By Nomi Health on April 26, 2023
Today, it’s difficult for anyone, including doctors, to find information about healthcare finance due to the lack of transparency and resources available. We know that doctors get taken advantage of financially and we wanted to create a place for you to learn about the economics of how healthcare finance impacts both doctors and patients.
For this series we’ve partnered with Dr. Eric Bricker, a physician and healthcare finance expert. This week, we are taking a moment to dig into the reasons we created this series and why we are shining a light on healthcare finance. We sat down with Dr. Bricker to talk about his experience as a physician, why he’s passionate about healthcare finance, and why he’s on a mission to democratize information on the topic.
Episode 1: Where’s my money? Why skyrocketing healthcare costs don’t make it into doctor’s pockets
Episode 2: Sorry, your request is denied: Medicare Advantage and the rise of prior authorizations
Episode 3: Damned if you do, damned if you don’t: The “No Surprises Act”
Episode 4: The check is in the mail: payors, patients, and payments
Episode 5: Where’s my money part2: Doctor pay fails to keep pace with hospital revenue
Healthcare is easy to understand when you understand the incentives that are underlying why insurance companies, doctors, hospitals are acting the way they are. When you understand their incentives, then you understand why they are doing what they are doing. And guess what? One of the major incentives is the money. By understanding how the money flows and how the incentives work in healthcare, it gives you a much better understanding of the system, and how to change it! By changing the incentive structure, you can actually improve it.
It’s beholden to us as physicians to clean up the incentives that are actually making care for people worse instead of better.
Doctors really struggle in understanding healthcare finance because they have received absolutely zero training in finance and organizations. In my medical school and my residency, I received zero training in terms of how I as a doctor was going to get paid. No one ever tells you how you are going to get paid! No one tells you how your patients are going to pay for their medical care. No one tells you how the hospital gets paid. There's this complete vacuum of non-information. I don’t know why that is. It’s like somebody being a racecar driver and not understanding that you need to have gasoline in your car. There’s some basic things you need to understand, and in my opinion, this is one of them in healthcare, doctors included.
Doctors are incredibly busy, so it can feel daunting to even get started learning about this topic. By creating these videos, we are giving them training wheels to just get going. If you can just start, it’s going to open up a world of understanding.
Healthcare has a real lack of competition problem. One of the things that keeps organizations hones is competition! So when you don’t have that it becomes easy to cut corners, not give full answers, and it’s only through competition that things get better. The majority of cities in America have very low competition between hospital systems. We only have 3 or 4 major health insurance companies in America. 20-30 years ago we had dozens and now they’ve all consolidated. There used to be more choices for your Pharmacy Benefits Manager (PBM). What has fueled this consolidation? Ironically, it’s been the ease of credit and low interest rates. In order to merge, you must raise debt and interest rates have been so low that these organizations can go into huge amounts of debt to fund their consolidation. And when you merge, guess what you can do? You can raise prices.
So when interest rates were made incredibly low, and debt incredibly cheap, they fueled consolidation that translates into a lack of transparency.
One of my goals for Healthcare Uncovered is for doctors to understand that they have tremendous power within the healthcare system. So many of them have become disheartened because of what’s happened to them, which is completely understandable! By understanding why things are happening to them the way that they are, and by understanding that there are small steps of action that can change that, then it makes the process of improving your patients' lives and professional career as much more attainable. I think these videos with Nomi Health are contributing to that.
We hope you enjoyed this behind the scenes look at Healthcare Uncovered. Our regular series will be back in two weeks, and we’ll have brand new episodes for you every other Wednesday.
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