Medicare Slashing Physician Reimbursements

JUSTIN NABITY:

All right. Welcome to the April edition of DocNation 2023 er 24? Whoa. We’re already four months into the year.

Man, this is an exciting session we’re going to have coming off of being at a conference in Las Vegas last week and talking to so many doctors about all the things that they’re experiencing, facing. And our title for tonight is all about Medicare cuts and what that’s doing to the industry and we’ve got some stats to share with you.

We want to have you involved so the chat bar, the chat options, feel free to throw comments in there, questions in there. We want to make this interactive and so this is going to be all of us together, it’s going to take all of us working, sharing ideas, and teaming up to make this possible to bring the change that needs to happen in the industry. So, we welcome your thoughts, we want to hear all about it.

And it was amazing coming off that weekend and we got to speak on advocacy, on contracts, on representation, on really the state of affairs and doctors talking about unionizing and actually the doctors are members of unions. They do exist. It’s something maybe up to 13% of doctors are a part of unions. And no joke, while we were speaking on Friday and leading up to that, we got word of the first strike of physicians, physicians striking in Detroit at Ascension.

And this is, like, it’s been since 1976, I believe since there’s been an organized, walking out sort of thing. And so, we’re at this breaking point, people are serious now. And part of the question that I want to have us think about is, at what point is it going to be enough? How far does it have to go before doctors are like, yeah, we’re not going to tolerate this anymore.

It’s game over for the way that business, the way that insurance, the way that all these different parties are affecting the industry and so we’ll dig into that.

Excited to have one of our members, Dr Verma, on to share some personal experience stories of being a business owner and what he’s seeing and experiencing with Medicare and when you look at the numbers, which we’ll dig into here in a little bit, it’s, it’s unsustainable. We’re at that point.

So, with that in mind, Nikhil, would you mind sharing a little bit about yourself and your practice and maybe tee up one of your stories you were gonna talk to us about?

DR. NIKHIL VERMA:

Yeah, of course. As always, I appreciate DocNation giving me the opportunity to come on and join you guys. And you know we don’t do this as interviews, it’s more of a group discussion as colleagues and we have great rapport of discussing these topics that are coming up.

And when this came up, I knew this was a good topic for me to talk about as we know that Medicare cuts continuously go down year after year after year and that’s a significant cut that was kind of signed into action by the end of 2023.

It took effect in January 2024 you know, those what, 4%? Four points out the percent and.

An effective 4 point something percent and I noticed that coming in at that beginning time of the year when we have a lot of our patients that haven’t met their deductibles on the commercial side.

So you’re relying on all these patients to come in and when you’re not getting that same reimbursement that you would typically get from the Medicare patients, that doesn’t only affect the practice, but how can I pay the staff, how can I pay my HR company, bills are still due, you know we still have to pay the bills for rent and for payroll and all that kind of stuff.

And I think that’s the second part to all of this is how all of that has been increasing over the same time period and really, really puts us in a tough position of how do we operate a practice when we don’t have any cash flow.

And our cuts are going down and down, with all the prices are going up and up.

JUSTIN NABITY:

Yep, absolutely. On that note, let’s take a look at what’s happened with the numbers. Think this will be, if you haven’t seen this lately or in a while, it’s, it’s gonna be a bit shocking.

Pull this up here. So, you can see it going across the top. Here we have the darker orange, the cost of being an inpatient, the blue of the cost of being outpatient, the cost of inflation – the consumer prices in the purple, the cost of being in business.

As a practitioner, and I don’t even know why they call this the physician update, like that’s such a terrible name for this, but from 2001 to 2020, you had a few more years on, we’ll need to get an updated chart to show what’s happened.

But, what’s the reason for this gap? How is it possible that the cost of living is up here, and we’ve seen virtually nothing happened with physicians’ reimbursement?

And we take a look at this and you adjust it for inflation. What this is saying is that since 2001, we essentially have had a 22% reduction in pay.

How does that make any sense?

DR. NIKHIL VERMA:

I don’t understand how they can think that practices or individuals can survive on this. And I think maybe that’s part of the goal is some conspiracy theorists or some people that are deep in the weeds will say that they want all the physicians to be employed by hospital systems, so the government has a bigger say in the healthcare industry and they dictate where patients go.

And now again, I don’t, I don’t want to play that card. I don’t know enough about it, but it is a theory out there.

JUSTIN NABITY:

Well, and if you go back in time, when my father got into business for himself and then you rolled that forward up until today, back in the 80s, it’s roughly 75% of doctors were in charge.

They were calling the shots. You go and look at things nowadays, some of the data says it’s like just over 50% of doctors are now employed.

But if you look at the graduating classes that are coming out, virtually almost all of them are going into employment. And so really when you, I think, factor everything in, we’re probably close to 75% are employed now.

So, it’s the exact opposite of what it was back then. Doctors aren’t in charge anymore. We’ve said this over and over again that only 5% of physicians are in the decision-making positions inside of these organizations. And how is it that the insurance companies, that the pharmaceutical companies, and these groups are making decisions on what healthcare should be provided when they have never been trained, they’re not licensed, they’ve never actually seen patients, it’s just totally unacceptable.

And so, think about that graph you just saw. You fast forward that in 10 years you stay on that trajectory. What’s going to happen? Do it in 20 years, what’s going to happen? It doesn’t work. The math does not work. It doesn’t take, you know, somebody who’s a mathematician to figure that out.

NEIL DOUGHERTY:

 Yeah, that’s a good, good point, Justin. I had a quick little story here. You know those really awesome DocNation hats that Reid helped us out with. I was wearing one at a track meet and my daughter takes my hat off my head, that’s how gangster she is. She takes my hat off of off my head and puts it on and she says, “Dad, you kind of help doctors and I think I want to be a doctor one day, so this hat works for me.”

And so that was a proud moment, right? And, but, I’ve asked a couple doctors this question that have children. I was like, “Would you, are you going to encourage your son and your daughter to actually be a physician?” And so maybe I’ll direct this part of the conversation to you, Dr. Verma.

But like, I, the answer has been overwhelmingly no.

And a lot of these are just, pretty innocent, that the answer to that innocent conversation of would you bring your child? And so…

DR. NIKHIL VERMA:

Yeah, no, you’re exactly right. I hear the same thing from my colleagues. I don’t have any children. But if there’s any people that come for my advice or hey, how do I do this and that, I’m like, it’s really not what I thought it would be and there’s still hopes and that we see glimmers of it, and we see some patient care interactions, but between the bureaucracy and the pay cuts, and you know, I’ll even give the benefit of the doubt if you throw out half of the medical student loans, you know, with all this loan forgiveness.

You’re not doing the doctoring in a lot of these cases, it’s an insurance company, it’s a hospital administrator, it’s guidelines and algorithms that aren’t using our knowledge and our best techniques to potentially help advance the field.

And I had a conversation with someone earlier this week and we’re talking on the topic of opioids. And I was questioning you know, maybe we should look into checking hormone levels because we know that the opioids can disrupt hormones and we know that it can affect the immune system and it can affect other things. And his rebuttal to me was, “Well, you know, it’s not the standard of care.”

And I said, “Well it doesn’t necessarily have to be standard of care, that doesn’t mean it’s not the right care.”

And when you kind of hear that from the business side of perspective and that’s all those people think about, you start questioning and this is just my small initial, my field of opioid management, what other things out there aren’t I aware of that have that happened to.

NEIL DOUGHERTY:

So, I guess I want to kind of pull out that thread a little bit because we’re talking about physician advocacy, and I feel like a lot of the physician advocacy positions are having to take up the mantle to advocate for patients in their care all the time.

With Medicare cuts, how do we maybe explain to people that had Medicare what things are being discouraged from their algorithm or is that a…

JUSTIN NABITY:

Are you talking about, from, like, a medical practice perspective, treatment plans, things like that?

NEIL DOUGHERTY:

Yeah.

JUSTIN NABITY:

OK.

DR. NIKHIL VERMA:

Yeah, yeah. So that’s a great way to phrase that question because that flow of a patient and as we know we’re going to have the baby boomers as our largest part of our population and they’re going to be relying on Medicare as their insurance for the most part. Now that same patient that might have paid, in the past, I would have been able to do a work up and gotten the orders in and checked their medications and all that stuff in an adequate 15-30 minute scheduled time, but if you’re getting reimbursed less for that patient and our administrative burning goes up, and we have to make sure we’re crossing all of our T’s and dotting all of our I’s. Now all of a sudden, that time per value of a patient goes down and you’re forced as a physician to start looking at, hey, I don’t have time for this. I don’t have time for this follow up. I got to get this next patient in, churning and burning, and you miss out on so many valuable things that could help the diagnosis and could help the patient.

 JUSTIN NABITY:

Let’s go back to the question around, you said Neil, about parents talking to kids.

I’d love to hear from those tuned in. If you could go into the chat, what would you tell – if you had kids or you do have kids – what would you tell them? What’s your perspective and experience on that? Because I’ve seen some data that says 60% of doctors would not, would discourage their kids from going into healthcare. And you think back in, over time, lots of kids pursued and following the footsteps of their parents because their parents were inspirational to them. Kind of like your daughter, Neil, is like thinking wow, this could be something that I would want to pursue.

Healthcare for the longest time has been thought of as a noble profession and when you have these bureaucrats and these decision makers that don’t understand healthcare are taking away.

So anyway, if you could throw it in there on the chat, I’d love to, yeah, chat or the Q&A, one of those two. I’d love to get your feedback on that would be awesome.

Let me share a little bit of the reality of what we’re up against and dealing with, on where this money has gone. If all of these costs have gone up and it’s clearly not going to you, where is it going? 

Take a look at these four companies. 

(Justin Nabity shares chart of healthcare revenue, profit and CEO salaries.)

This is from 2023. $794 billion in revenue. Forty years ago, what do you suppose these numbers were? They were a lot smaller than this, I can tell you that.

Right. And this may sound silly to say, but how many doctors are there in the US? Well, it’s about a million. You take $794 billion and divide that by a million. How much money per physician, if you just, across the board, has been extracted per doctor?

Specialties are going to be different; I get that. But that’s $794,000 per doctor that’s going to these insurance companies. You can see their profits; you can see their CEO salaries. And there is a strategy in place. This is where I feel like we’ve let the fox in the hen house. And little by little, they just been sneaking their way around and they’ve been gobbling up as much as possible to take from you. Well, what’s been fueling that? 

(Justin Nabity shares chart of 2023 Lobbying Spend.)

If you take a look at how much money is going in to buy influence…86% of it is pharma, health products, hospitals, nursing homes and health services.

You fall into this category as a practitioner $96,000,000. But this is all…this is, including nurses, optometrists, this is everybody. This is not just MDs and DOs. This is everybody.

And so that’s gonna drop your number down to probably less than 10% of the total. And we had Dr. Rich on last year speaking to us, one of our members, and I remember that very vividly because what he said was that he was actually speaking at a hearing, congressional hearing, and you got the CEO of a big insurance company, they may or may not be on that previous list, and you’ve got Dr. Rich there, advocating for patients and advocating for the profession.

And these politicians were done listening to what the CEO had to say because they were pretty aggressive and I don’t know if I should say mouthy, but they were very confident what their position was and what they were having they were trying to say, whereas those in the, on the congressional side they wanted to hear what’s going on with the patients.

Well, why? The patients are the voters. They’re gonna be the ones that decide whether or not these politicians and reforms can take place.

And it’s not going to take very many of you to make that change. It may look like we’re up against. too difficult of a task when you compare these numbers to the smaller amount here out of the $745 million.

But a small group of people at that hearing was already having an impact and you can see that the prior authorization reform that took place in Arkansas, that has been passed in another state, there’s actually three other states that are in the midst of having legislation passed to make medication and procedures more accessible and trying to prevent companies from being so ridiculous with their delays and their stall tactics and all that kind of thing, we were talking to a member of the AOAO last week at that conference and he said that he had four surgeries get cancelled because the insurance company didn’t approve the authorization. They said something was wrong with it. The patient is upset. The patient calls the insurance company. The insurance company blames it on the doctor. And what’s the doctor going to do? How’s the doctor going to defend himself or herself in the midst of that kind of a comment?

And it’s just a mess, but we’re starting, we are seeing some change taking place here. And so, you know exactly what you’re experiencing in your practice and in your colleagues. And so, we want to hear those things.

We have a practice in Utah that is trying to do some big things there and they’re having us work with the legislature. So, we’re supporting the legislature with developing an op-ed, writing articles, putting together the messaging to communicate with the politicians. That’s what we, at DocNation, are for you. We are what sports agents are for professional athletes.  That’s what we at DocNation are for you. We go to bat for you. We fight for you. We help on the business side, the personal side, whatever you may need. Whether it’s cutting expenses, increasing revenue, all those areas, that’s what we do for you, just like an agent does for an athlete, it’s no different.

And that’s why we’re going and we’re helping in Utah and we’re supporting these other efforts that are taking place. And if you have something that you’re thinking about or aware of, we’d love to hear about those things to have those be something that we can champion and can support as well, but it’s not going to take a huge number of you to band together because again, you have significant reach.

How many patients do you interact with on an annual basis, your colleagues interact with on an annual basis? You have your finger on the pulse with the voters. I know that there’s going to be sometimes some fine lines to walk with that, but it’s not going to take a huge number, the fact that we’re finally seeing the willingness to step out and strike like happened last Thursday, Friday, 24 hours, it’s a big deal.

People are ready to make this type of move and that’s why  on change.org, we’re encouraging everyone that’s tuned in, anyone who watches this list and to tell your friends, go to Change.org and actually Betsy if you want to throw it in the chat, we have a petition that we started which has stopped the Medicare cuts because if there’s one thing that everyone’s going to unanimously support, that’s going to be the thing and let’s get all of us gathered together.

https://www.change.org/stop-medicare-cuts-for-physicians

We had a, one of our speakers on our panel, he talked about how he just got invited to an AMA closed door meeting, talking about what they need to do to get themselves back into a position of really supporting the industry because they’ve lost like 75% of their members in the last 25 years. They’ve gotten crushed. And so, they were talking about, we need to start empowering you to have the confidence to do the things we’re talking about. So please go check that out. It’s super quick and easy, and to tell one friend. We just started this. We want this thing to catch on like wildfire and to start identifying pockets because that will give us the ability to do, what, jump into here next, which is some of that union process and getting involved in.

So, with that Neil, looks like you’ve got a question.

NEIL DOUGHERTY:

Yeah, I wanted to just tail on to what you said, tag on what you said there. I wanna thank everyone who signed on today and are in this conversation. We have some stuff in the chat Justin through your, in the Q&A here.

JUSTIN NABITY:

Yeah OK.

NEIL DOUGHERTY:

I just spent a little bit of time reading it and I’m…It’s…a lot of it…a lot of it’s moving.

Here it is, “Me and my wife are both physicians, I managed the business side of things and even though she wants to encourage them to go into medicine, I don’t believe the field is sustainable. I’d rather that they have a different passion.”

I hear that.

JUSTIN NABITY:

These are the people that we need and want to be in medicine. It’s you and it’s those that are interested. We have to create a different environment. So that way you would be on board with having your kids go that direction.

NEIL DOUGHERTY:

But this was interesting, Justin, “I would strongly encourage my children to enter a surgical specialty as it provides the most job security. It would be a long time before we see mid-levels and some AI powered robots performing surgery. I still find my career in medicine to be very enjoyable and rewarding.”

I’m going to send that to you Dr. Verma, because there is a tinge of that, that it’s showing the fear of like devaluing positions that don’t do surgery and even some more of the conservative things that patients would be offered.

DR. NIKHIL VERMA:

Yeah. So I don’t want to speak for Dr. Brown who said this, but in my experience I have friends that are surgical colleagues and it doesn’t necessarily mean your job’s secure because what happens is, this the hospital administration, or the bigger organizations, they have a hold on you and if you aren’t producing how they want you to produce to make those reimbursements that they might come back at you be like we don’t need you anymore.

And that job recycling is happening a lot in the surgical fields. I have a lot of surgical friends that are saying they can’t really find a job in a spot that they want because this is what they’re getting from above. But you don’t feel like there is something to this though.

NEIL DOUGHERTY:

 I feel like there’s something to this though, what he’s saying.

DR. NIKHIL VERMA:

Absolutely. Like if you have a technical skill such as a surgeon would or interventionalists would, you do have more job security or whatever you want to call it, you do have some sort of protection, but that doesn’t take away the fact that reimbursements are still going to cut, cut, cut.

So that same surgery that you do you might get paid $1000 now, but in 10 years, as Justin just showed that other chart, you know that same surgery might be $500.00, but inflation’s going to go up, so cost of living is going to continue to go up. So, it’s the right idea, the right of mentality because it’s hands-on. But that’s what my fear is, and I’m not trying to be a naysayer, it’s just a reality that we’re seeing already.

NEIL DOUGHERTY:

Sounds like there’s going to be an attack on conservative treatment and medicine though.

DR. NIKHIL VERMA:

Why wouldn’t you just start busting out procedures just to make ends meet? And I’m not going to lie, there are people out there that are doing some of those things.

Again, it’s not necessarily outside of standard of care, but just to make. They’re growing and they’re A/R. They’re going to start pushing more procedures and more patients. And then there’s that other side of the story where you have salespeople coming to the door and selling unauthorized stem cells and saying it’s being reimbursed by Medicare and these doctors are falling for these scams. And all of a sudden, they’re getting claw backs and they’re getting letters from the FDA and closing down clinics and they’re paying back hundreds of thousands of dollars just to make ends meet. So, I think the overarching thing of these Medicare cuts are detrimental, and I think that’s the whole story of tonight.

JUSTIN NABITY:

Yeah, Dr. Johnson was just sharing some good news in the chat about the FTC. Looks like they decided to make non-competes unenforceable, to essentially block them. So, we’ll have to see if that’s just a blanket over all-encompassing sort of a change. Is that gonna be what we’ve talked about before that people have been looking forward to or what segments is that gonna touch.

And so, that’s potentially some good news. Creates more mobility and puts pressure on employers that if they want to keep and retain people, they better treat them right. And if they don’t, then the next best place that has a better culture is going to be the one to win the day, and you know, gather your, gain your attention.

NEIL DOUGHERTY:

I wanted to talk about that there real quick, Justin, because this is, this should be encouraging and really, really good news here. But I want to make sure people understand, like doctors, freedom of movement, that’s great. Movement doesn’t mean more value. Doctors are still going to need to come together and make sure that they, in using DocNation, using the services, those kinds of things where negotiating is probably going to be even of more value in those scenarios.

Hey Dr. G!

JUSTIN NABITY:

Hey, welcome to the party.

DR. ANTHONY GIUFFRIDA

Hey! I had another meeting, we were doing a journal club actually, so, but I wanted to jump in because I think this, this not competing is a huge thing that just happened, and I don’t think anyone knows where it’s going to go. You know, they outline very dramatically where they think it’s going to go. I think it’s good overall for physicians. It makes competition happen which is good for the employee, not for the employer. Right?

So, I think initially, we’re going to see a lot of jumping. I don’t know what you guys think about that. I mean, why, why wouldn’t you test the waters in your five-mile radius that you weren’t allowed to, you know, for so many years?

JUSTIN NABITY:

I think we would agree with you that when the power and the control is no longer in the doctor’s hands, this is a good move to give you more freedom. If we go back to the 1980s as we discussed earlier, where 75% of doctors were running and owning their own practice and investing a lot in their people to get them up and running.

But there was an investment that should be protected. So there are some pluses and some minuses here associated with this, but I think that we’re in this stage today where it’s better for people to have the flexibility now since it’s overwhelmingly on the employed side compared to the self-employed side.

Dr. Verma, is there anything you could expand on with your experience with what’s going on with insurance companies and whatnot with your practice? Just to give some people some understanding of what you’re seeing.

DR. NIKHIL VERMA:

Yeah, so briefly to your guys’ point, I read the FTC fact sheets on the ban that they have proposed or put out today, and just the most shocking one relevant to us is the FTC estimates banning the non-competes will result in reduced healthcare costs from $74 to $194 billion.

By reducing on physician spending services and all those other things that we lose while increasing innovation practices, opening up, allowing people to take ideas and expand out. So I think that would be a good example of helping not only bring down the national healthcare costs, but actually allowing physicians and other healthcare industries to get reimbursed what’s appropriate.

And I think that probably what my whole message of it all is, you know, I feel currently the amount of work that I do in my private practice for a patient, I don’t see that reimbursement. And we’ll use a quick example of, we’ll say an epidural, which is a standard procedure that we do quite often for radiculopathy.

If I get paid X amount of dollars and we’ll say $200 for ease’s sake and that $200 comes to me, then the billing company takes 3-7% out of it. Then you have to pay your front staff you know $15.00 an hour. You have to pay all the other things, so at the end of the day, or all the supplies, so that might be another $10, you know your MA, and everyone else another $20. So, at the end of the day that same $200 that I would have gotten a few years ago and I maybe got $50 profit out of it if they cut that by 4, 5, 6%, now that $150.00 turns into a $20 profit, $10 profit.

So, I think that’s the biggest thing that we’re seeing and how it’s affecting practices. But the administrative burden is continuing to go up because we need to have people fight for us to get prior authorizations and to deal with the changes in Medicare and if we just saw recently how the MIPS program is going to be a penalized program in 2025-2026 and if we don’t do those things now, we’re going to get penalized in the future.

So, we have to hire administrators, EHR companies are sending us messages, by added on MIPS programs so you don’t get charged in the future, so it gets very difficult and we just keep getting taxed and burned on.

DR. ANTHONY GIUFFRIDA

You bring up a great point with your margins, right? And, you look at any company in the Fortune 500 and what kind of margins are they really running on, right? Is anyone running on 9% margins? 5%? Now it’s 2 to 3% margins, right?

And physicians just get a cut in salary every year of 3% when they were expected to still have some kind of margin? I mean, if you cut back Walmart’s profits by 3% in one year, they wouldn’t be making any money at all, right? But they do it to physicians and it’s definitely a squeeze play.

And the reason you know it’s a squeeze play is you look at who’s getting that reimbursement bump for the hospitals, the ASC’s. So it’s not hurting medicine, right? That the reimbursement isn’t pretty.

The hospital isn’t hurting, the AC isn’t hurting, the long term care facilities… it’s only on the physician reimbursement it’s getting tough. So if that’s not a squeeze play, I don’t know what is, because the hospitals are, they might lose out on the physician side, but they’re gaining on the possible inversion size. They’re normalizing the only people getting hurt here are private practice physicians that don’t get that hospital reimbursement, don’t get the long term.

(Justin shows chart of scheduled Medicare payment updates for 2024)

I mean this is the perfect chart. I mean that is just wild to me how obvious it is. And then physicians, since we don’t come together, we just take this lying down. Not only do we take it, we celebrate!

That’s the part that makes me sick, right? We all have gotten an e-mail in the last two months that says, “Hey the cut was going to be 7%. We got it down to 4% because of all of our hard work.” That just is like, that’s mind boggling to me that someone sent that e-mail to their constituents, like the AMA sent that e-mail out saying kudos, like, “Yeah, we know this is bad, but it’s not as bad as it was gonna be.”

And you know, this is just where it’s gotten out of control. It’s every year, year over year over year, and I think there’s some stat, and Justin correct me if I’m wrong, it’s almost like 22% cuts in the last 10 years or something like that?

JUSTIN NABITY:

Well, yeah, I had, I had that up earlier. It’s a 22% cut since 2001, we’ve seen nothing but go in the red as the direction and this is really a psychological, like this, the PR departments that are pumping this information out to get to you, what you’re saying about talking about this as a victory or as like a win, it’s not as bad as it was thought to be, This is psychological strategy where they’re trying to manipulate and get people to have this group think mentality that it’s OK and to your point, we have to have everybody come together and it doesn’t take a lot.

If we discuss a little bit about employer by employer, each employer can do their own union. We’re not like the European countries and some other countries around the world where you can band together as one industry and we’d be one collective voice. You can be supported on a national level, but all it takes is 51% of this employed class to say we’re done with this. And collective bargaining can begin.

And it can be all about improving patient care, improving work conditions, improving and lessening the burnout of your colleagues and potentially you, and it can be a way for the numbers to get improved for you. It’s not just the numbers, it’s really all everything across the board and so, if you have interest at your employer or you’ve got a colleague at an employer, all it takes is one person to talk with us and we can help you get organized and we can get the movement started within and all it’s gonna take is a few places to have some victories similar to the fact that we just saw like I mentioned – the Detroit, at Ascension.

Those doctors in the emergency department, like, of all the specialties that would not be available for service like emergency, like, come on.

If they’re not able to, because they’re trying to stand up against private equity, we hear story after story and there were many people telling me at this last conference in Vegas about how PE and other industry, other businesses will come in and buy up practices, strip out all the cash, and then they’ll run them in the ground to bankrupt them.

Got a call from a doctor in Oregon who, that just happened to them out there.

NEIL DOUGHERTY:

Wait, say that again?

DR. NIKHIL VERMA:

I’ve heard this as well Justin and so I’ve heard this…

JUSTIN NABITY:

We’re going to have somebody come on that is in the know and has seen up close the mechanics of this, but no joke. These consolidations are buying up physician practices. They’re stripping out the cash, getting the investors’ return of the money and then they’re running them into the ground. It makes no sense for the community. Like, this should be banned. These businesses should be getting in trouble, like it’s criminal what they’re doing.

And so, if not the next in May, possibly in June, we’ll have this be a focus of what, how businesses just, you know, it’s just extracting everything away from you and there’s just no care or concern about actual care being provided in the community and so, that’ll be something that we touch on.

DR. ANTHONY GIUFFRIDA

With taking on meetings, Justin is, the point of DocNation, really the simplified thing of DocNation, is to take the business people out of medicine. There was a huge shift from physicians being in charge of medicine in the late 90s, early 2000s to giving it to the lawyers and the businessman.

I mean, the fact that the physician can’t own a hospital , right, that’s just one thing that came about. But if you’re a businessman, all you think about is dollars and cents. The people that went into medicine, the first thing we think about is the patient and medicine. And there are business people in medicine that think about the dollars and cents. But still when it comes down to it, we think about medicine.

The whole point of DocNation is to give that control back to the physicians, right? Let physicians run healthcare, I mean you were talking earlier today Justin, like we aren’t doing a good job in the US of health delivery, right? We don’t have the healthiest country in the world. We have the most expensive healthcare and then somehow doctors get blamed for that, when in reality we have no say in any of this, right? We don’t want to change the whole system.

It’s just now if we all get together and shout it from the rooftops and hopefully we can get some media coverage and we can, ,hopefully don’t have to strike, but at least get something out there as a combined group to say, hey, this is what we want.

We don’t want it to be this way. This is what we want. Let us have control back, let us run the hospitals, let us run the insurance companies, we can still have insurance companies but you’re gonna play our rules instead of vice versa.

That is the point of DocNation is to put the physician back in charge. And it has to happen, or else things like this happen.  Like no physician would ever do what you just said. Ever. Even to make an extra dollar, right? Hopefully. If they did, they’re going totally against their Hippocratic oath.

Every businessman I know would do that because it makes sense to them to do that, right? Because that’s all they think about. That’s where we’ve lost our way in medicine.

JUSTIN NABITY:

The $794 billion that the insurance companies have picked up last year, we haven’t done the math on it as far as what they’ve taken on cumulatively going back to the 80s. But if you think about all that money staying in your practice, giving you more time with your patients so that way you can advise them, coach them, help them be accountable, follow up with them, champion, you know, being an advocate for them, we will be in a much different situation than we are in today. And there’s no heart, there’s no soul in these companies toward the patient.

One of the things that I shared on stage at this conference was from the book Free to Choose by Milton Friedman, how there’s four ways to spend money.

You could spend your money on yourself – which you’re going to be the most careful, you’ll be the most desiring to maximize the value and the ROI on that spend.

Or you can spend your money on other people and you’re gonna be careful with it. You want to get good value for it. But you’re not going to be as concerned as you would be for yourself because there’s something about self-interest that actually is good. There’s a lot of pluses to self-interest.

You could spend other people’s money on yourself. And that could maybe be a company expense account sort of thing. Yeah, you want to get good mileage out of that money, but you’re maybe not as concerned about getting as much as you would in the first two categories.

And the final category, which is the worst category of all, is you spend other people’s money on other people. And that’s what government is today, it’s taking money from other people and then spending it on others for their welfare. And there’s no connection. There’s no there’s no heart, there’s no soul, There’s no real empathy behind that.

And we need to get the money back into your hands. That way you could be with your patient the way that you should be, to give them the care that they need.

We would be in a dramatically different situation if that was the case.

NEIL DOUGHERTY:

Yeah, Justin, take a read of this, “Every day in my work in the emergency department. There are examples of people without a medical degree telling me how to do my job.”

DR. ANTHONY GIUFFRIDA

That’s true. I mean, and the sad thing is you, you could send that to every physician in the country, and they agree with that. But why do we just take it? Why do we just take it as gospel, like that shouldn’t be the case?

NEIL DOUGHERTY:

No.

JUSTIN NABITY:

Yeah. Well, you don’t have to continue to let that happen anymore. We’re here to be the team behind you. You don’t have to do this alone. I think that’s probably one of the barriers or one of the limitations is that people feel like, “What am I gonna do? I’m just one person. How am I gonna change things, stand up for things?” You may not have the bandwidth, but we do. While you’re seeing patients for the day, we can make the calls. We can send the emails. We can do the organizing. We can get the meetings held. We can make the connections.

We have a lot of support available here for you, so you do not have to feel like this is something that you have to try to carry on your own. You have a whole team behind you and the team will grow. We can get people excited by championing, getting behind what it is that you’re concerned about. So do not feel like this is a 1-person mountain to climb, it’s, that’s not the way it has to be.

NEIL DOUGHERTY:

And Justin, I mean, I feel like I’m in a different city every day right now talking to doctors. And I just, I let them know like, just connect with DocNation.  There’s…conversations go everywhere.  But anytime I hear someone dealing with an issue I’m like, just connect with DocNation, there’s so many things that they can do for physicians, but the conversations and stuff like that. So, I’d encourage that to any of our listeners tonight, any of the physicians you guys are involved in these conversations, just send them over, we’re here to help.

DR. NIKHIL VERMA:

I want to add on to that. I think a lot of times people are afraid of the retaliation or some negative remarks that their employer may say. And I know DocNation does a good job of protecting you as an individual if that is your concern.

You know, again, I’ve had lots of conversations in the past couple weeks for my upcoming, next upcoming YouTube channel episode about how people are just wanting to quit medicine and how it’s not what they wanted, but they don’t know where to turn and who to say this to.

So I think, you know, letting them know about DocNation getting you guys up in front of them is going to be somewhat encouraging for them as well.

JUSTIN NABITY:

We had a plastic surgeon reach out to us and she was 18 months into her practice and she was wondering what we could do to help her switch careers. 18 months!

DR. NIKHIL VERMA:

I’m having these conversations all the time, it’s crazy.

JUSTIN NABITY:

It’s like, no, no, you can’t do that. Like we need to fix…so we immediately got to work on the financial side to help her understand. Because think about this, I’ve literally spoken at hundreds of institutions in the last 15 years: Residency program, fellowship programs, HOA meetings, gatherings and whatnot. And these programs, these medical schools and institutions, they don’t care to provide any education in business, finance, legal.

Well, I wonder why that is. There may be a reason why the machine is cranking out more and more worker bees that don’t think maybe as independently or as confident as they could be to stand up for themselves, leadership courses like…it’s baffling that yeah, our program doesn’t have any…there’s no responsibility on the part of our program director to provide this information.

And it’s just completely silent on these things. Well, the system is rigged. And it’s not rigged in your favor as far as getting you equipped. So that’s what we’re here for, is to get you the tools, resources, information that you need to be equipped. So that way you can take a stand for yourself.

DR. ANTHONY GIUFFRIDA:

I think there’s two things that just came through the chat that’s really good. Sam Brown talks about life moving in cycles, and he’s right. I mean, I think the physicians got slapped back pretty hard because they got over their skis in the late 1990s, early 2000s possibly. But like he’s saying it’s, it’s gotten, the pendulum swung way too far in the other direction.

And the one thing I would say is…healthcare in America was better even when the physicians were a little corrupt versus when the business people were…

JUSTIN NABITY:

Wait, wait, what did you say? When physicians were what?

DR. ANTHONY GIUFFRIDA:

So physicians were over billing, they’re doing a lot of stuff in the late 90s, early 2000s, right? That’s why a lot of stuff that came down, came down. A very small few ruined it for a lot, right?

The heyday of medicine, the golden years of medicine in the early 90s, probably, you know, when family practitioners were making $2,000,000 and sitting behind home plate at Yankee Stadium every night, right? That’s why we have a lot of rules that we have. But, at least medicine at that time was doing well. American healthcare was doing a lot better, you know worldwide rank than we were now. So that’s one thing I always want to point out that a lot of people say that to me, hey physicians have their shot, you know, and it didn’t go well and I don’t think that’s the point Sam’s trying to make, but I’ve heard that and you know I don’t think you can just look at data on how well the average American is doing with their healthcare, how much it costs, I don’t think anyone would regret to go back to that time. And we’re not saying go directly back to that time, but we got to swing the pendulum, at least to the middle.

And the second thing I came up here, is our state is, this is what DocNation for, the second one, “Our state is a right to fight our state and challenging administration can be detrimental to your job. I think many are fearful of being terminated and forced to relocate.”

That is, that’s 100% true. That’s what they want you to think – the relocation thing is true too because we have non-competes, but that’s what DocNation does. It protects you and insulates you from your administration because you don’t have to go fight administration, DocNation does.

And DocNation could be the bad guy. And you could even blame DocNation if something doesn’t go well with the negotiations, which it won’t. It shouldn’t right a negotiation and should have some tense moments or that side is getting absolutely destroyed. So that that is the reason DocNation started, it’s exactly that reason and DocNation challenges the administration. You know, it’s your agent challenging the administration, not you.

And this is what the owners in football wanted. The players didn’t believe until the 70s, right? And then they formed the players association and the owners even said this will never relax.

I remember the first, there’s some story about the first agent ever to meet with them – an owner and that owner’s like, well this will never happen again. Like we don’t have to worry about this… and look where they are now. No one would even believe of being a professional athlete without an agent, right? We all made fun of Lamar Jackson when he did it on his own, right? The fact that doctors are still doing it on their own is insane to me.

And hopefully we look back 10-15 years from now, we say, wow, remember when we didn’t have representation? Remember we didn’t have agents? Remember when we didn’t have a players association?

That’s the whole point of this.

JUSTIN NABITY:

So on that point, let me bring up a slide from one of our talks that we gave last week, and maybe, Anthony, you can speak to this a little bit.

DR. ANTHONY GIUFFRIDA

Umm-hmm.

JUSTIN NABITY:

We have, we have a precedent that’s been set back in 1953…let me try to zoom in on this a little bit more…

DR. ANTHONY GIUFFRIDA:

You can zoom out. I think we’ll be able to read it.

JUSTIN NABITY:

So this happened in the professional sports arena. What we’re talking about doing right now has been done and it’s been done really well.

Once you unpack that a little bit, Anthony, as far as what was going on at the time, and what they did, and then what it did to gain the players’ voice back.

DR. ANTHONY GIUFFRIDA:

Yeah, I mean, the cliff notes are, the players were making about 10% of the revenue, if not less at these times, and players were treated as a commodity, right? Not as, not as the stars that they are today.

And that’s when the players association started. And when it started, the owners brushed it off like it was nothing, like it was never going to stand, never going to work. And then once the players association came about, we all know collective bargaining agreements happen now. And they’ve been in every major sport now except for hockey for some reason, it’s 51/49, but every other major sport, it’s a revenue split of 50/50.

And this wasn’t even close to that when all these started. And baseball was actually the first one to have a players association.  For some reason, football gets the most, people know about football because it’s more publicized with their agents and everything. But baseball was the first one and it totally changed everything.

Everyone talks about in baseball, I’m a huge baseball fan, you know, why don’t the players stay on one team like they used to back in the old times? The reason they used to in old times is they couldn’t move, right.? They were stuck in that location just like a lot of physicians are now, right?

It’s good for a player to be able to…for the player it’s good, maybe for the sport, for the fan, it stinks to lose your favorite player. But for the player, it’s good to be able to shop around in 10 different teams and see who the highest bidder is going to be instead of staying with the same team for 20 years. That’s how it used to be, right?

And that’s what it is right now in medicine. Right now in medicine, we’re at that tipping point of we need a players association, we need agents, and we need to fight because we’re getting destroyed. That’s all it is.

JUSTIN NABITY:

I think the good news is that it worked. And it still works, and it’s still being done. And what’s the population of professional athletes, Anthony, compared to doctors?

DR. ANTHONY GIUFFRIDA

Ohh I mean there’s many more doctors than there are professional athletes.

JUSTIN NABITY:

I know! Exactly.

DR. ANTHONY GIUFFRIDA

So it worked for a much smaller group of people.

JUSTIN NABITY:

I think that what’s under-realized here is that doctors probably represent what could be the strongest voice of any industry. You look at what nurses have done and what they have achieved. The volume and the support and the intellect, the caliber, it’s bigger. It’s possible for this to be a major reckoning in healthcare.

DR. ANTHONY GIUFFRIDA

It has to be. Healthcare is going to break.

So, look, I know we’re going to wrap up soon. So the last thing I want to say is, the physicians need to come together and form a union not for the physicians anymore. Now it’s for the patient. Because if they don’t, healthcare in the next 5-10 years won’t, won’t, won’t exist in the way we even know it today.

And the only people that are going to stop it are the physicians because the hospitals, the insurance companies making money hand over fist do not care about the patient, they care about the bottom line.

So if you’re afraid to join because you don’t think it’ll look good as a physician, do it for the patients.

JUSTIN NABITY:

Yeah, I mean, that’s really what most of your motivations and purposes were in the first place, and to really care for them it’s going to be to do these types of steps to make that possible.

Looks like we’ve got a few more comments here.

We’ve got Dr. Downey, “My kid has expressed interest in medicine, surgical specialty only,” So that’s similar to what we heard from another. “The current state of affairs and health care is not sustainable as anti-physician and anti-patient that it is, the optics are shifting within the eyes of those who are increasingly seeing the non-medical personnel make medical decisions without a medical license.”

I was having a vision. while at this conference about how you it’s you, it’s the patient and the doctor. There used to be a strong connection, And then that connection has been severed, it’s been broken. And I’m thinking about like a campaign that could be just shared everywhere with this type of a visual of the insurance company, something in the administration in between, breaking that connection.

DR. ANTHONY GIUFFRIDA

The insurance companies have 100% broken that.

JUSTIN NABITY:

Yep. And I think patients will have your back, they will support you if they start to know and understand what’s going on. This sucks for them too. They don’t like what’s going on. And I think part of what we want to do is rolling out to help patients recognize how much is actually going, what percent is going to the doctor, going to you, in comparison to everybody else. And then they’ll start being, it’ll tick them off that, once they see how much it is swinging in the wrong direction.

So, we’ll work on that. Well, we’re working on a dashboard to get these numbers more transparent on what’s taking place. And then we’ve made some progress since the last few sessions on the voter guide to help you know who in your area is truly pro doctor, pro medicine, and not in the tank for these politicians and bureaucrats that want to take more away from you.

So we’re continuing to work on that as it’s a big year obviously for that information to be in the hands of you and your patients. That way votes can go the direction of what’s in your best interests. So we’ll have that and as we were talking about earlier…sports agents for professional athletes. That’s what we at DocNation are here for. For you.

So reach out with questions. I would love to have your feedback and we’d be happy to get together with your colleagues and if you’ve got an environment that you’ve been pushed to the brink, we’re happy to get a union going within your employer.

So don’t hesitate to reach out even if you have just a slight interest in seeing some movement in your employer take place. Let’s talk about it. We can help create a pathway for that.

DR. ANTHONY GIUFFRIDA

Awesome.

NEIL DOUGHERTY:

Thank you, Dr. Verma, thank you for joining us on that.

DR. NIKHIL VERMA:

No, thanks for having me again guys. I really appreciate it. And yeah, I really encourage everyone out there to join DocNation, at least you have a conversation with their team, see where they can help you out and help out with all medicine.

JUSTIN NABITY:

All right, thanks for tuning in.

DR. ANTHONY GIUFFRIDA

Awesome. Thanks guys.

DR. NIKHIL VERMA:

Take care.

NEIL DOUGHERTY:

Until next time.