The Paradocs Podcast

Many physicians and those supportive of markets in medicine are making a big deal on Trump's proposed executive order to increase price transparency in hospitals. The thinking is that by exposing how much each hospital charges for their services, hospitals will begin to compete on price and the cost of care will go down. Although I believe this to be an admirable goal, I think it is very shortsighted to think that a law or order without a significant market demand will change the behavior of hospitals.

One of the most common questions I get asked about the health care system is why are medical bills so enormous? It seems strange that the explanation of benefits you receive after getting care or services are so obviously inflated. Yet those charges which the hospitals, health care professionals, and pharmacies post are there to see which they clearly have no expectation of getting paid. Why does this happen?

If you own your own business, which physicians who are independent or run concierge or DPC practices do - you need to focus part of your time on branding and marketing. What words you use to describe yourself is critical to success and an important part of marketing and branding. I speak with Dr. Nitin Gupta about what he did with marketing to turn things around at his clinic.

One of the most expensive ways to receive care in the US health care system is thru an emergency room. The use of urgent care centers is a less expensive alternative. Unfortunately, one of the problems with urgent care centers is that the care is often not very good. It is especially poor when it comes to treating children where the average urgent care refers 40% of its patients to the ER even though about half receive no special treatment.

Moving from academic medicine to private practice is a scary thing to do for any doctor. But what is it like for a specialist is the city with the highest concentration of her specialty to find patients?   My guest today is Dr.Rudrani Banik, who treats patients with vision disturbances, headaches, and other neurological conditions related to the eye. By leaving academics (partly since she still does research) and striking out on her own, she recognized the need to do more than just practice medicine.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.