Ep 25 – Physician-Led Healthcare Reform and Medicare-For-All, with Ken Terry

What this episode covers

In this episode, we interview Ken Terry, author of one of the best-researched books we’ve ever seen! The new book, Physician-Led Healthcare Reform: A New Approach to Medicare For All, explores why we must, and how we can, get doctors to change how they practice. Most employed physicians and independent physicians alike feel powerless. Hospital-employed doctors feel like cogs in a machine, and community doctors are increasingly threatened by forces beyond their control. The biggest problems of physicians--both employed and independent--are a loss of professional autonomy, overwhelming administrative requirements, and the conflict between business and patient care imperatives. This book, directed to physicians, healthcare administrators, health policy experts, politicians, and consumers, explains why the U.S. healthcare delivery system must be restructured to lower costs--and how to do it. Physician-led healthcare reform will give them back a large measure of control and pride in their work. Ken Terry has been writing about health care for more than 25 years. He was a senior editor at Medical Economics, has contributed to numerous publications, including Medscape Medical News, Information Week, and FierceHealthIT, and has received several journalism awards, including the Neal Award from American Business Media. He's also authored the book RX for Health Care Reform. You can read more of Ken’s work, including articles and blogs at his website: https://physicianledreform.com. Episode Bookmarks: 3:33 The progression of value-based care over the last decade (e.g. hospital VBP program, BPCI, the mandatory bundled payment program CCJR, CPC, MSSP) 6:20 Consolidation of the healthcare system and employment of doctors driving up costs 7:33 ACOs led by health systems are not as successful as physician-led ACOs in the MSSP 7:58 The first wave of managed care did little to move provider organizations towards taking financial risk (with the exception of Kaiser Permanente and a few others) 9:18 The push towards value-based purchasing in the Obama Administration (e.g. P4P, bundled payments) did not go far enough to change industry appetite towards risk 10:00 Advancement of medical technologies have been driving up healthcare costs (not lowering them) 10:42 “The evidence shows that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes at lower cost.” – Dr. David Nash 11:31 Research by Barbara Starfield showing that a higher ratio of PCPs to the population is associated with a lower mortality rate from all causes, heart disease and cancer 11:50 States where a higher percentage of physicians who were PCPs have higher quality of care and lower cost per beneficiary 13:00 The impact of medical school debt burden on the supply of primary care physicians and the relegation of PCPs to lower tier status in the medical community 13:51 How Advanced Practice Providers are filling the void to meet unmet primary care needs 14:32 Retail clinics and urgent care centers competing with PCPs 14:53 “The best way to reduce costs and improve outcomes in healthcare is to have larger groups of primary care doctors taking financial risk and competing on quality of care in local areas.” 15:20 Changes that would need to occur before we implement Medicare-For-All health reform (i.e. hospital payment parity, corporate practice of medicine restrictions) 16:10 Proposing federal requirements of hospitals divesting of their medical practices 16:35 Medicare-For-All option that would pay PCPs Medicare rates unless they join a larger primary care group and take financial risk for a larger upside oppor...

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