Licensed as an RN since 1984 with over 30,000 hours of direct care. I remember when doctors were in charge. It would be great to be a part of a series of conversations to repair our healthcare system. I have ideas and believe things can change for the better but people have to stop being afraid and get angry! The anger helps us prepare to fight rather than run from the problem. Stay angry my friend! <3
I will keep saying this as long as we have a for profit capitalist model for healthcare profit will always come before the lives of the patients it’s why Cuba has better patient outcomes than the US
Too bad you misrepresent Single Payer so badly. Single Payer is not for profit. Per Bernie’s plan, he takes on the corporate bureaucratic B’s that makes healthcare so expensive and time consuming. Your plan is more flushed out than when you were on TYT, but it still leaves too many people without care due to cost. If people can’t afford your subscription to medical access they still will not get the education and care they need.
Call the issue what it is capitalistic/opportunistic medicine. A concentration of quality care requires paying boucoup bucks to specialist and prevents people from being primary or community physicians.
What about a company that has employees spread out across the country? Is there a large enough network of direct care docs available to service an employer that wants to offer such a program?
I would love for my company to offer a catastrophic plan and then rather than sharing premiums like they do now, they just give a monthly stipend to go towards healthcare. They would then be able to reduce the amount they pay out to a managed care company and benefits coordinator because they reduce the amount of time spent handling insurance companies.
You assume people who have insurance have cash In hand to pay for primary care. M/care Advantage plan copays has gone up much faster than Social Security. On top of which all the pharmaceutical assistance program does not include us.
I had to get out of primary care specifically because of everything you said. Transferring to urgent care in 60-90 days (when my replacement gets credentialed).
Primary care is my passion and I’ve helped many take their A1c down from double digits to 5s/6s on just metformin and major diet/ exercise changes… but im crushed under all this paperwork. I can’t do it anymore. In the bay area though, it’s near impossible to start up a DPC while still paying off student loans. I feel stuck. It is a nice dream though.
A few other things: YES! We are mind, body, and spirit! It’s exactly why I only went the osteopathic route! I’ve had patients really change their anxiety/ depression around when I carefully went through each category with them during a visit. It’s amazing to see someone transform, it’s soul crushing to have to go back, jot it all down enough to reach a lvl4 visit, and find that all you’re doing every hour of every day is thinking about all the charts still not done.
Are there routes for you to go to Congress to tell them this??? I would be happy to sign anything in support of you being our voice, curses and all ��������
I never use my insurance, it doesnt cover anything anyway. I speak with my doctors and make a deal with them to pay as a cash pay patient. I can get any services i need at affordable prices. Doctors dont want insurance companies hindering them anymore. Talk to your doctors. Go zdogg!
I had my “physical” recently, it took all of maybe 15min. The doc listened to my lungs and heart, quickly looked over my skin, and checked my male parts (no prostate check). I know he couldn’t have really do a thorough check of everything that should be checked. Physicals I had in the past took around 45min. He did have a scribe listening in and doing the chart notes on the computer system, but still. It was obvious to me that the bare minimum was done and I know it is because the amount of time that is allocated to meet insurance guidelines.
3000 per panel was a dream. I had 5500 in FFS when I changed to DPC. Now I know all 600 by name and my team sees diabetes reversal every week because we have the time to invest in each one personally. #dpcftw
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This is solid content. I deeply appreciate the way you’ve taken time to innovate these ideas, validate them, and speak about them on here.
I signed up for a year with a direct primary care. But there is a per visit charge and he does no labs (I did not realize this when I signed). There is no team, only one dr who doesn’t remember me when I go in and advised me to go to the ER for a minor procedure. I don’t have health insurance. There just are not enough direct care options near here. It is close to impossible to find information on what doctors are good and not (how I ended up with the one I have now). There is one doctor in the town I live who sees patients with no insurance. I agree with you on these issues but can’t really use any of these things just due to lack of availability. Just so frustrating.
Yes! Get Andrew Yang on the show to discuss Healthcare solutions! If he wins you should be the Secretary of Health or whatever the leadership position for that is.
First things first. The per capita cost of health care in the U.S. is $11,000 a year. In Germany with universal access it is $6,000. Simply moving the “who pays” food around the plate is not “reform”. Any health care reform proposal that does not explicitly reduce the per capita cost of care is bogus. BTW, DPC as voiced here with the usual vulgarian overlay conveniently avoids the obvious unintended consequences. Like given the extended visit time, what happens to all of the patients who are not seen? And at 70 bucks a month, a relatively healthy person is paying $840 a year for one or two visits. Which implies a DPC practice death spiral when the healthy patients bail out.
Pretty sure you’re my spirit animal Zdog ❤️ I’m a baby RN, 4 years of experience was going to go for FNP, held off enrollment to plan my wedding and honestly glad that I did. I realized all the parts I despise now as an RN would only get worse when I became an NP especially now that I work for a private office and I see the affects of billing and insurance a lot more than I did when I worked for a big system.
I started with a Direct Primary Care doctor and it was by far the best thing I ever done in regards to my healthcare. In the past it was like an assembly line and the doctor dictated to me which doesn’t work and rushed me out. When the bill came it was huge for the 10 minutes he spent with me and I usually ended up paying since it fell out my deductible. Finally a doctor I can partner with working towards keeping me healthy. My new DPC doctor spent over an hour getting to know who I was and for me to get to know him. During my physical everything was explained to me and he had the courtesy to ask permission before touching me. That was my first appointment and every appointment since then has been great. He actually knows my name when I walk in and he ask me how I feel and how things are going. You are so right there is no personal connection with doctors today. How can someone ever feel comfortable enough to actually be open and truthful with someone who considers you a number or a cash cow. For a low monthly membership fee I have unlimited access to my DPC doc. Everything office related is covered under that fee (except bloodwork, vaccines etc.) and it ends up being much less expensive then using insurance that covers office visits etc. I now have a very high deductible with just catastrophic coverage and my insurance premium combined with my DPC membership fee is way less then before and the care is 1000 times better. Last week I saw my doc at the grocery store and he said “hey Mark how you doing?” Not many people can say there doctors would greet them away from the office.
This in no way challenges the power that greedy insurance and pharmaceutical companies have over average working people in our country. Just another snake oil salesman. Support Medicare for All.
YES����������KEEP ON Not Giving a Fuck. ���������� So tired of corporate healthcare.
All the money people pay for big healthcare: The insurance, the co pays, the out of pocket fees, the procedures that insurance doesnt pay for, the $$ expensive drugs, the donations..healthcare can charge you what they want…all that $$$….so…….
…��NURSES SHOULD NOT WORK UNDERSTAFFED.�� Do not expect to get what you pay for because your hard earned cash-ish lines those soft velvety pockets and pays for corporate retreats NOT SAFE STAFFING.
Decades ago I remember my parents having medical insurance and major medical. Routine procedures were paid out of pocket, up to an annual limit and then a lifetime limit (which we all hit as teenagers). Then things changed and EVERYTHING was through insurance. More and more paperwork was added, CYA procedures were mandated by malpractice insurers, etc.
Like your oil change example, we’d be paying $200 for an oil change if we did it that way. But we need to convince people that paying out of pocket for routine care is cheaper in the long run. Too many people think it is “free” when done via insurance.
It’s a fantastic premise. I get it…the support needed just to satisfy CMS and Big Insurance is crushing and awful and totally gets in the way. I left the bedside last year, and I’m a “quality improvement nurse.” This means I’m the one who has to tell the hospital how high CMS federal and state…and Joint Commission and all the damn certifying bodies say that we should jump. I’m interested in why you are no longer doing Turntable….did it not catch on? I’d like you to talk about that.
whose gonna pay for the unnecessary outpatient lab tests and scans that the PCP’s order under the Direct Primary Care Revolution.
All the money people pay for big healthcare: The insurance, the co pays, the out of pocket fees, the procedures that insurance doesnt pay for, the $$ expensive drugs, the donations..healthcare can charge you what they want…all that $$$….so…….
…��NURSES SHOULD NOT WORK UNDERSTAFFED.�� Do not expect to get what you pay for because your hard earned cash-ish lines those soft velvety pockets and pays for corporate retreats NOT SAFE STAFFING.
I’ve been using direct primary care for a year now and I will never go back to the old way of traditional insurance. It’s like taking the blue pill and having your eyes open about how much we have been getting shafted by the system. Plus, best part, I never sit in a waiting room. Ever. I actually get to spend as long as I need with my doctor, no 7 minute average time we are use too. Plus prescriptions are insanely cheap because they helped me find the best place for my meds. But I love most of all the access to MY doctor, not A doctor, on my phone to text with any questions. No more Google as my side doctor. This fixes 80% of the preventable and predictable portions of healthcare. Fun story, I had a bunch of skin tags removed by my primary doctor and it was included in my monthly membership of $99, when my dermatologist wanted to charge me $500. Once you go DPC you never go back.
Didn’t catch you live but if you can have some of these policy makers on that would be great. I know how they’re going to pay for “Medicare for all” but I get zero response when I ask how are you going to change the delivery of healthcare. I wonder if this is flying straight over their heads. OK my rant over, keep preaching it.
You are solid! Thanks for being REAL when you present on Direct Primary Care. No more filters when you talk. Aa a nurse of 23 years an RN entrepreneur for twelve years, your verbal medicine is exactly what our broken medical system needs. If you need support from a home health perspective, I’ve got you! What your spitting is a soap box presentation my team and i give on a weekly basis! Stay a bad ass!
DaveRN
http://www.acahealthservices.com
Preventative Care how freaking NOVEL! LOL. Why the heck has the system been so slow to gravitate, navigate and actually apply the preventative pathways and functional health and wellness models that include prevention? One word: Greed. Greed from the pharmaceutical companies, and those healthcare systems that benefit from their fraternization. Greed from the companies that poison our patients. Someone’s death is another person’s dollar. That has been the perpetuating force behind the 1950’s & 1970’s based healthcare model in our country. I am surprised when people react as though preventative/functional/total health and wellness systems are something novel. They are, in fact, common sense. The flabbergastingly frustrating conundrum is the transition from greed and worshiping the dollar to valuing prevention of disease and caring for another human being more than the stock exchange.
Your “fix” screws over poor people. Most people can’t pay out of pockets for imaging or lab tests or specialty care. Catastrophic coverage insurance will just lead to more medical bankruptcies.
You have been wealthy for too long and don’t understand the finances of regular people.
So.eone please get this in front of Bernie Sanders, Mayor Pete, Trump, the rest of them. Get them to comprehend this shit instead of just trying to promise the best freebies for your vote.
Direct Primary Care sounds like a great thing for patients! Just to pay $40-60 per month and get an actual Dr to really care about your condition, so much so that they will actually do the exam and needed tests to look beyond the surface to actually what’s causing your actual symptoms!!!! Wow, what a concept!!!!!!! Take my Sleep Apnea for instance, now don’t get me wrong! I LOVE my Doctor and I know he knows his stuff for sure, but he has so much red tape and crap going on that he just has the time to put a band aid on my symptoms, here’s the machine just use it for the rest of your life!! But hey, there I’m sure is an underlying cause somewhere located in my general body which may be causing my SA and I’m sorry there must be something out there which could be done other than me having to wear this crazy mask at night for the rest of my life!!!!!!!! If only my Dr could have the time and wherewithal to delve a little more deeply into it!!!!! Anyways sorry to go on, but this I felt was a good venue to bring up my story, thanks for listening!!!
I truly believe you Doc can impact how healthcare is delivered in the USA. Going on Rogan would be helpful as one commenter mentioned
Thanks for the comment catch Dr Z! I am a seasoned EMT (12 years) in school to finish my Paramedic, and planning on PA school right after. Your health 3.0 is going to be one of my term papers on the way to Physician Assistant. I have shared your channel with a few of my first responder friends and we all would love to see a video about EMS/First responders! What can we do to help Health 3.0 as EMS/First responders? Love the channel, keep up the amazing work!
Great Summary of the changes by an innovator for many years. Very helpful practical summary on how to start doing Telemedicine in the COVID19 ERA.
Here’s a Timeline:
Intro
Dr. Brown Start: 2:10
History and Regulations: 5:33
Coding 11:55
HIPAA 13:30
State Regs 16:00
Commercial Insurance 19:00
Local/system 20:28
Workflow Processes 21:40
Technology Setup 25:15
Facetime/skype/Facebook
Scheduling and examples 31:00
Clinical RULE: 38:40 What would you do on Friday Night at 11:00 pm?
Changes Summary since COVID19 39:55
Questions: 42:40
Scope of practice 43:45
Insurance coverage 44:30
New Patient? 45:30
99213 w video req? 46:28
Medications Rx regs waived? 47:18
Copays 48:20
Phone vs video 49:25
Phone only reimbursement 50:36
Documentation /SOAP 51:40
Specialist visits 52:05
Time based visits 52:50
Typical visit times 53:20
Other people in the room? 54:00
Vital signs 55:10
Billing if visit is needed 56:45
Nursing home visits? 57:50
TikTok/Zoom/Social media 58:35
controlled substances 59:40
AOA resources 1:00
And a bunch of others but you can see it’s extensive.. Good luck… JB
People don’t read the details and listen to the mainstream then label it and make people fear itsocialized medicine can be good plus primary care being real humans. Kaiser was developed by Nixon who wanted to cut cost but not increase care. Kaiser ignore BP on my family for 10 yrs now heart problemsnever like them.
OMG! You absolutely made my day when you mentioned Andrew Yang!! He is the you of politics. The damage your two minds could do to the status quo would be freaking amazing! And F**K is his favorite cuss word!����. How do we make this happen?!?
Health knowledge standards should be part of the U.S. education system. Make a list of what every person should know. Submit it to every legislature. You’ll ensure that every single human being knows that Dr. Pepper in a sippy cup is going to contribute to diabetes. The whole problem with solutions like this is that the healthcare system has no incentives to make people healthier. Childhood diabetes?? CHA-CHING!!! MO MONEY MO MONEY…..I’m happy to see the anger at this reality. It’s the main fucking problem.
Clearly a smart man and doctor who loses me with his willingness to dismiss “socialized medicine” (which is a FOXnews slur against single-payer/M4A) without really acknowledging that the evil socialists throughout the rest of the developed world are somehow able to improve their medical outcomes; life-spans, quality of life, happiness, etc. with that same evil “socialized” medicine. Frankly, the plan sounds like a way to keep people paying for the right to live, while corporate money keeps access to healthcare profitably distant from those who need it. The doctor’s attitude, while refreshingly honest, doesn’t seem to allow for much room for people who maybe start from a different POV. It is my problem with libertarianism in general.
I don’t think it’s an education problem, but one that there’s so much disinformation that nobody knows what to believe. For example, the food pyramid being a total farce after years of doctors telling us that it was healthy.
Any honest and thinking person can see that Medicare-for-all (M4A) is more cost-effective and far superior in accomplishing the task of delivering public healthcare, than is the status quo private and corporate health maintenance organization (HMO). But the debate over this gets bogged down over taxation and, to put it bluntly, where the rich are concerned, whether they can still get their private cosmetic surgeries.
The biggest obstacle to enacting M4A, is the private insurance companies who don’t want to give up their profits. The only solution is for the insurance companies, which are destroying public health & welfare by gouging the public, to give control of the hospitals, clinics, and laboratories over to the public; let the doctors, health workers and patients reorganize the healthcare industry. The HMOs have been exploiting that gravy train long enough, and if they won’t give it up, it will be expropriated, and they’ll have everything taken away. The only caveat being, neither the Democrats nor the Republicans will ever favor the workers over the capitalists, so the solution will require the founding of a Workers Party.
Z, I agree with just bout everything in this episode. I would like to share parts of this with my occupational therapy students but the language would get me fired. I am not personally offended but please do consider the importance of getting your message out there and the limitations to doing so because of the language you use. Keep going, keep speaking the truth, just make it easier for those of us who believe in you to share your brilliance.
There is a grass-roots movement against the US medical system because more and more of us know by traveling to other countries we can pay out of pocket there because the prices are so cheap. What Venezuela? not a chance try France the best if the best or Japan where people live for ever. But one things for sure your gonna see a single price system of rules and procedures because as a country we cannot afford to pay 20% of GDP on medicine that means that docs pay is gonna suck, Hospitals will have to tare down their Water Fountains and CEO’ have to sell their G7’s Since nobody is playing nice to
The patient, surprise billing, bankruptcy, Medical errors. The system must be simplified to a single system and single National IT system so people can figure out how to allocate resources. Right now that info is proprietary and EMR’s don’t communicateFrance and Germany have a single health IT card which contains your data so you don’t regurgitate the same medical garbage to nurses and providers wasting 15 minutes each appointment.
BTW, M4A under the current fee-for-service model is a ticket to national hyper-bankruptcy. The problem with U.S. health care is not the cost of insurance it’s the cost of health care services. The only way M4A would lower the per capita cost of care is by the Government imposing massive fee cram-downs on the providers. A hip replacement that costs $80,000 in the U.S. can be had for $20,000 in Europe. An orthopedist in the U.S. takes home $500,000 a year. Primary care doctors average $250,000. How much is enough? And people don’t need a DPC provider to find cheaper drug and blood test prices. Those can be found online. In fact simply mandating that ALL prices for health care services be posted and fixed for ALL patients would at least put a dent in the pathological system that is U.S. health care. Moreover, the U.S. has a doctor shortage with little being done to increase supply. Under the current restricted supply model of physicians (i.e, low competition), DPC is a gimmick in which the average visit cost would be over $400 with many sick people not receiving any care because the number of available patient visits per day would be cut in half. Under the existing regime of Big Health Cartels, Health Care 3.0 is a half baked illusion.
Brilliant rant! Can you talk about why Turntable is no longer in business? I’ve seen several similar medical centers like Turntable in the Washington, DC area and after 2-4 years they went out of business. How can your needed primary medical vision come to fruition and be successful? Thanks!
I’m a third year family medicine resident looking for my first job after residency. How do I find a job where I can practice compassion preventative medicine without becoming a slave to the commercialized healthcare system?