Podcasts

Invest in What You Know with Jeffrey W. Ross, MD, MBA

Jeffrey W. Ross, MD retired in 2017 from a successful first career as a fellowship-trained Interventional Radiologist and a board-certified Diagnostic Radiologist to become the founder and managing director of Vailshire Capital Management, LLC and Vailshire Partners, LP. Passionate about investing wisely and teaching others to do the same, Jeff is a former contributor for The Motley Fool and current contributor for Seeking Alpha.

We start out by defining terms like mutual fund, hedge fund, venture capital, angel investing, and private equity. He teaches us the importance of diversifying beyond the market and investing in what we know, which is why many of his investments are in the healthcare and healthtech space. He retired from being an interventional radiologist, but after a year and a half away, he is back to teleradiology. After being away from medicine, even for a little while, gave him some perspective he was able to share with us.

The previous Secretary/Treasurer of Colorado Springs Radiologists, P.C., Dr. Ross also sat on the Board of Directors as co-owner of Penrad Imaging in Colorado Springs, CO. In addition, he was an active member of the CSRPC Investment Committee, Executive Committee, Radiology Peer Review, and Penrose- St. Francis Hospitals Cancer Committee. He went to med school at University of Minnesota – Twin Cities and then did residency and fellowship in radiology and interventional radiology at the Medical College of Wisconsin. After being in practice of 10 years, he got his MBA from the University of Colorado – Colorado Springs.

Vailshire.com

@vailshirecap on Twitter

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Invest in What You Know with Jeffrey W. Ross, MD, MBA

Jeffrey W. Ross, MD retired in 2017 from a successful first career as a fellowship-trained Interventional Radiologist and a board-certified Diagnostic Radiologist to become the founder and managing director of Vailshire Capital Management, LLC and Vailshire Partners, LP. Passionate about investing wisely and teaching others to do the same, Jeff is a former contributor for The Motley Fool and current contributor for Seeking Alpha.

We start out by defining terms like mutual fund, hedge fund, venture capital, angel investing, and private equity. He teaches us the importance of diversifying beyond the market and investing in what we know, which is why many of his investments are in the healthcare and healthtech space. He retired from being an interventional radiologist, but after a year and a half away, he is back to teleradiology. After being away from medicine, even for a little while, gave him some perspective he was able to share with us.

The previous Secretary/Treasurer of Colorado Springs Radiologists, P.C., Dr. Ross also sat on the Board of Directors as co-owner of Penrad Imaging in Colorado Springs, CO. In addition, he was an active member of the CSRPC Investment Committee, Executive Committee, Radiology Peer Review, and Penrose- St. Francis Hospitals Cancer Committee. He went to med school at University of Minnesota – Twin Cities and then did residency and fellowship in radiology and interventional radiology at the Medical College of Wisconsin. After being in practice of 10 years, he got his MBA from the University of Colorado – Colorado Springs.

Vailshire.com

@vailshirecap on Twitter

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

Healthy Habits in the Age of COVID-19 with Dr. Monique Tello

COVID-19 has turned the world upside down and although prevalence may wax and wane, we are going to have to get used to living, knowing that it is out there. We are going to have to develop new routines and habits in order to minimize our risk of getting it. We can’t eliminate our risk, but we can mitigate it and when developing habits that stick, simplicity is key, so on today’s podcast, we have internist, author, and habit expert, Dr. Monique Tello, who has previously been on our show to discuss her book, Healthy Habits for your Heart. We talk about staying safe in the grocery store, actionable advice we can give our patients to decrease their risk of COVID complications, how to work physical activity into the day and why we should consider getting a pet.

Dr. Tello is a primary care physician at Massachusetts General Hospital in Boston, Massachusetts and instructor at Harvard Medical School. She practices part-time internal medicine at Women’s Health Associates, a small MGH-based primary care practice with all female providers that serves predominantly female patients. She is originally from the Boston area, and graduated from Brown University and the University of Vermont College of Medicine. She completed a med-peds residency at Yale and after residency, she earned an MPH and GIM research fellowship at Hopkins. She writes a popular blog, generallymedicine.com, about her life as a doctor and a mother and contributes to many other blogs, including Mothers in Medicine and Harvard Health Blog. Her writing focuses on work/life balance and healthy lifestyle.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

Healthy Habits in the Age of COVID-19 with Dr. Monique Tello

COVID-19 has turned the world upside down and although prevalence may wax and wane, we are going to have to get used to living, knowing that it is out there. We are going to have to develop new routines and habits in order to minimize our risk of getting it. We can’t eliminate our risk, but we can mitigate it and when developing habits that stick, simplicity is key, so on today’s podcast, we have internist, author, and habit expert, Dr. Monique Tello, who has previously been on our show to discuss her book, Healthy Habits for your Heart. We talk about staying safe in the grocery store, actionable advice we can give our patients to decrease their risk of COVID complications, how to work physical activity into the day and why we should consider getting a pet.

Dr. Tello is a primary care physician at Massachusetts General Hospital in Boston, Massachusetts and instructor at Harvard Medical School. She practices part-time internal medicine at Women’s Health Associates, a small MGH-based primary care practice with all female providers that serves predominantly female patients. She is originally from the Boston area, and graduated from Brown University and the University of Vermont College of Medicine. She completed a med-peds residency at Yale and after residency, she earned an MPH and GIM research fellowship at Hopkins. She writes a popular blog, generallymedicine.com, about her life as a doctor and a mother and contributes to many other blogs, including Mothers in Medicine and Harvard Health Blog. Her writing focuses on work/life balance and healthy lifestyle.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

Addressing the Vaccine-Hesitant with Dr. Gretchen LaSalle

Gretchen LaSalle, MD FAAFP is a board-certified family physician with a passion for preventative care, from which vaccine advocacy is a natural extension. She is an active writer and public speaker on the topic and, in October 2019, published a book with Wolters Kluwer Press titled Let’s Talk Vaccines: A Clinician’s Guide to Addressing Vaccine Hesitancy and Saving Lives. In a growing climate of vaccine hesitancy, her primary mission is to keep patients from falling victim to vaccine misinformation and to decrease the frustrations, while increasing the successes, that clinicians have in getting patients vaccinated.

We discuss how to have the most fruitful discussion with the vaccine hesitant. She has a system for addressing these patients and parents and no surprise, it starts with listening. The hesitation comes with all sorts of concerns, from stories they have heard, to potential side-effects, to simply indecision and she has a well thought out discussion for all of these. We get into the cognitive biases that may be at play and end on her experiences on social media with the vaccine averse, who are the vocal majority, but really the minority vs. someone who is simply hesitant.  

She completed her medical school training at the Tulane University School of Medicine and her residency at the Oregon Health and Science University. She has practiced at MultiCare Rockwood Clinic in Spokane, Washington for the last 13 years and serves as a Clinical Associate Professor for the WSU Elson S. Floyd College of Medicine.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

Addressing the Vaccine-Hesitant with Dr. Gretchen LaSalle

Gretchen LaSalle, MD FAAFP is a board-certified family physician with a passion for preventative care, from which vaccine advocacy is a natural extension. She is an active writer and public speaker on the topic and, in October 2019, published a book with Wolters Kluwer Press titled Let’s Talk Vaccines: A Clinician’s Guide to Addressing Vaccine Hesitancy and Saving Lives. In a growing climate of vaccine hesitancy, her primary mission is to keep patients from falling victim to vaccine misinformation and to decrease the frustrations, while increasing the successes, that clinicians have in getting patients vaccinated.

We discuss how to have the most fruitful discussion with the vaccine hesitant. She has a system for addressing these patients and parents and no surprise, it starts with listening. The hesitation comes with all sorts of concerns, from stories they have heard, to potential side-effects, to simply indecision and she has a well thought out discussion for all of these. We get into the cognitive biases that may be at play and end on her experiences on social media with the vaccine averse, who are the vocal majority, but really the minority vs. someone who is simply hesitant.  

She completed her medical school training at the Tulane University School of Medicine and her residency at the Oregon Health and Science University. She has practiced at MultiCare Rockwood Clinic in Spokane, Washington for the last 13 years and serves as a Clinical Associate Professor for the WSU Elson S. Floyd College of Medicine.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

Is Single Payor Really Bettor? with Dr. Kwadwo Kyeremanteng

Dr. Kwadwo Kyeremanteng is the founder of the Resource Optimization Network and a critical care and palliative care physician. He is also the host of the Solving Healthcare Podcast. He is also Canadian, so we discuss the Canadian Healthcare System, which, on its surface, looks like a comprehensive, all encompassing, federally administered single-payor system, like what some of the democrats are discussing in the US. We discuss why this is not the case, and get into some of the details about what isn’t covered, how it is more of a provincial system and what are the differences in provinces. We discuss how the money flows through the system and how private insurance can play a role in some ancillary services. And true to the name of his podcast, at the end, we solve healthcare.

Dr. Kyeremanteng was born and raised in Edmonton where he did his medical school at the University of Alberta. He and his wife then moved to Ottawa where he did his Internal Medicine residency training at the University of Ottawa followed by a two-year fellowship program in Palliative Care and Critical Care. He stayed after his training and is now an Assistant Professor in the Division of Palliative Care and Critical Care Medicine. He also has research positions with Ottawa Hospital Research Institute (OHRI) & Institut du-savoir Montfort as a Senior Clinician Investigator.

His academic interests include the integration of Palliative Care in the Intensive Care Unit as well as health services research and cost evaluations. More information regarding his current research interests and projects can be found here.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

Is Single Payor Really Bettor? with Dr. Kwadwo Kyeremanteng

Dr. Kwadwo Kyeremanteng is the founder of the Resource Optimization Network and a critical care and palliative care physician. He is also the host of the Solving Healthcare Podcast. He is also Canadian, so we discuss the Canadian Healthcare System, which, on its surface, looks like a comprehensive, all encompassing, federally administered single-payor system, like what some of the democrats are discussing in the US. We discuss why this is not the case, and get into some of the details about what isn’t covered, how it is more of a provincial system and what are the differences in provinces. We discuss how the money flows through the system and how private insurance can play a role in some ancillary services. And true to the name of his podcast, at the end, we solve healthcare.

Dr. Kyeremanteng was born and raised in Edmonton where he did his medical school at the University of Alberta. He and his wife then moved to Ottawa where he did his Internal Medicine residency training at the University of Ottawa followed by a two-year fellowship program in Palliative Care and Critical Care. He stayed after his training and is now an Assistant Professor in the Division of Palliative Care and Critical Care Medicine. He also has research positions with Ottawa Hospital Research Institute (OHRI) & Institut du-savoir Montfort as a Senior Clinician Investigator.

His academic interests include the integration of Palliative Care in the Intensive Care Unit as well as health services research and cost evaluations. More information regarding his current research interests and projects can be found here.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

 

EPISODE TRANSCRIPT

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Dr. quanto caramon Tang is the founder of the resource optimization network and are critical care and palliative care physician. He’s also the host of the solving healthcare podcast. He’s also Canadian. So we discussed the Canadian healthcare system, which on its surface looks like a comprehensive all encompassing, Federally Administered single payer system. Sound familiar, kind of like what Medicare for All is supposed to be. Which is because why this isn’t the case in Canada and get into some of the details about what isn’t covered, how it’s more of a provincial system. And what are the differences in some of the provinces we discussed how the money flows through the system, and how private insurance can actually play a role in some ancillary services, and true to the name of his podcast. At the end, we solve healthcare. Dr. Sherman Tang was born and raised in Edmonton, where he did his medical school at the University of Alberta. He and his wife then moved to Ottawa, where he did his internal medicine residency training at the University of Ottawa followed by a two year fellowship program in palliative care and critical care. He stayed after his training and is now an assistant professor in the Division of palliative care and critical Care Medicine. He also has research positions with the Ottawa Hospital Research Institute. And I apologize for the pronunciation Institute disavow your forte as a senior clinician investigator. His academic interests include the integration of palliative care in the intensive care unit, as well as health services, research and cost evaluations.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Dr. Quadro Carmen Tang, thanks so much for being on the podcast.
Bradley. Thank you for having me.
So, Canadians seem to think that American ambulances are going to check your credit score before they’re willing to take you to the hospital. And on the other end, you’ve got Americans thinking that Canadians have having a heart attack need to wait in a Soviet Cold War, breadline get into the hospital, right? Clearly, neither of these things are true, but this is how we view each other systems. Yep. American we’ve got multi payer private insurance with a little bit of government assistance and Canadians you’ve got this concept of single player. That being said, it’s it’s a bit more complex or a lot more complicated than that. So we’re gonna get into it. To start, how long has Canada been on single player and how did that system end up starting?
Yeah. Great question. Bradley. It’s, so officially this all started in 1968 ish. And so it was Put about by Tommy Douglas, from sketching. So one of our Western prairie conference provinces and yeah, Canadians being Canadians wanted universal health care that was accessible, complete, publicly run. And so with those principles, they produced the universal health health care in the mid in the late 60s and basically would find the federal government would fund provinces to say, you know, this is what our principles are, and you guys decide where their money needs to go. And, but like it in the big picture has to adhere to some key principles. And so, the Canadian Health Act was produced in 1984, which kind of solidified the principles of what Canadian healthcare was all about. And so, the key elements of that was that it was publicly run. That was accessible that was comprehensive, comprehensive, was universal and portable. And so since then that’s been officially documented and so legal document and yeah, and since then we’ve been running a publicly a universal single payer system
since 1968. That that, yeah, that sounds like a really civilized place to live.
And I gotta tell you, Brad, it is a civilized place to live yet because I get a lot of it’s like you said like those worries that if you come in with a medical problem that you are going to wait forever for, for things to be addressed. And to be honest with you. There are some areas in medicine where you are waiting a long time like if you depending on what province you’re in. If you are waiting for a hip replacement, you might be waiting a long time if you were waiting for any other orthopedic, elective procedure, but if you come in with any Thing urgent. Okay, so whether that’s you’re having an EMI you’re having trouble breathing, you need urgent surgery. Like doesn’t matter where you’re from doesn’t matter what card you have in your wallet, you get treated the same and you get treated urgently you get treated with respect and, and that’s key principles for Canadians and and we abide by that
well and they’re also I would imagine ways to kind of game the system, right? If you’re an orthopedic surgeon and you’ve got a patient who you think might need a knee replacement, I’m sure there are ways to kind of put them in line so that it makes it seem like it’s a six month Wait, but in reality, it’s really not that long of a wait because they they know the patients that are likely to need it and the patients that are likely to not so you don’t ultimately waiting, you’re waiting that long.
Yeah, exactly. As you put it like that. You can adjust a priority like if you think somebody needs a procedure sooner than later you have that prerogative If and so it’s like, there aren’t, I don’t want to make it appear like there’s millions of people suffering waiting for some procedures to happen. But I think what is consistent is that if something needs to be addressed sooner than later
it’s addressed. If it’s elective, it’s elective and urgent. It’s urgent. Okay, exactly. So is it? Is it really a federal system? Or is it more of a provincial system that utilizes federal funds?
I think the latter like is a better way to put it. So literally, the federal government gives payments to each province based on population based on need, and the provinces decide how they’re going to distribute funds. So for example, in Alberta, when I was still living there, there would be about I think, eight or nine health authorities and the government would give the provincial government would give each money, each Health Authority a pocket of money, and they decide whether that’s should be more focused on outpatient impatience or whatever. Ever, like community resources, like whatever they felt was of higher need in Ontario now they’re just in the process of trying to establish a system similar to that, but every province is variable. But the principle though is that federal government gives money to the each province and the decide how its allocated.
So you mentioned it’s based on population and it’s based on need How is need assessed? Is it based on the idealization?
Yeah, so once again, it’s it depends on the province, but I could speak to Ontario because that’s where I’m at right now. Part of the funding model for each hospital is based on it used to be on based on need, like if you’re seeing more volume of hip replacements, then we’re going to fund that are going to give you a certain amount of money, certain amount of intensive care admissions will give you a certain amount of money. Now they’re using it on quality metrics, like so if you’re, if you’re meeting specific quality metrics within each sector in medicine, like within the orthopaedics within general surgery, then they will provide a certain amount. So basically, they’re rewarding hospitals that are of higher quality. But this is something that’s always changing in healthcare, like I think Ontario now is, is trying to go towards that Alberta model that I was describing earlier where there’s a health authority, we’re going to provide you with money in that health authority. And you as the Health Authority, decide where you want to put your money and how you want to put your money into your area,
but more regional control, if you know that exactly. That happens in American in Medicaid, you have these private companies, where the if the patient qualifies for Medicaid, they can get their insurance through a managed Medicaid provider. So the provider or the the insurance company will get a lump sum per patient that they take care of, and they will decide how they’re going to administer that. And that kind of takes the government out of the loop because, you know, I think government does something Well, but it’s not the most efficient, the private industry tends to be more efficient. So it’s a way to capitalize on both of those strengths. So that’s what it sounds like you give more regional control. And now the federal government doesn’t need to be involved in the minutiae of what happens in that province or even within the region of that province.
Exactly. And this is obviously just my opinion, I do feel like it’s probably a wiser approach, you know, like almost like a bottom up approach where you in your region, you know, where the needs are, like, you might be a region that has more and more elderly population, you might have a population that has, you know, more youth and having some more resources towards that specific patient population might make more sense. And so I, my bias, personally is like, this is the way to go because you get so much variability in in these approaches to how we fund healthcare and, and in my humble opinion, Brad like, the more government that gets involved, the more I find administrative positions or being involved in the more inefficient everything becomes so I love the idea of it coming from like a bottom up approach and be more regional and I think where you’re thrown down makes a lot of sense. I forgot what
it’s called. It’s it’s someone’s law based based on a some British ship captain where bureaucracy fills the space it’s given. Like you said, If you set a meeting for two hours long Parker’s meeting will let Parker’s nice I’m impressed. Yeah, by. Like, if you set a meeting for two hours long that meeting will last for two hours, even if you could get everything done in an hour. So yeah, Parkinson’s Law.
We talked a little bit of pre interview about some of our similarities. And I think one thing I must reinforce is efficiency. Like we’re both busy people. So yeah, the Parkinson’s Law is and I know you’ve been in these medical meetings too, like they are. Most people just like to hear
themselves talk. Exactly. I got stuff to do.
Yeah, go see patients got some family. Got some costs of health care. That’s right. Yeah.
Out of South Africa, or so we’re trying to do here. So so one one attempt at the American government to solve healthcare was Obamacare. Right, the Affordable Care Act and one aspect of the Affordable Care Act is that insurance needs to have these 10 essential benefits in patient care, outpatient care, medications, emergency department, maternity and newborn Mental Health and Substance disorder, physical and Rehabilitation Services, labs and imaging. I’m not sure if I’ve named them all i don’t think that was 10. But but you get the idea, right? All these different aspects of health care. If you’re going to have insurance, it needs to cover all of them. So But the Canadian healthcare system, right? It’s it’s single payer to some degree, yes. But it hasn’t covered all 10 of those things in their entirety, right? Because that would just be to expect to have all of that paid for in its entirety for every single person in your country. Just the the costs would end up skyrocketing. So that’s not how it works in Canada.
Exactly. What says
what is paid for,
it’s about 70 to 75% of healthcare related costs. So it’s essential services, actually, it’s probably easier to just say what’s not covered. So typical allied health like physiotherapy, occupational therapy, optometry is not covered drugs, unless you unless you’re elderly in most provinces aren’t aren’t covered. So there’s a good chunk of services that aren’t covered within the healthcare system and it’s as you said, like, we Pay this I would need to check a reference. But somewhere between 45 to 50%, I think of our GDP goes to goes to healthcare related expenditures. So we spend a lot. And that’s my whole area of research, to be honest with you is how we can be more efficient with our spending. But yeah, it is not complete. And so some argue do should we be covering more like one of the hot topics in Alberta, or in Canada, we just had a an election was pharmacare and having within the universal health care initiative to have drugs covered, and no party was really diving into details on how this would be approached. But it was certainly on the minds of Canadians of having more complete coverage of some of the medication. So yeah, but you nailed it, Brad, like we’re not it’s not, we’re not covering 100% of health care’s use, or their private insurance companies that come in to fill the gaps like You pay us this amount per year and you’ll get this percent of your rehabilitation services or medications or long term care or whatever it is that’s not being covered. Are there private insurance companies that are trying to fill those gaps? 100% So, the I’m in a government town capital of Canada, Ottawa here. And a lot of for example, government employees have a very complete insurance packages where, you know, a large portion of medications, a large portion of massage therapy, physiotherapy, optometry, all those have to be covered. And usually there’s limits but there’s, that is absolutely true that there’s private health care companies that supplement Yeah, so
a lot of single payer system that that makes it
illegal. I guess a single payer for essential services is the way I would look at it. Okay. But for the, you know, the non essential services like dental, for example, didn’t mention that as well. You we all have most of us have insurance, separate insurance for that.
Yeah, I’ve been in the situation I’m in. I’m an EMT. So I’ll have a patient that comes in with a neck abscess. Right? So I get called by the emergency department to assess this patient. They’ve got an abscess, where’s the next neck abscess coming from what’s coming from an infected tooth. So the tooth needs to be pulled? Well, this patient doesn’t have dental care, they have Medicaid, so their emergency department stay is going to be covered. But if we call a dentist to take out their tooth, not covered. So you know, they’re kind of stuck having to pay out of pocket even though they have you know, they’re, they’re a certain percent below or I think it’s like 135% above the poverty line qualifies for for Medicaid. Right. So they’re not coming in with much of pay for this dental care, but now they’ve got to pay for a dental extraction out of pocket. So it’s dental dentistry is I think sometimes is frequently forgotten about in these insurance plans. But it is, it’s sometimes critical. Yeah.
And I mean, we kind of touched on this earlier about some of the myths of, you know, within Canada, everyone, it’s very, you have a heart attack, you’re gonna have to wait. But, you know, one of the, like, a true common concern when we hear about some of the scenarios in the states is that if you for example, and correct me if I’m wrong, okay, because I don’t you know, this is just from what I’m hearing from my colleagues is, if you have you know, minimal insurance and you come in with a problem, say you have a cancer related a head neck, malignancy, and you need x medication to be able to, to cover or to go to chemo or to have an adjuvant therapy, you might not have, like, if you don’t have insurance, you might not be able to afford treatment. And so what we often hear about us people having to do, you know, their second mortgage on their house, just to Ford
most common cause of bankruptcy in America medical bills. Absolutely. So, so what, you know, the whole pre existing condition debate, right, that’s something that that came out in the Affordable Care Act is that if you had head neck cancer before the Affordable Care Act, you couldn’t afford insurance. So what would need to happen, you’d need to pay for it out of pocket until your funds are so depleted, that you would qualify for Medicaid, and then you’d go on Medicaid, and then the government would pay for the rest. But meanwhile, you’ve you’re, you’re just depleted. You’re just depleted your future, right? Yeah. So so but now with the Affordable Care Act, you can now apply for private insurance. However, it’s not on a rolling basis. You can’t just apply for it right now. You need to apply for it when it’s available, and I can’t remember if it’s quarterly or once a year, but you’re you know, in that interim, you’re either just gonna have to wait for your cancer to progress waiting for insurance, or you’re gonna have to pay out of pocket until until that happens and end up in that in that similar slip. scenario. So preexisting conditions doesn’t mean you can get insurance just when you need it. Oh, wait till you get pneumonia and then apply for insurance? No, you should. It just prevents you from when you make that decision to get health care. It can’t or health insurance, right? It’s not the same thing to get health insurance that they can’t stop you from getting it, which can also make premiums go up for everybody else because now you have to pay for the possibility of someone with an expensive condition that’s going to end up on your plan. And that’s what insurance does, it spreads out the risk. That risk needs to be spread up beforehand, but you’re totally right. It can. You can you can end up bankrupt from a condition but you did have the ability to pay for insurance. The problem is that some people end up with plans frequently that they don’t understand. Meaning like yeah, I have a high deductible. And so I have low premiums but I have a high deductible which means that my monthly payments if I don’t go to the doctor are low but If I do go to the doctor, then it’s I’m gonna have to pay out of pocket, probably 100% until I meet my deductible. So it seems like I don’t have health insurance, because people think that it’s going to cover everything. But really, it’s, it’s in a lot of ways just for those disasters that you’re referring to where, if you didn’t have it, you would end up bankrupt. Yeah, those are some plans or you end up with a high premium plan and the low deductible it just, you know, but you’re when you’re choosing it, you it’s hard to understand all the nuances of it.
Yeah, cuz it sounds like there’s a lot of nuance. You know, just to contrast that with us. It’s, you know, there’s some provinces that have you pay a small premium for your insurance from like your provincial health care insurance, usually somewhere between than what’s and forgive me if this is mildly wrong, but it’s usually between 50 to $400 a year kind of thing. But regardless whether you if you didn’t pay it, you still get treated. You might get a bill for the government versus you had to pay for your insurance premium, but you’re still getting treatment. And I, I think, when we hear stories like that, like, I could speak for almost all Canadians, when we hear, you know, someone’s has to bankrupt their house in a time of need, when, you know, they just need optimal care. It just breaks your heart, especially, you know, we’re talking to clinicians here we got in this game because we want to help people, not break people. You know what I’m saying? So it’s, it’s it’s tough to hear
scenario scenarios like that.
But it doesn’t mean that you Yeah, the American system is just, it’s preposterous. Yeah. I had an interview a little while ago with an evolutionary biologist. And one thing that we the whole theme was, the human body just doesn’t make sense. It’s kind of cobbled together over time. And things are built on other things like the fact that our hand has is like a bunch of rocks, like Put together and then our fingers extend out of these like eight different buttons. It doesn’t make sense. And that’s kind of what the American system is. It’s not like it was built from the ground up. It started kind of with in World War Two there because there was no workforce, there was caps on salaries. And so they they started offering other benefits like pensions and health insurance. And that was the start of the American system. So it’s based on it’s an employer based system, which just if you’re going to build it from the ground up doesn’t make sense. It doesn’t mean that single payer is the way and the only way. But I think you and I are on the same page and that we believe in universal coverage. So you know, so everyone has something so that stuff like this doesn’t happen. And I think most Americans are on the same page with that, that like health care is a right. You know, I’m of the belief that there is a role for the private sector and for individual payers, you know, for individual people, if you want to pay for more care, then and you want to pay for foster care and you want to pay for that, you know, great have a way to get private money. For those that can afford it, to just inject more money into the system, rather than just having it be single payer, everybody gets the same because it’s just, it’s just not going to be as as efficient. But that’s my personal. That’s actually what happens in I think, Germany. If you make less than 30% above the poverty line, you get health insurance, you just you just have it. You don’t don’t, I don’t think you have to apply for it. You just have it. And above that, yeah, you have to pay for private insurance. And there are a bunch of different systems out there and you choose which one that works for you and in fine. So that’s, that’s my, that’s my soapbox.
And Brad like, honestly, it’s a hot topic in Canada to like privatization, you know, cuz you bring up a lot of good points. Like it’s not, it’s not the most efficient system in the world. And like, like I said earlier, there are people that have long wait times for some elective procedures and there’s people out there that want to be more functional and not wait 18 months or are a year for their hip to be done.
And also you’re spending a ton you’re spending a ton there’s more efficient ways to spend the money. I mean, it’s great that, that you have the system but, you know, American is America is much more efficient with the spending, but but Canada, also you got the person that you said, I think it was 50% of GDP. Like, that’s
just a tremendous, it’s like,
it’s high. And like, and once again, this is my personal belief, too. I actually legit feel like there’s a role of privatization in healthcare, even in Canada. And the worry is that, you know, one of the common words that you hear mentioned in debates is having that read, like resource drain where, you know, the best surgeons, the best EMT surgeon is now just going to work in the private sector and, and you know, not not, so it’s going to be kind of like a two tier system. Well, yeah, the rich get a better service. But you know, there’s like everything else like you just got to be a little bit nuanced about it, like Say, if that EMT surgeon is only allowed to work 25% of their time or 50% of their time in the private sector, that will offset some of that, you know, concern that the, like the quality drain is is happening. And so I just think we got to be, we just got to think through it a little bit more. And use util because we have the capacity we have, like I can speak for the our orthopedic surgeons, like we have guys that are on their third, the third fellowship, they got some of them even got PhDs because there’s no work. Right. And if you think about what’s happening in North America, throughout the world, we have an aging population, baby boomers are getting into the height of resource utilization. There’s tons of people that need work like that need to have treatment, and it’s just we don’t have enough money to fund a wars for 24 hours or for you overtime and so on. But if there was a private element to that, where, you know, people that could afford it are willing to pay there were 20 to 25 K to get their hip done earlier. Yeah,
wait times go down, and that money is going to be used to offset the cost for those who don’t have that type of
exactly. Yes, exactly. So I think there’s, I think resolving
right now, right, we’ll get right.
But yeah, no, I do. My bias is there’s a there’s a role.
So we got a little off the rails and that both you and I, we know how to self healthcare if someone would just listen to us. Yeah. So but there are some things that are done well in some promises, and maybe a little more poorly in another. How do the promises differ in how they administer health care and which province is your favorite? It’s
gonna give me a trouble
So, in terms of different provinces will have a more regional approach. So bottom up where, you know, they fund the region and region decides where the resources go, some are not regionalised. And, you know, the provincial government decides how much money a hospital is going to get based on either a volume based on quality. I got to go back to Alberta, like I really, they went away for a while from the regionalize approach, and I think it in some ways, made care worse. The function functionality of the province worse, they’ve been not totally adverse to privatization so you could get your an MRI CT scan, you can get that done and pay for it privately in a bat doc did that quite early. The reimbursement for their physician services is is I would Say, more than appropriate. So if you if I had to say one, I would, I would, I would, I would lean on Alberta. And sorry for my Ontario folks that are listening. But like I said, they’re they’re moving towards a more regionalized approach as well. And I’m optimistic that things will start to be more efficient and, and, and care will improve. But we also one of the things that I don’t know if it’s fair to talk about, but I’ll do it anyway, one of the things that really irked me about how things were handled in Ontario was from physician pay perspective, they made some unilateral cuts. So some specialties For example, some cardiologist based on if there were heavy diagnostic practice, they they could have lost up to like 20% of their income from these unilateral cuts. And I I gotta tell you, I was not happy with this approach because, you know, we this is a clinic, a physician audience, but you We hustle, we do what we need to do for our patients. We take the brunt of, you know, Dr. Google, of administrators of unhappy patients, we do our best to try and serve. And then for the organization to just unilaterally, you know, take the wheels out and make these cuts. It was it was upsetting for, to say the least. And so that left the sour spot and a lot of clinicians for sure, and things have gotten better in terms of now there’s arbitration between our Ontario Medical Association and, and the government. So the process is better. But when you do that, you know, I guess just, it’s just a big slap in the face, like our specialty lost about about 5%. And, and I’m all about, you know, if there’s areas where it needs to be tweaked, because yeah, there was some specialties that Some opinions would say is overpaid and or the fee schedule is outdated. And, you know, I think that’s fair. But it’s got to be discussion. It’s got to be a by, like both parties to decide what, what’s the best approach. But so that left of real. Ah, that was upsetting.
Yeah. And that happens that happens in the states too, where an insurance company can just make this unilateral decision. And, you know, if you’re a big hospital system, then maybe you have some leverage, but then then you’re leaving a lot of patients out in the lurch if you just decide, you know, what, we’re not taking your insurance anymore. So you know, it gives the insurance company a lot of leverage, just make these heavy handed decisions. And, and there’s very little recourse other than just not taking that insurance and ultimately, in that situation, it’s the patients who suffer. So how does the money flow? Like, how is it that doctors get paid to that you said, you know, in a lot of provinces, it’s Regional, it’s a bottom up, you’re given a lump sum. So So is it? Is it your a salary? Is it fee for service? Is it come some combination
of the two? I’m glad you brought this up. So most provinces, it’s a combination, it’s a combination. So most provinces regardless of whether it’s mostly regional or not, it’s actually going to be the province that decides a fee schedule. And it’s agreed upon that every physician in the province is going to be paid that same within that specialty the same further based on the fee schedule. So most specialists, our our our bill, essentially the Ministry of Health or the government, the provincial government, and would be reimbursed based on the services they provide some province. Some specialties also have like an academic plan which is mostly salary based So basically incentive to be able to teach residents because there’s also a cost to that, right? Like, if you’re teaching residents, you’re not as efficient, you’re not as fast. So compared to the dogs that are in the community that would be able to see more patients in a shorter period of time. So there’s a lot of provinces and a lot of specialties have that option to go towards a more salaried approach. And some also have a hybrid where they get a salary but for example, if you all their night calls or weekend calls might be billable. And so there is some flexibility in terms of how it’s how it’s how physicians are paid, certainly in our in my situation in critical care, we are paid a fee for service. And then my I also do Pyatt of care which that is being paid a salary. And so I get both sides of the equation.
Interesting. What about the hospitals? How do they How do they give you? Or is it the money flows from the region to the hospital in the hospital is the one that pays the doctor. One thing
I guess that’s quite unique in Canada, like, I am not a hospital employee, you know, the hospital, hospital doesn’t pay me, jack, it’s I build the government and the government pays me based on services are provided based on this fee schedule. Okay. And then the hospital does the same thing. And so the hospital, so they will either get paid by like, the most updated one that I know is our hospital will be paid based on quality metrics on the ability to minimize, for example, part of the equation, not the whole equation be the volume of patients they see but also are you meeting your quality metrics, less, you know, surgical infections, less ventilators, associated pneumonias, and so that enhances their their budget as well. So, yeah, so basically physicians get paid by the government. directly, hospitals get paid by the government or region. And but certainly the docs are being paid by the hospital. Okay. Okay.
Is there anything right now that’s being debated in the government any any hot topics? Or is it something that they’re trying to stay away from? Because because it’s too much too
sensitive to touch all man, there’s a lot of like hot topics in general like, or no healthcare sorry,
healthcare related. Yeah, being
debated in the government. Ya know, there’s lots so there’s where to start. So we mentioned pharmacare. There’s the privatization that’s still being debated, like having some level of privatization. There’s medical assistance in dying, like, you know, having more clear legislation in terms of who’s eligible. What else is there, all the cannabis legalization like, Ah, you know, in terms of, you know, right now, you could legally purchase Cannabis, but how safe is it? Are we doing effective monitoring? Well, what what if you’re if you if you consume and you drive like what’s the level? That is okay and what’s not okay?
They recently maybe figuring that out before legalizing I gotta
tell you a bunch of it in the wind and seeing what happens.
I gotta tell you this. There’s been a bit of a shotgun approach with a couple of things, but one of them was the candidates who were eager to to get the my personal opinion they’re eager to get the revenue because it’s obviously heavily lucrative if adopted appropriately and then medical assistance and dying. I don’t know what drove that one. But we, I would say we weren’t 100% ready for that when it came out as well. But, um, but yeah, there is a bit of a, hey, we’ll figure this out as we go approach in some of these. Some of these tissues.
It was popular so the politicians decided to pass it and just figured they would kick the can down the road for figuring out all the nuance that really makes it or breaks it.
Yeah. That’s what it feels like. Interesting. Okay.
Just like America. Yeah. So tell us about your podcast solving healthcare. My main question for you is, have you solved healthcare yet? And if not, What’s taking so long?
I love it. I love that question. So, so Brett, what’s it stem from is like I mentioned earlier that we have a research group resource optimization network. And we’ve been pretty productive over the last few years. And our area of interest is how to make healthcare more sustainable. How do we save money? How do we improve care? And honestly, we were doing these what I would say pretty great studies and nothing was changing at all. And it was totally myself like what are we like, what are we doing? Like, what’s the purpose of this if nothing’s gonna change? So then, you know, podcasts and fuzziest. And so I was like, you know, maybe if we increase awareness, and maybe maybe this could start drumming up some noise. And so, we decided to develop solving healthcare. And, you know, we’re about at the time of recording about five months deep into it, and I gotta tell you, Bradley like I’ve, I’ve never outside of like moments in medicine, but a this is truly been a humbling experience because like, I do feel like we are solving healthcare and things are changing and things are improving. I’ll give some examples. Like we did an episode on overparenting and, and the lack of support for kids with anxiety, depression and other mental health disorders and Like, for example, in Canada, we’re talking about what’s covered what’s not, if you wanted to see a child psychologist for services, that’s about a $3,000 bill for a proper assessment, and a lot of people can’t afford that. And so we brought this issue up. And now one of the clinics in Ottawa is going to be providing free care for, for kids that can’t afford it, essentially. And so I
feel like that’s such a great investment. Right? Like you provide child childhood mental health services, and you’re gonna save yourself a ton, right decades down the road, but you’re gonna save yourself a ton down the road that and that seems like they could. It’s so it just intuitive. But you’re right, you got to find the money somewhere to do that. And someone’s got to have the political will to say, you know what, we’re going to take money away from this and put it towards that.
Exactly. And so by increasing the awareness, bringing it up and like I’m married to a psychologist, and I had no idea what some of some of these issues, you know, I didn’t Know About the $3,000 bill that these families got to sort out or, or maybe just not go to see a psychologist because of and that discussion with Adrian, it was Dr. Adrian Matheson. And talking about as you put, if you invest in this in these kids early, it could have such upstream positive impacts on their lives. And that you wouldn’t believe it, you know, avoid long term mental illness, avoid them being incarcerated, avoid them and having drug addictions. And and it just hits such a. I mean, you and I, we both have three boys. And like, it’s like if we can’t step up for a kids, but can we step off for you know what I’m saying? And so like, when, like, when I heard about this initiative of having free care for the kids, I was like, This is what it’s all about. This is why we’re doing this. This is a small step. This is a little thing, but this i’m a i’m one person. I have a team now helping out with the podcast, so shout out to the team. Love you guys. But this is me five months in and already having a footprint. And this is to me, this is how we’re solving. And this is just the beginning to Bradley like, we, because of this similar episode, we did one on marginalized patient populations, like people that are on the streets in the care that they need. You know, there’s one of our intensivists approached me saying, Can we not start funding some kind of program to get, you know, these kids that are vulnerable into some program to try and, you know, give them some hope. And so, like, nothing has materialized yet. But we’re having that discussion. We’re having that dialogue, and that’s how it starts, and it’s how it started.
I can’t happen without that dialogue.
And I believe in my loins, I believe, like, things are gonna get better.
Well, where can people find where can people find your podcasts? Yeah, so
solving healthcare. We’re on or everywhere. We’re, we’re on. We’re on Apple. We’re on Spotify, Stitcher, everywhere you find your podcasts cost box, wherever you are Google Play, you can follow us at Quantcast on Twitter, Facebook, Instagram, YouTube, and I really appreciate the listenership and those that are listening already.
And I think there’s also a link to it on your web page resource optimization network comm it’s a good place to find it too.
And can I say one more thing, Bretton Woods, I, I want to make sure that your listeners realize how beautiful of a thing what you’re doing is okay. We as clinicians, and and medical trainees, we don’t get some of these finer skills in medical school. It’s very mentorship dependent and if you don’t have that kind of access to good mentors and like, some of the stuff the content you’re creating, we people don’t get that exposure. So I think Just want to commend you for the value of the show. I’ve been a recent subscriber and the content that you’ve been throwing down. It’s been beautiful and i think it’s it’s a way that we can become stronger we could become more connected with our patients and their families. So like, Good on you, my friend.
I appreciate that. That really means a lot that really warms warms the cockles. Should buddy
should
so I really appreciate you taking the time to be on the show. You’re you got a lot of hats, the podcasts resource optimization network, palliative care, the ICU three boys. Yeah, you got a lot going on. So I really appreciate it and it’s been a lot of fun, a great conversation, and I appreciate the compliment there on the
absolutely means a lot. Thanks for reaching out boyfriend.
I take care.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians. Guide to doctoring comm or wherever you get your podcasts. If you have a question for a previous guest or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
Transcribed by https://otter.ai

Economic Impact of When To End Shelter-in-Place for COVID-19 with Adam Block, PhD

Adam E. Block, PhD, is a recurring guest, having spoken previously about common misconceptions of the Affordable Care Act, and Medicare for All. Today we will be discussing the how erring on the side of an earlier end to shelter in place could have a worse impact on the economy than waiting longer. We also discuss what a return to work could possibly look like and when can we expect our elective patients to start coming back to the offices. In our industry and many others, it is important to be able to pivot and adapt to the new needs created by this virus. From a public health perspective, we also talk about when the risk of poverty as a social determinant of health starts to outweigh the risk of the coronavirus itself and what populations are at highest economic risk.

Dr. Block is currently an Assistant Professor of Public Health at the School of Health Sciences and Practice at New York Medical College. He is a health economist with deep experience in the hospital, health plan and government sectors. His research is focuses on how individuals make decisions in health care markets including patient choice of hospitals, physicians and insurance plans. 

Prior to joining New York Medical College in 2017, has worked for a major hospital system, a large Medicaid managed care plan, spent several years developing the legislation on the Affordable Care Act as an economist at the Congressional Joint Committee on Taxation and later as Division Director of Health Plan Policy in the Center for Consumer Information and Insurance Oversight at CMS. 

In July, 2018 Dr. Block founded Charm Economics, LLC a translational economics consulting group.  His consulting work focuses on managed care contracting and pricing optimization of new technology and data analytics.  Dr. Block received his PhD in Health Policy from Harvard and undergraduate degree in neuroscience from Amherst College.

@AdamBHealthEcon on Twitter

CharmEconomics.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com

Economic Impact of When To End Shelter-in-Place for COVID-19 with Adam Block, PhD

Adam E. Block, PhD, is a recurring guest, having spoken previously about common misconceptions of the Affordable Care Act, and Medicare for All. Today we will be discussing the how erring on the side of an earlier end to shelter in place could have a worse impact on the economy than waiting longer. We also discuss what a return to work could possibly look like and when can we expect our elective patients to start coming back to the offices. In our industry and many others, it is important to be able to pivot and adapt to the new needs created by this virus. From a public health perspective, we also talk about when the risk of poverty as a social determinant of health starts to outweigh the risk of the coronavirus itself and what populations are at highest economic risk.

Dr. Block is currently an Assistant Professor of Public Health at the School of Health Sciences and Practice at New York Medical College. He is a health economist with deep experience in the hospital, health plan and government sectors. His research is focuses on how individuals make decisions in health care markets including patient choice of hospitals, physicians and insurance plans. 

Prior to joining New York Medical College in 2017, has worked for a major hospital system, a large Medicaid managed care plan, spent several years developing the legislation on the Affordable Care Act as an economist at the Congressional Joint Committee on Taxation and later as Division Director of Health Plan Policy in the Center for Consumer Information and Insurance Oversight at CMS. 

In July, 2018 Dr. Block founded Charm Economics, LLC a translational economics consulting group.  His consulting work focuses on managed care contracting and pricing optimization of new technology and data analytics.  Dr. Block received his PhD in Health Policy from Harvard and undergraduate degree in neuroscience from Amherst College.

@AdamBHealthEcon on Twitter

CharmEconomics.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com