The Paradocs Podcast with Eric Larson

Surprise billing is a nationwide problem and Michigan is not immune. Surprise billing refers to the instance where patients are expecting their insurance company to pick up the entire tab of a medical bill but they instead find a huge bill for the amount 'left over.' The worst instances of this occurring is when the patient unknowingly encounters someone who is 'out of network' with their insurance company. Learn more about your ad choices. Visit megaphone.fm/adchoices

Direct primary care is just starting to really accelerate within the primary care world. And Josh Umbehr, MD has been at the forefront with his practice and line of products to service DPC doctors at Atlas MD. In this episode, we discuss the state of DPC, how commercially there are more people looking to get involved in selling ancillary services, and the battle he and other DPC docs are having with their own professional society, the American Academy of Family Physicians. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Kris Held is the president of the AAPS and is an ophthalmologist in private practice in San Antonio, TX. She is suing the state of Texas to have the right to dispense drugs to her patients in her office. This would improve patient safety, reduce costs by over 50%, and is already being done in 44 states and the District of Columbia. We discuss her lawsuit, how she practices as a surgical specialist without insurance, and more. Learn more about your ad choices. Visit megaphone.fm/adchoices

My discussion with Jennifer Zeng, a Chinese woman who was persecuted by the communist government for her beliefs. She is an author and activist working to bring to light the actions of China on its own people and those in Hong Kong. We discuss growing up in China, who China tortures, their process of murdering political prisoners to sell organs for transplant, and what the struggle in Hong Kong is all about. Learn more about your ad choices. Visit megaphone.fm/adchoices

What's the deal with nurse practitioners (NPs)? Why is there so much anger from physicians and NPs when it comes to how patients are treated? Every day on my twitter feed I hear about how nurse practitioners are "acting like doctors without the necessary training" and are "dangerous because they know nothing." Meanwhile my friends who are NPs and PAs cite studies that claim they provide better care than physicians. Both camps' arguments are hogwash. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today's discussion is about hospitals. Namely, what does it mean to be nonprofit? Over half of all hospitals in the United States are not for profit entities - but do they really look differently than for profit institutions? That is the question that few politicians or those debating health care speak about. In many instances, one would be hard pressed to know whether hospitals are for profit by how they run. Learn more about your ad choices. Visit megaphone.fm/adchoices

I haven't spoken to a lot of ancillary medical professionals in the show and explored ways that they are changing the way we deliver medical care. Today I spoke to a physical therapist who chose to run his practice unlike traditional practices. He doesn't structure therapy based on what maximizes revenue from insurers but instead on treating the patient and their injury. Learn more about your ad choices. Visit megaphone.fm/adchoices

Serving the poor in health care is a mission that many enter medicine to do. Whether that is through medical missions, working free clinics, or in some other way - doctors are doing what they can to help the poor receive care. Some choose to work in underserved regions of the country both urban and rural that are paid in part by the federal government. These clinics are called federally qualified health centers. The question we must ask is if these clinics are the best way to serve the poor. Learn more about your ad choices. Visit megaphone.fm/adchoices

Irish doctor Clodagh Ryan worked in the UK's NHS and US as a family doctor. She says the NHS has some advantages but they come at a cost to patient care. Among those are excessive wait times, reduced innovation, and poorer outcomes in certain treatments. Learn more about your ad choices. Visit megaphone.fm/adchoices

Direct care is a newer way of providing care to patients. It is a cash system without insurance. Direct care is now becoming more common for specialists. My guest is an allergist who has adopted this model and practices medicine the way she wants that isn't rushed or filled with bureaucratic paperwork. Learn more about your ad choices. Visit megaphone.fm/adchoices

Self Care is the term used to describe how patients can take care of themselves and use techniques to improve their health and healing. Utilizing self care is a component of integrative health where traditional medical services are combined with other strategies to help patients recover from illness or deal with chronic conditions. Learn more about your ad choices. Visit megaphone.fm/adchoices

February marks the month designated by the American Heart Association as its "Go Red for Women" campaign to raise awareness of the real risk of heart disease in women. Too often, men are seen as the victims of heart attacks and people forget that women can suffer from heart disease as well. In fact, women die more from heart disease than men, right? Well, not exactly. And that's what we discuss in the show. Learn more about your ad choices. Visit megaphone.fm/adchoices

Everyone needs health insurance, right? Health insurance keeps you from going bankrupt, right? But what if it ends up costing you more for basic expenses? In this episode, I recount my experience getting a 2000% markup on a laboratory test. I explain how this is a perfect example of so much that is wrong with our health care market. Learn more about your ad choices. Visit megaphone.fm/adchoices

Zombies aren't real, but sometimes they sure seem like it. Especially when it involves medicine and the law. Health Diagnostics Laboratories (HDL) went into bankruptcy after being discovered it was ripping off patients by overcharging them and providing kickbacks to doctors and health organizations for using their services. Learn more about your ad choices. Visit megaphone.fm/adchoices

The topic of abortion seems to have gained more momentum in the news cycle of late with states passing laws relaxing or loosening restrictions on the practice. It feels like the 1973 ruling of Roe v. Wade might actually come before the US Supreme Court. As a physician and hospital, the social and ethical questions that surround abortion are both personal and professional. What is the obligation of institutions to perform abortions? How about the physicians or nursing staff? Learn more about your ad choices. Visit megaphone.fm/adchoices

National health care policy is always at the forefront of the political discussion in the US. Democratic candidates are offering their visions of what the US system should look like and point to other countries in the world. One held up is the United Kingdom and its National Health Service (NHS). But is it better than what we have here? My guest today is Philip Booth. He has written on the health care policy in the UK and is able to describe the UK system and how it differs from the US and Europe. Learn more about your ad choices. Visit megaphone.fm/adchoices

Physician wellness has come to the forefront today as health systems deal with ever increasing numbers of physicians dealing with mental illness and even suicide. There is no shortage of explanations nor ways the health systems are trying to fix these docs. Dr. Sanchez Wohlever has personally dealt with burnout and offers her own prescription for solving the problem. Its systematic approach is both simple and personal. Learn more about your ad choices. Visit megaphone.fm/adchoices

One of the most important things a young student can do to help their future is to pay attention to finances when he or she is young. This means to focus on minimizing debt, living lean after you get a paying job, and investing a sizable amount of your take home pay to achieve financial independence. Dr. James Turner, aka the Physician Philosopher, is an anesthesiologist and hosts a very popular financial website to help those in medicine to navigate the treacherous waters of finance. Learn more about your ad choices. Visit megaphone.fm/adchoices

Physician burnout and mental health problems have been well documented as has the physician suicide epidemic. Health systems implement wellness programs and have mental health awareness initiatives. However, the wellness programs do a poor job addressing the root causes of burnout and physicians have a hard time getting mental health help because of the professional stigma and inability to be sure that their treatment is truly confidential. Learn more about your ad choices. Visit megaphone.fm/adchoices

There has been no shortage of ink spilled arguing how we fix our broken US health care system so today I will use the spoken word instead. Fundamentally, we all want the same things from the system: Quality care, Affordable care, and Access to care. The real question is how do we move from here to there? Are there people who have fixed these problems even on a small scale that we can use as guides to work things out? Finally, should we look off shores for solutions to our woes? Learn more about your ad choices. Visit megaphone.fm/adchoices

This podcast has been dedicated to bringing you disruptors to the health care market and today's show features a discussion about health sharing ministries. The ministries work as a substitute to carrying health insurance allowing for people to use the service to pay their medical bills. Individuals pay a "sharing amount" each month which is then aggregated by the ministry amongst its members and sent to those with medical bills. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today, we continue our journey discussing physicians who are using direct patient care through a membership model as disruptors in the health care field. Direct primary care is one of the most disruptive and innovative models to emerge in recent years and more and more specialties are looking for ways to adopt the insurance-free notion of providing care to patients. Now we can add an OB/GYN to the ever growing lists of physician specialties as I discover the practice of Deborah Herchelroath, DO. Learn more about your ad choices. Visit megaphone.fm/adchoices

For women, a very scary and anxious time of their life is pregnancy. C/sections are a very common procedure in the US for women constituting 33% of all live births. However, my guest Dr. John LaGrand's practice, in which he works collaboratively with four certified nurse midwives (CNMs), he believes is a different way to practice obstetrics and has led to a c/section rate of only 5%. Learn more about your ad choices. Visit megaphone.fm/adchoices

One of the great challenges to those paying for our health care today is determining who is high quality, who is truly expensive , and who is doing the right thing. Unfortunately, the payers in medicine are not the patients but third parties like Medicare. Since the person receiving the care is not directly paying for the service, administrators in an office have to make the determination of how to pay without experiencing the care and knowing whether the physician was providing the right care. Learn more about your ad choices. Visit megaphone.fm/adchoices

Physicians today need to be more than healers. They need to also be leaders for their patients and partner with the patients throughout all aspects of care. Until we as physicians take an active role in finding solutions to every problem encountered by our patients, we aren't doing our job. This includes being mindful of the cost of tests, procedures, and pharmaceuticals and doing something to lower those costs to make getting the necessary care affordable. Learn more about your ad choices. Visit megaphone.fm/adchoices

How do PBMs (pharmacy benefit managers) pass on savings to themselves and leave patients and insurance companies holding the bill? It's hard to answer that question without first understanding what a PBM is, how they work, and what their role is in the pharmaceutical market. Unfortunately, the PBMs intentionally cloud what they really do in order to continue ripping off patients and insurance companies with unnecessarily high drug prices. Learn more about your ad choices. Visit megaphone.fm/adchoices

This week's episode is a longer interview I did as a guest on the Gray Matters Radio Podcast with Mike DeVine. He had me appear in February as part of his series exploring the US health care system and its many dysfunctions. In this episode we explored the problems with the pricing system, group purchasing, economic scarcity, and why things are just so darn expensive. Of course they all get answered and wrapped into a nice little bow at the end of the interview. Learn more about your ad choices. Visit megaphone.fm/adchoices

Only in medicine is discussing prices before providing care a revolutionary concept. Prices serve as an important signal to both providers and patients as to the relative scarcity of care. Whether that is time with a physician, time in the operating room, the cost of equipment necessary for procedures, or medications the price signal is important for both sides to understand the real cost of using resources. Learn more about your ad choices. Visit megaphone.fm/adchoices

How would you feel if someone who didn't know, was unfamiliar with your symptoms and story, and had never examined you dictated the way you were treated? Would you be upset if the people making those decisions were not specialists or maybe even had the same training as a physician? Unfortunately, this practice is very common today in every doctor's office in America and it is called prior authorization. Learn more about your ad choices. Visit megaphone.fm/adchoices

If there were a conventional treatment for a disease in a traditional medical practice that worked only 10% of the time or less - would anyone feel comfortable claiming it was a fantastic cure? I suspect not, yet those abysmal successful treatment numbers are present in some areas of the mental health arena when it comes to addiction treatment. However, you almost never hear about the failure of the 12 step programs or outpatient treatment plans and their high failure rate. Why is that? Learn more about your ad choices. Visit megaphone.fm/adchoices

Today, the topic physician burnout and looking at the numbers at who is suffering and what the causes are. Medscape published its 2019 Survey of Physician Burnout, Depression, & Suicide that dives deep into the demographics and causes of the phenomena. However, what was notably absent from the possible causes for burnout was financial matters. What effect does a high personal debt have on physician well being? And if it is a problem, how can you find your out of debt to improve your psyche as a physician? Learn more about your ad choices. Visit megaphone.fm/adchoices

I have spent a lot of time discussing innovative ways of delivering medical care on this show and it has primarily been based around primary care. However, those who are specialists who traditionally practiced using third party payors (Medicare, Medicaid, commercial) are also beginning to strike out on their own and switch to cash pay. The reason for this is that the cost of using insurance and the lack of access allows these specialists to find a market for the type of medicine they want to practice. Learn more about your ad choices. Visit megaphone.fm/adchoices

What is the difference between a first year medical student and a senior in college? A lot of debt and neither knows anything about medicine. Contrary to popular belief, medical students don't know the first thing about the health care system, how it is delivered in the United States, or what challenges face physicians in caring for their patients. So all of the popular opinions floating around in the general undergraduate student population are present upon their training. Learn more about your ad choices. Visit megaphone.fm/adchoices

For those who have encountered the health care system - the emergency room is the greatest mystery for charges. Although little of emergency care is truly emergency life threatening care (est. ~3%) the care is some of the most expensive in the hospital. Whether that it is imaging, laboratory, or professional services - patients and insurers are expected to pay the inflated costs. So how do we control costs and not break the bank for all of our patients when they are possibly at their most vulnerable? Learn more about your ad choices. Visit megaphone.fm/adchoices

If there is one thing patients and doctors agree about when it comes to primary care it's that it isn't properly working for either one. Doctors have too little time to spend with patients, can only address one or two problems at a time, and spend most of the little face time they get staring at a computer screen than at their patient. Learn more about your ad choices. Visit megaphone.fm/adchoices

When it comes to working, we all have different goals on what to accomplish during our careers. However, almost everyone anticipates on retirement as the way they end their professional life. The FIRE movement is one which emphasizes achieving your financial independence and retirement at a younger than traditional age. With careful planning and goals in place at a young age, you can achieve the goal of financial independence with more time to control your life without worrying about financing living. Learn more about your ad choices. Visit megaphone.fm/adchoices

One of the tasks assigned to physicians, and certainly not a task one thinks of when entering medical school, is to verify death. The first time you declare someone dead - for me, it was as a first year resident in the ICU - is a weird feeling because of the finality of it. As with anything you do as a physician for the first time there is some uncertainty that you aren't "messing up." But you don't need to be a doctor to declare someone dead because anyone can tell when someone or something is dead, right? Learn more about your ad choices. Visit megaphone.fm/adchoices

Direct Primary Care (DPC) is starting to gain some steam and popularity with established physicians, residents, and medical students. Patients are also beginning to learn about this alternative to traditional insurance based care. Instead of copays, deductibles, and limited visits and times with the physicians - DPC works as a monthly fee with unlimited access to the physician. Learn more about your ad choices. Visit megaphone.fm/adchoices

Physician suicide is an epidemic. How else do you describe 400 physicians per year ending their own lives which is over twice the national average? Why do so many doctors feel that the only escape from their pain is suicide? How do we end this epidemic and begin to heal the healers? Learn more about your ad choices. Visit megaphone.fm/adchoices

We can all agree - outside of a few overpaid pharma CEOs - that the American Health Care system is too expensive. In fact, one could argue that the system of delivering health care in America is designed to cost the most possible without any parts that can check its growth. If you were to try and design a more costly and inefficient system I dare say you would be unsuccessful. Learn more about your ad choices. Visit megaphone.fm/adchoices

Who is that man or woman in the white coat? What is he/she thinking as you are being examined or operated on? Is that physician burned out? Suicidal? Feeling optimistic about his/her profession? The future? There is a lot going on between the ears of that physician that isn't devoted to healing people. Today, I take a deep dive solo-style into the results of the comprehensive 2018 Survey of American Physicians by the Physician's Foundation. Learn more about your ad choices. Visit megaphone.fm/adchoices

The opioid crisis has been in the news for a few years now and those to blame for it are many. Is it pharmaceutical companies who made easy to prescribe formulations of powerful pain killers? Is it physicians for over prescribing pain medicine for simple aches and pains? How about federal guidelines that encouraged the over treatment of pain? Or the creation of the fifth vital sign in the late 90's that treated pain as important as heart rate. Learn more about your ad choices. Visit megaphone.fm/adchoices

Social media is ubiquitous in our lives and doctors have a less than average presence within that sphere. The reasons are many but probably partly related to concerns about medical liability, their employers, and reputations as physicians. Dr. Dana Corriel set out to change that. She created the #SoMeDocs which encourages physicians to engage the world more and bring their unique perspectives to patients and the public through the use of social media. Learn more about your ad choices. Visit megaphone.fm/adchoices

Our discussion hopefully offers some insight into grief while being sincere with brief moments of humor. What to expect, what is comforting, what is not helpful, and how it has changed our lives. Specifically, we discuss the process of forgiveness, grace, and practical things you can do to help your family members or friends in dealing with the grief. My hope is that this episode will be a comfort or helpful for those in the grieving process or those helping a loved one go through the process. Learn more about your ad choices. Visit megaphone.fm/adchoices

Sometimes, the best way to understand your present is to view it through the lens of the past. HMOs (Health Maintenance Organizations) were a product of the 70's and exploded onto the scene in the early 80s. Specifically, he recounts the 'industrialization' of health care delivery where a cottage business of caring for the sick transformed into the business it is today run by large corporations. Learn more about your ad choices. Visit megaphone.fm/adchoices

HIPAA (or the Health Information Portability and Accountability Act) passed in 1996 and has been touted by legislators, physicians, patients, and health industry leaders as a law that protects patient medical data privacy. It turns out, as with the names of many laws that pass in Congress, the act does the exact opposite as what you might guess. The act allows for over 2.2 million entities in the US to trade, disperse, and sell your personal medical data without your consent. Learn more about your ad choices. Visit megaphone.fm/adchoices

Did you know that most hospitals (or hospital systems) enjoy a non-profit tax status? Despite revenues in the billions of dollars these entities operate within your city or community with a tax exempt status including all the medical offices, laboratories, imaging centers, and billing offices that they build and purchase. Does this give them an unfair competitive advantage over for profit imaging centers, laboratories, or physician private practices? Learn more about your ad choices. Visit megaphone.fm/adchoices

Few are aware of the practice of public reporting for health care and on its face, it seems to be an obvious goal for policymakers. However, comparing health care systems, hospitals, or individual physicians is incredibly complex and probably impossible to do in any sort of meaningful way. Traditionally, patients relied upon local knowledge with their primary care physician to refer to the best few specialists. Learn more about your ad choices. Visit megaphone.fm/adchoices

Maintenance of Certification (MOC) continues to weigh down physicians encouraging early retirement, burnout, and financial strains leading to all sorts of other personal and professional problems. The private specialty boards (ABIM, ABA, ABP, etc) are under the auspices of the ABMS which sets many of the rules that are ruining physicians' lives. Learn more about your ad choices. Visit megaphone.fm/adchoices

Certificate of Need (CON) laws are commonplace in the United States and affect every patient and physician who lives in one of the 36 states which have them in place. The laws stipulate that you need permission from one a government regulatory board proving a need in your community to open a competitive health care service like ORs, laboratories, imaging centers, or hospitals. Learn more about your ad choices. Visit megaphone.fm/adchoices