Fixing Healthcare Podcast

Fixing Healthcare co-hosts Dr. Robert Pearl and Jeremy Corr thought they new a lot about their latest guest, Dr. Eric Topol. They’d both read his bestselling books and closely followed his groundbreaking work at Scripps Research. And then Dr. Topol opened up about his plan for fixing American healthcare. Each month, a new guest appears on the show to compete for the highly coveted (and totally fictitious) role of “Leader of American Healthcare.” The guest is given 10 minutes to present his plan for radically improving the U.S. medical system and Dr. Topol didn’t waste a second of his time. Here are some of his most memorable quotes: The United States is the only country that does not provide healthcare to all of its citizens. That needs to be fixed. We can’t address the reduction in these critical metrics unless we provide healthcare equitably among all U.S. citizens. That’s step No. 1. At least a third of the $3.6 trillion a year in the U.S. that is spent (on healthcare) is wasteful, unnecessary, and harmful. That has to stop. I view the professional societies as trade guilds. Basically, their role … is largely to preserve the reimbursement of their constituents. They’re not interested in fixing these problems. They don’t have any role—and that goes not just for the AMA but across the board—in dealing with the waste and unnecessary procedures and testing and treatments. That’s a problem. We can’t rely on professional societies to lead the way because they’ve shown us for decades that they are not part of the solution. One of the most absurd aspects of medical care in this country (is) that our electronic health records are proprietary systems (owned) by the likes of Epic and Cerner and Allscripts. They have no real interest in the patient. The problem with electronic health records is that no one in this country has all their data—from being in the womb through the present time—and they all should. They should see their data, they should own their data, and it’s just the opposite of the way we’re set up here. That has to change. My solution there is that we forget the whole idea of the current model. We need to reboot. Every individual should have their medical data. How can we reduce hospital costs, because that’s $1.2-trillion-a-year and rising quickly? The way we can do that is to get rid of hospital rooms. We’re not talking about getting rid of the emergency room or the operating room or the intensive care unit, but the rest of the hospital should be gutted and (patients) should be at home to avoid the 1 in 4 chance of serious harm or error that takes place in the hospital … and the ridiculous cost of a hospital stay in the United States, which is approaching on average $5,000 a day. We have exquisite remote monitoring capabilities now and we should be using that. Just like decades ago when we saw the big shift from inpatient to outpatient, we need to have the shift … from inpatient to home. Seven minutes for an appointment in a clinic is grossly inadequate, and that’s for a return visit. Twelve minutes, on average, for a new patient consult is ridiculous. The gift of time can be achieved by using analytics. That is: deep learning, artificial intelligence, taking data that’s from not just the electronic record, (but also) from sensors, from genomics, from all different sources and being able to process that data and put an investment in making life better. It can make medicine more efficient, improve workflow, and give the gift of time to both clinicians and patients. I’m very much a proponent of telemedicine. I think it’s a welcome addition to the ways that we can connect clinicians and patient. Unfortunately, today we still have most American physicians unwilling to communicate with their patients through email or other electronic means, which is remarkable. If you ask them why don’t they do that, it’s just because we don’t get reimbursed. Everything’s ‘I don’t get reimbursed,’ so we have to fix the model of reimbursement if we’re going to make some headway. We’ve got some real roadblocks there. We know that the doctor who suffers from burnout has twice (the) rate of medical errors. We know there are more than 12 million serious medical errors in the United States every year and that number is not going down, but rather increasing as the rate of burnout increases. We need to make life better for clinicians. We have a lot of genomics today that we’re not using, particularly polygenic risk scores for the most common conditions that include heart disease, breast and prostate cancer, type 2 diabetes. These are probabilistic, but if you have hundreds of variants from a low cost, high throughput genotyping that costs today less than $50, you could go into prevention mode. All these things are actionable, but we’re not using them. Part of this problem is we have a lack of comfort among clinicians using genomics. We hope you enjoyed listening to this episode of “Fixing Healthcare.” Don’t forget, you can also read this episode, as well … READ: Full transcript of our discussion with Dr. Topol Next month, Dr. Donald Berwick joins the podcast to share his plan to transform healthcare. Dr. Berwick is the former president and CEO of the Institute for Healthcare Improvement (IHI) and led the organization’s 100,000 Lives Campaign, a nationwide initiative to significantly reduce morbidity and mortality in American healthcare. He’s the former administrator for CMS and has served on the faculty for Harvard Medical School and Harvard School of Public Health. We’re looking forward to having him on the show. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post Episode 4: Dr. Eric Topol says ‘step one is providing healthcare to all citizens’ appeared first on Fixing Healthcare.

The Fixing Healthcare podcast continued its quest this month for a candidate worthy to fill the highly coveted (and totally fictitious) role of “Leader of American Healthcare.” Dr. David T. Feinberg is president and CEO of Geisinger, one of the nation’s largest health services organizations. He’s also triple-board certified by the American Board of Psychiatry and Neurology in child, adolescent and addiction psychiatry. Prior to joining Geisinger, Feinberg served as CEO of UCLA’s hospitals, associate vice chancellor of UCLA Health Sciences, and president of UCLA Health System. When asked to present his plan for fixing American healthcare, Dr. Feinberg immediately seized the attention of co-hosts Dr. Robert Pearl and Jeremy Corr. “I think your question is actually really easy,” he said. With that, here are some of Dr. Feinberg’s most memorable quotes from the show: Fixing healthcare in America is the simplest thing we can do. The problem is, we’ve been looking at the wrong problem … Really what we need to do is say, “Well, what does drive health, and what does drive mortality?” We probably get 20% of whether we live or die, whether we have life in our years and years in our life, based on going to good doctors and good hospitals. We’re going to put all of our efforts in my plan, or the majority of effort, on all the other stuff, the stuff that really matters: your genetic code, your zip code, your social environment, your access to clean food, your access to transportation, how much loneliness you have or don’t have. I run a health system and we have about 13 or so hospitals and I think my job is to close every one of them. I think a lot of patients, even the ones that you managed well but ended up in the hospital, could be managed better at home. We look at our highest utilizers, our sickest patients. We show up at their house in two cars, because we can’t all fit in one car, and we got a nurse, a palliative care nurse, a community health worker, a pharmacist, a doc. We say, “Hi, sir or ma’am, we’re here to take care of you, and our goal is you never go in the hospital again and we know you’ve been hospitalized 12 times in the last year. Let’s clean out the medicine cabinet. Let’s make sure the house is safe. Oh, you have a bunch of appointments that are hard for you to get to? We’ll do them through telemedicine right now at the kitchen table.” Just completely eliminate the need for those folks to ever go in the hospital again. Why do people have to come to a doctor now? I don’t go to the bookstore anymore. I don’t go to my travel agent anymore. I can actually do so much through my phone, why can’t I tell you here what my symptoms are, and can you hook me up with someone who can help me? If I do need medicines, why don’t you just drone them to my house? Those types of interventions I think are coming and those disruptions are absolutely crucial. When I was born, the chances of me developing type two diabetes was 1 in 100. If I were born today, the chances of me developing type two diabetes is 1 in 3. That’s not a genetic change. Something happened in our food. We spend more on obesity than we spend on defense. Somewhere between 3% and 7% of GDP is spent on obesity, and that’s a new problem. So, if we’re going to fix American healthcare, we’ve got to put aside American healthcare for a second and figure out how come people aren’t exercising? If we look at your genome now, we can find medically actionable conditions that we can prevent in advance. We can find half the people that wouldn’t know they had BRCA based on their family history and intervene early. We can literally save lives based on your genetics, and that’s probably about 10% or 20% of my plan. Eating right, normal BMI, not smoking, alcohol in moderation, not shooting one another, getting preventive screenings will decrease healthcare costs overall by 50% in the United States. 50% of the disorders we’re paying for are lifestyle disorders. So, we’ve now cut healthcare costs in half. We have happy employers. We just decreased hospitalizations by 50%. By definition, there’s going to be less errors because there’s less people going through the hospital. I’m happy to talk more about how can we improve quality and measures, but we’re missing this big picture of understanding people’s genetic code, their zip code, their micro-environment, and really what drives behavior. That’s what’s costing us so much in American healthcare. We hoped you enjoyed this episode of “Fixing Healthcare.” A very big thanks to Dr. David Feinberg for coming on the show and sharing his bold ideas. Next month, our guest will be Dr. Eric Topol, the founder and director of Scripps Research Translational Institute. Dr. Topol is the author of the bestselling books, The Creative Destruction of Medicine and The Patient Will See You Now. He also serves as the chief academic officer for Scripps Health, a professor of genomics at the Scripps Research Institute, a senior consultant at the division of cardiovascular diseases at Scripps Clinic. We’re looking forward to having him on the show. READ: Full transcript of our discussion with Dr. Feinberg * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post Episode 3: Dr. David T. Feinberg says fixing healthcare is ‘the simplest thing we can do’ appeared first on Fixing Healthcare.

The Fixing Healthcare podcast is back with a new candidate for the highly coveted (and totally fictitious) job of “Leader of American Healthcare.” Dr. Halee Fischer-Wright is author the national bestseller Back to Balance: The Art, Science, and Business of Medicine, and president and CEO of Medical Group Management Association (MGMA), the premier membership association for professional administrators and leaders of medical group practices. Dr. Fischer-Wright brings a unique perspective to the role of fixing American medicine. As a former pediatrician, management consultant and chief medical officer, Dr. Fischer-Wright has seen the healthcare industry from practically every angle. As CEO of MGMA, she and her colleagues represent roughly 50% of the healthcare delivered throughout the United States. Dr. Fischer-Wright is a nationally renowned speaker, recipient of numerous awards for leadership in healthcare, and one of Modern Healthcare’s “Top 25 Women in Healthcare.” This month, she joins Fixing Healthcare for what’s being called “The Toughest Job Interview In Healthcare.” The show’s co-hosts and “hiring managers” Dr. Robert Pearl and Jeremy Corr have asked Dr. Fischer-Wright to present a plan to fix healthcare. Here’s what she had to say: I didn’t have one moment where I knew healthcare was broken. Instead, it was a series of personal experiences that brought the deeper problems into the light. The day that I watched my dad get poked again and again for a spinal tap by residents and interns who didn’t speak to him or even look him in the eye. The moment I realized that my husband and I could possibly lose our home because of crushing medical bills after his cancer surgery. The night my mother convinced herself that she had ALS by Googling the symptoms and double checking it with WebMD. The problem with talking about all these underlying problems in healthcare is that we lose sight of what healthcare is. Healthcare is one human trying to help another get and stay healthy. Healthcare is human, personal and intensely local. And yet we take an army of problem solvers and innovators, and prevent them, daily, from making decisions that could dramatically transform healthcare. I’m talking about every provider, leader, clinician, staff member working in a medical practice, and the patients they serve. In my design of the future of healthcare, I’m choosing to ignore everything at the top and start with all the experience and brilliance and passion and, most importantly, the common sense that I see in medical practices every day. In fact, I’m recommending that we do the exact opposite of what we’re currently doing. First, I’d ask: ‘Do we really know what we want out of healthcare?’ While we keep talking about cost, quality and satisfaction—the triple/quadruple aim—is that really what patients want? Meaning, every single one of us. Would that be what I tell you I personally want? Or do we as policymakers and professionals use those as surrogates because we struggle to deliver what patients really want: to be healthy and trust in all of the institutions that are supposed to take care of them. That includes not just the practices and hospitals, but also the insurance companies, the policymakers and every other player in the system. We have to treat the whole person and not just the disease. We have some amazing practices in the country that are pushing really hard for that idea: Iora Health, the Methodist Health System in Nebraska, and the Mayo Care System. They’re succeeding by focusing on outcomes and not just the preconceived notion of all-mighty processes to get to those outcomes. I believe that empowered partnerships, in which the right people have the right amount of control over the right decisions, are crucial to building a culture of excellence in the whole industry. If we all trust that every other player in the industry is making decisions with the same goals in mind, we’ll be more collaborative in decision-making and contributing to that progress, and we’ll be more willing to share ideas far and wide. We need trust, though, and right now we definitely don’t have it. What empowered partnerships can help eliminate is that tendency to hunt for silver bullets, or so-called disruptive ideas. Because when you have excellence, you don’t need disruption. There are so many solvable problems and yet we keep making many of them worse. Two of the biggest are administrative complexity and regulatory burden. Solve them, and you rapidly save hundreds of billions of dollars, reduce burnout, improve frontline satisfaction and free up amazing time and resources that can be used to improve life expectancy and improve the health of people, leading to quality outcomes. Since 2011, just the direct costs for managing claims, billing and collections for primary care practices have increased by 74%, which is ironic since we’re supposedly at a time where technology and electronic transactions are supposed to be making everything more efficient. A journal article put the total cost of billing and claims at $471 billion in 2012. If we saved just 50% of that, that gives us our decrease in cost. A recent AMA survey shows that practices spend 14.6 hours per physician per week on prior authorizations. If I gave any physician back 14.6 hours per week, I guarantee you we would increase life expectancy and improve quality outcomes. The solutions exist and they’re actually right in front of us. With a little collaboration and common sense, they could be executed on in the next 18-24 months. And these simple things that are right in front of us would have dramatic and lasting effects toward better outcomes … READ: Full transcript of our discussion with Dr. Fischer-Wright * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post Episode 2: Dr. Halee Fischer-Wright wants to unify all the healthcare players appeared first on Fixing Healthcare.

The Fixing Healthcare podcast debuted its first episode by welcoming to the show one of healthcare’s most brilliant and entertaining leaders, Dr. Zubin Damania, MD. Dr. Damania is known throughout the digital and social media landscape by his moniker ZDoggMD. He’s also an internist, a hospitalist and the founder of Turntable Health, an innovative primary care startup in Las Vegas that earned the backing of Zappos CEO Tony Hsieh. In addition to his clinical accolades, ZDoggMD performs stand-up comedy, “mercilessly satirizing our dysfunctional healthcare system.” He posts viral videos and hosts an online series, which together have amassed a following of 1.7 million patients and providers worldwide. This week, ZDoggMD became the first-ever applicant for the newly opened position: “Leader of American Healthcare.” According to co-hosts and “hiring managers” Dr. Robert Pearl and Jeremy Corr, Dr. Damania’s first task: Present the American people with a plan to fix healthcare, not minor tweaks or trade-offs among quality, cost and service. Here are the top ZDoggMD highlights from the show 1. On how we pay for healthcare vs. what we’re paying for I think the first thing we need to distinguish if we’re going to address this huge, huge, huge, issue is that there’s this distinction between how to pay for healthcare and what you’re actually paying for. First, we have to fix what you’re actually paying for. So, the first thing we’re going to do is invert healthcare from a sick-care reactive system that puts band aids on problems … to a focus on actual healthcare. And in order to do that, we have to start inverting the problem we have in this country, which is too many specialists, hospitals, and not enough primary-care prevention: OB/GYN, geriatrics, pediatrics, family medicine, internal medicine, etc. 2. On simple steps to improve patient service and convenience Let’s go where the patients need us: telehealth visits, phone, email, Skype. That’s where our patients want us but instead we’re stuck behind a clunky EHR that looks like it was built in the ‘90s or worse. Also, not everybody needs a doctor. Sometimes a health coach, a licensed clinical social worker, the team—the nurses, the respiratory therapists—those are the people on the front lines. So we need to encourage that teamwork where everybody’s practicing at the top of their training. 3. On restructuring the hospital system I’m a hospitalist and what I would say is that, for a single hospital, trying to be everything to everyone is very hard. Toyota would never build cars that way because you’d never be able to isolate failure points in a process that’s so chaotic … So, the first thing you do, is you take everything that has been shown to work and apply it as a standard. Then you break hospitals into bits, so that a surgical hospital that does elective procedures very well should optimize towards that. And it should be geographically accessible to a triage or urgent care center that can send patients to those places, maybe even faster than they could get transferred within one single hospital. And then ultimately realizing that 50% of what we do not only doesn’t work but it causes harm. And so (we should) focus our research and implementation efforts on getting rid of that 50% that doesn’t work. You know what works? Washing our hands, weighing maternity pads to see how much blood is actually lost, etc. And it’s going to take a quality-improvement culture that hasn’t really existed. 4. On keeping patients out of trouble (Turntable Health) was spending more on primary care. Spending three, maybe four times, what insurers spend normally in Las Vegas, you know, $18 per patient per month or something is what United spends on patients for primary care. And they get what they pay for: fragmented, crappy care with lots of specialists. Now, if you had a value network of patients who are a bit empowered, with a little bit of skin in the game, where they have this $2,000 and they’re like ‘I can spend this on a really good primary care doc who will keep me out of trouble, keep me from spending it downstream,’ well, that’s helpful. So (the plan is) having that support structure and the Medicare for all component of it, which is a very high-deductible, catastrophic plan that keeps people from medical bankruptcy. 5. On the ‘moral injury’ that causes physician burnout There’s a moral injury that occurs to (doctors) when we feel like we have to treat patients differently because of their insurance status. When we have to treat an undocumented immigrant differently for dialysis—they can only get it emergent in the ER—than somebody who has insurance … it creates moral injury and therefore ‘burnout’ in our physicians. And that’s not a sustainable thing. I think the difference, what caused (Turntable Health) to fail, is that we didn’t have that structure. We were a little too early with the model. READ: Full transcript of our discussion with ZDoggMD * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post Episode 1: ZDoggMD has a plan to fix American healthcare appeared first on Fixing Healthcare.