Episode 89: Tips for saving money in health care. And, calling all 2nd year medical students! It’s your time for a USMLE score boost!

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Download transcript: How to boost your USMLE Step 1 score and save health care costs

The Dark Side of Medicine

Today I’m going to be talking about the unveiling of the dark side of the medical-industrial complex and how the institutions and boards that run the hospital systems can often times have a different agenda than you the physician, the one charged with taking care of the patient.

Calling All Second Year Medical Students

Before we get into the meat of that discussion today I want to put a call out to all second year medical students.  I have an IRB proposal that I’m putting together for a research project.  This about the fifth one I’ve done now on medical students or pre-meds or residents and such.  This one is specifically looking at mood states prior to taking the USMLE Step 1 or the COMLEX Part 1 if you go to an osteopathic medical school.   Then I’ll do a mastermind intervention and re-survey students to see if their mood states change.

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If you happen to be a second year medical student you could benefit be participating in the intervention.  Of course we’ll do official informed consent and all that stuff to tell you what’s expected and what you get out of it.  The bottom line is I want to survey some students about 40 questions.  How long does that take you, a couple minutes at the most then give you a three week, twice a week teleconference style delivered mastermind meetings to boost your USMLE study plan, to decrease your anxiety and help you get better organizational skills.  I don’t need to go into all the details here, but if you will visit medicalschoolpodcast.com, sign up for the email list.

That will instantly send you some speed reading videos, but that’s beside the point, just get on the email list because very soon I act fast, I’m telling you.  I’ve written most of the IRB proposal today with some spare time.  I am going crazy with research.  I’ve got all kinds of stuff going.  I’m about to have a gig in Philadelphia at a sleep conference.  I’m going to have a paid trip to Berlin to speak on military research that we’ve been doing here.  Everything I’ve touched is turning to gold in the research department and I would like to bring you in along for the ride and I hope that you’re enjoying the podcast.

Perhaps you’ve noticed I have a different little swing in my step, a little bit more boost of energy and reinvigoration of the medical school podcast.  That’s in large part due to getting my medical license and having the horror and black smudge of pain in my life from my previous emergency medicine residency experience wiped away with my medical license and it also has to do with being finished with my current residencies, nights and weekend call.  It’s just done.  I have a day job now (laughs).

Physician Ethics

Today the idea is that you start out in medicine, you take a Hippocratic Oath, you put on the white coat, you’re here for the patient first.  Many times you hear the term medico-legal, you hear ethical, you hear law and ethics often times combined as topics for presentations.  You’ve been beaten to death with this stuff like patient autonomy, justice, beneficence, non-maleficence, first do no harm.  Of course you have law and often times laws can be unethical.  I don’t even need to get into that here.  As a healthcare professional, specifically as a physician you have one bent, to take care of the patient, that’s my point.

Today I wanted to highlight a problem.  Especially as healthcare systems are being squeezed for finances in The Affordable Care Act is crushing smaller practices and hospitals as we have a payer shift to more public payers, namely Medicare and Medicaid, decreased patient responsibility.  I would say society is becoming more irresponsible and copay is going up for private insurers and public and on and on and on increased use of service is at least until recently.  There’s a lot going on in healthcare today and when the board meeting sits there for your hospital system and they’re behind closed doors, technically the board is not supposed to be more than a majority or 51% physicians because at least in my state physicians aren’t supposed to own hospitals.  Yeah, right.

We put business people in charge of them.  They care about dollars and cents and that makes a lot of sense except as the economy crushes in healthcare is in some terminal death rows nationally, economically, it puts a lot more pressure and I think that what we’re seeing is more clarity around why hospitals make more and more decisions with regard to money and less decisions about patients.  I want to throw something from a sociologic and mental health perspective.  When I say mental health I don’t mean schizophrenia and bipolar, what I mean is a healthy approach to patient care that works for us so we have our own mental health care and of course mental health of the patients.  

Let me put the backdrop in there just a little bit that the majority of hospital beds are filled with preventable illness and an overwhelming majority of all prescriptions are never filled.  There is a huge disconnect in what us as a healthcare community are able to provide to patients because we don’t understand them, we don’t know why they tick.  We don’t understand why they won’t just do what we say.  We tell them to eat healthy, quit smoking, quit doing drugs and excessive amounts of alcohol, take care of yourself, get plenty of sleep.  How many people do you know that do that, exactly.  That’s the problem.  We are the problem, right (laughs).

Anyway the point is hospitals currently bill every time they see a patient.  As long as they admit a patient doesn’t return to the hospital within 30 days they can bill them again for the same COPD exacerbation on day 31.  Hospitals are incentivized to bill people, to consult specialists, to run extra CT scans when they don’t need them because they bill, bill, bill the more complex it seems.  The future is coming where accountable healthcare organizations will be given a certain amount of money to take care of a population.  If you have money leftover you get to pay yourself.

If you don’t, well you’ll have to close your doors.  Kaiser Permanente is the biggest hospital system that was the first to become Accountable Care Organization (ACO) accredited and they are leading the way in a whole lot of ways.  By the way, they fund their own residency education internally and I would look at residencies that operate with the Kaiser Permanente if I had to do it all over again, consider that.  What I’m getting at is that we need to shift our thinking from here’s the treatment plan, here’s a consultant, here’s the problem.  Let’s make sure we have something on the list next to every problem on this patient’s note regardless of it is really going to help them and let’s just make sure that we cover ourselves medico-legally even though all this ginormous medical bill and all these tests that are unnecessary may not help the patient.

How to Reduce Health Care Costs

What we need to do in healthcare I think and so do a lot of senior faculty in my department, is step back and say what’s the best thing for this patient.  Let’s understand their treatable diseases and we need to put more responsibility back on the patient, some diseases are really untreatable and if we’re given medications they’re really not going to have a meaningful effect then why are we spending the money, why don’t we use generic medications and on and on and on and on.

We’re spending too much money folks.  I want you to think about that today.  Notice as you go through your rotations that some physicians are very conservative on what they order.  Some will order consultants on everything and employers are keeping track of that.  Make sure before you think about ordering any tests you know exactly what diagnosis you’re trying to confirm.  Make your diagnosis before you order the test, right because you’re at a differential and also before you order the test you have to know exactly what difference in the management or prognosis is it going to make if you get that test.

How Physicians Order Tests

Sometimes you can order a test to confirm something, but it’s not going to make a difference at all like severe in-stage [masculopath 00:10:35] with vascular dementia as another little mini stroke.  Do you really need another MRI?  What are you going to do different; they are DNR, DNI on all of the appropriate medications.  Do you need the $2,000 test?  Can they write a check to pay for that?  Food for thought, enjoy it.

Medical Student Research

Again, second year medical students, go to medicalschoolpodcast.com because you will soon be offered a free account to the medical mastermind community with all the great resources in there and a sense of community and direct access to me and on and on simply for filling out a survey and the intervention itself for that study is currently in draft to go to the IRB is actually to give you a short course on mastermind type principals to help you prior to the USMLE Step 1 or the COMLEX Step 1.  I’m going to hook you up.  Yes I said it’s free.  Yes I said you get it free MMC account.  I look forward to hearing from a number of second year medical students.

I’ll be honest; it’s going to be a little harder for me to get the sample size when I’m asking for such a specific group.  If you’re a second year or you know second year, please tell them about that to get on or even watch the email list for them and when the opportunity announcement comes out, shoot it to them.  I need all the second years I can get.  I really appreciate your help, thanks.  Take care.

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